Framework and Methodology

This essay uses Mill’s normative theory of utilitarianism to boost organ donation in KSA and employs the Institute of Healthcare Improvement (IHI) methodology for quality improvement. The rising interest of people in these issues can be supported by the view of the classical utilitarianism that is dealing with pleasure maximization and pain minimization.

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FRAMEWORK AND METHODOLOGY
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FRAMEWORK AND METHODOLOGY
Introduction
The starting motivations and assumptions for this project are as follows. Firstly, the
notion and actuality of the good must be acknowledged as both intuitive and rational. Rational in
the sense that it is corresponding to the ethical system’s construction; and intuitive as the
reaction to the learned behavior and encounters with other individuals. Irrespective of the ethical
systems’ construction, the good is displayed as the quality which can be related to at the
bottommost level as humans (Al Sebayel et al. 2017). Secondly, that people actively establish
ethical systems of thought to provide form and structure of their ethical inclinations as well as to
guide the dismayed to the realization of the good in their individual lives and that of their
societies in respect of particular issues and overall goals. Thirdly, the idea of methods of
maximum attainment of particular goods. For utilitarianism, the rights are proceeded by the good
whereby right actions’ enactment creates the state or condition of good. Thus, utilitarianism is
helpful in this project as it aids answer the question about the picture of good and whether it
differs as a result of a theoretical nature approach.
III. Theoretical Framework
Mill’s normative theory of utilitarianism is applied in this paper as the best defensible
approach to boost organ donation in KSA (Mill 2016). Utilitarian is a model that pursues the
greatest good’s enhancement for the largest number of individual. Mill’s model is the paramount
approach to promoting organ donation in KSA since it leads to maximum adult organ donations
(greater-good) thus the amount of saved lives would automatically rise alongside the quality of
life (QoL), and further saves both time and money (McCloskey 2015). The theory argues that
donating organs saves many people’s lives since when individual continue donating their organs,

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more lives will consequently be spared. A utilitarian argues that individuals would instead assist
themselves via liposuction than helping others. Kant fails to acknowledge that organ donation
experience overweighs the potential injury to the organ donor (Mill 2016). This is because taking
an organ from the freshly deceased implies no bodily risk or harm to the individual donating
such organs. Nevertheless, many doctors who use such donated-organs from recently departed
persons to save several lives might be creating desired outcomes for the recipient population.
The possibility of successful organ donation is higher than the adversarial outcomes (Patrick and
Werkhoven 2017).
A utilitarian will recommend to Kant that his judgement to go via the procedure for
donating organs is viewable as the universal maxim since every rational person would always
wish to prolong life or save life (Mill 2016). Essentially, by extending life, people are optimizing
their greater good. To optimize such greatest-good, a utilitarian considers both living adult
donors and from the dead (recently). Getting an organ from the latter saves lives and also saves
money and time for the doctors performing transplantation. Donors of the organ save lives,
money and time (Mill 2016). Recipients would no longer require dialysis if donations of organs
were to become prevalent in the KSA. Because dialysis will become pointless, the cost of using
the machine will decrease; implying that equipment cost would also drop thereby saving the
insurance companies alongside hospitals’ the money. Many lives would get saved and benefit
from the people that no longer require the organ (Mill 2016).
Utilitarianism is a dominant philosophical model within bioethics since it is primarily
concerned with securing maximum potential donors. Utilitarian view is all about
“consequence/outcomes’ in administrative parlance (Mill 2016). The traditional philosophical
perspective of organ donation as “a gift” to organ recipient reflects the regard of the nature of

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donation act as the altruistic act (Mill 2016). Organ donation is contended to be unproblematic
good in that legitimately obtained organ donations provide for the society in need of such organ
transplantation and alleviate the demand on resources of the society for managing the patients;
and conditions awaiting transplantation (Mill 2016). Thus a consent system of donating organ
stays aligned to the contemporary utilitarianism.
Methodology:
The methodology employs in this paper is quality improvement through the Institute of
Healthcare Improvement (IHI). This method is suitable because it is a health policy project
whereby the researcher is looking to change the way the organ donation is attained via the use of
a governmental piece of identification especially by having people give their consent to donate
their organs at the point of driver’s license application or renew. This policy change will see the
government spend a lot of money to change the licenses and if the policy does not work, the
government will incur a lot of money to revert. Therefore, the methodology adopted here is to
request the government to embrace the system of mandated choice and have everyone give his or
her consent as he takes a new driver license or renews the licenses.
The focus here is to convince the government to adopt the new system to minimize
unnecessary variation. This will ensure that the outcomes (increased number of organ donors)
become more predictable as well as certain to save the money lives being lost due to
ineffectiveness in the current system where organ donation of an is low due to lack of awareness
and system which can help people register as organ donors. Thus this project aims at persuading
the Ministry of Interior to put an organ donation checkbox on the driving license to increase the
number of organs available for transplantation in KSA.

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To persuade the Ministry of Interior officials to accept this initiative, the research will
seek to showcase the mandated choice consent via the driving license checkbox will be effective,
patient-centered, timely, efficient and equitable which are the six dimensions of quality. This
project will show the ministry that they can improve the current system of organ donation to
accomplish better results in the dimensions of quality by embracing the mandated choice
consent. Thus, the 2-step model will be used in this case whereby.
The Two-Step Model will be used. The model is made of: Step 1 (Three questions) plus
step 2 (PDSA Cycle) = Model of System Improvement. PDSA implies, P-plan a change; D- Do
the change; S-Study results and A-Act on the results. Thus, Step 1 will involve explaining to the
Ministry of Interior the aim, the measure, and the change. The aim will involve what this project
is trying to achieve. The measure will be to explain how the project will know that a change is an
improvement. The change will involve showing the Ministry of Interior officials what changes
they need to make in the current system of organ donation to result in improvement.
Iv. Argument for the Need for the System of Obtaining Consent
The primary challenge to any consent system’s acceptance is the notion of voluntary
choice as captured in the concept of consent. Where consent can get satisfied in respect of
Utilitarianism, then the overall acceptance of the organ donation is unproblematic itself (Chin
2018).
Thus, it is argued that organ donation is an unproblematic good and hence need for a
system of consent. Consent remains the basis for a decision on the system of donation.
Utilitarianism emphasizes the cumulative values of action to maximize the good and less on
individual autonomy as the premise for making decisions. Consent issues remain the focal point

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to schemes of organ donation and the question about such schemes’ construction circumvents
around how the issue of consent is framed (Consolo and Wigmore 2017).
While many different kinds of consent schemes exist including, normative consent,
mandated choice, hard opt-out, explicit consent, soft-out, presumed consent (opt-out), presumed
non-consent (opt-in) and tacit/presumed consent, the mandated choice is selected (Chin 2018).
The mandated choice system requires everybody to register their respective choices via
conventional mechanisms like drivers’ licenses (chosen for this paper) or taxation. The
arguments regarding consents circumvent the bodily rights and autonomy of a person. Whether
given explicitly or implicitly, consent describes the action either as an action or mental state
respectively. Consent violation takes place routinely in the donation of organs whereby relatives
always override the deceased’s antemortem decisions.
Stakeholders must distinguish between antemortem decisions and post mortem harm to
decide if any real harm has taken place to the antemortem decisions of the deceased. Whereas
some can argue that harming a deceased is fallacious, others support presumed consent argument
(Etheredge, Penn and Watermeyer 2018). However, this paper takes a compelling position that
consent is never necessary for organ donation since the expressed wishes of the deceased via
antemortem directives, organ registers, and wills are sufficient to create a valid consent. Where
such directives are missing, the default organ donation position is perceived as neither a violation
nor presumption, but a legitimate action that expresses the mutual societal ties. Therefore, what
is needed is a mandated choice via drivers’ licenses, and this will be enough to confirm a valid
consent.
The mandated choice is the prime instance of how KSA can transform its ineffective
system. The mandated choice will make each person state his wishes before death explicitly.

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This method will only require people to state their respective preferences about donating an
organ when they take new or renew the drivers’ license. When KSA enhances mandated choice,
it will eliminate the obstacle of presumption and will require that people consider their individual
death and their feelings regarding the donation of an organ. This method will be effective since
unlike the presumed refusal cases, and in other presumed consent models, the families of the
deceased always have to agree to donate the required organs.
The mandated choice is appropriate since it would be unfair to ask the families if they
wish to donate the organs of their loved ones during the death of their loved ones since they are
engulfed in anxieties and chaos at that time. Therefore, using the mandated choice, each
individual is mandated to decide for themselves which spares the family the agony of deciding
while at the same time bolstering the autonomy of a person. Presumed refusal and presumed
consent that both seek to respect the individual’s autonomy, they fail to achieve this goal.
Irrespective of the system enacted, some individual will still exist whose desires are never met.
This is because there will be those wishing to donate, but their organs will never be donated
under the presumed refusal system.
Similarly, there will be certain people who are not wishing to donate their organs;
however, under the presumed consent system, their organs will get donated. Therefore, either
way, there still will be a violation of the people’s wishes. Thus, by enacting the mandated choice
as the alternative, the violation of the people wishes will cease. This is because this method
allows each individual to state his wishes legally in an explicit manner. This will both prove to
be the top autonomous platform, as supported by the polls and surveys, and will make the
number of individuals willing as well as able to donate to surge tremendously.

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Therefore, the disparity between the organ supply and demanded will significantly lessen.
Thus, the mandated choice method via the driver’s license remains the best feasible option to the
dilemmatic organ procurement in KSA since it both respects the autonomy of the people,
eliminates the members of the family from deciding, and further increases the available organs
supply for transplantation.
The mandated choice method will thus deal with the critical organs’ shortage problem
which is a key barrier KSA’s organ transplantation is facing currently. When this system is fully
implemented and adopted, the shortage will be stopped. This is because the mandated choice
allows every adult in KSA to decide independently whether they are willing to donate on their
deaths and such decisions would stay controlling. This means the family will no longer be
required to make any overriding decision contrary to the deceased’s wishes. This method will be
widely accepted because the studies have shown that many people in KSA believe that the
family should never be allowed to override the initially expressed wishes of the lately deceased
loved ones.
V. Argument Explaining People’s Interest in the Issue
From the utilitarianism point of view, many people have an interest in organ donation
because the most significant utility remains that which leads to a higher number of patients
awaiting organ transplantation getting satisfied. People believe that by donating their organs,
they engage in the right action in the form of action which establishes conditions in which the
most significant number of donations are accomplished (Alattas et al. 2018). This is why the
people of KSA are increasingly becoming organ donors despite the challenges of lack of
awareness and lack of systems of consent to promote the donations to save not only lives of
many people, but also save on time and money (Hejaili, Attar and Shaheen 2017). Indeed, many

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people in KSA believe that the managerial efficacy of utilitarianism appears suited to the
mandated choice organ donation and other ethical issues in the contemporary medical practice
with scarce resources and rising demands of organ transplantation (Al-Sayyari 2017). The rising
interest of people in these issues can be supported by the view of the classical utilitarianism that
is dealing with pleasure maximization and pain minimization. Organ donors believe that when
they donate their organs, they will indeed help a person in need reduce his pain and maximize
pleasure in the society through maximization of greatest happiness and the highest number of
recipients (Majeed 2016). Therefore, the people in KSA are willing to give their unswerving
consent through mandated choice system where they will consent as they replace or take new
driver’s licenses in order that they deter the occurrence of a mischief, evil, pain, or unhappiness
to the individual whose interest is under consideration (Arredondo et al. 2018). Indeed the people
of KSA concur with the view of Mill that if they are given a choice they would instead go for the
life of a dissatisfied Socrates than the life of a happy fool since the happy life of a fool would
only be drawn from trivial pursuits alongside activities (Shaheen 2016). Thus, idealized or
maximal satisfaction as the life of intellect is displayed as different quantitatively to
unadulterated pleasure looking for the hedonic utilitarian. Therefore, people’s increased interest
in organ donation is viewed as their increased ability to make wise decisions which are inclusive
of the welfare and the needs of other people into their actions and decisions (Shaheen, Al-Attar,
Kamal, Santiago and Al Sayyari 2017).
Vi. Argument for Easy Implementation of the System
Holding other factors constant, nothing can be done to a person’s body, not even
deceased in the absence of their prior consent. This is why the idea of consent by the potential
donor before death or by a relative for the elimination of organs stays central. Thus, this explains

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why there is a need for an easily implementable system that can ensure that everyone gives his or
her consent before they die. Therefore, the mandated choice system meets the requirement of a
system that can easily be implemented. This is because this system can quickly be promoted to
create the desired awareness so that people will readily give their consents as they take or replace
their driving licenses. Thus, during the death of a consented individual, the problems will not
arise from the relatives to violate the consent by stopping the removal of the organs (de Groot et
al. 2015). This system will thus help avoid the re-opening up of such areas as personal autonomy
and power issues over the body of an individual, the rights of other people to make post mortem
decision regarding the body of a person and the very subject of whether consent remains a
necessary or proper requirement in the process of organ donation.
VII. Conclusion
The methodology conceived organ donation as the unproblematic good by recognizing
that schemes for organ donation are situations-suited to the utility ideas, the problem
encountering utilitarianism concerning donating an organ is never insurmountable. It sought to
demonstrate that ideas of consent presumption are conceived poorly, if not in error, and
presenting a case where only mandated choice consent system is enough to confirm a valid
consent (Howard and Cornell 2016). It is demonstrated that the utility of a given action manifest
mutual responsibility towards other people in society and accomplishes the realization of virtue
beyond self, directed towards other selves.

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