10 Organ Donation Practices and End-of-life Care ... 257terrible if his perfectly good organs were not used to help the lives of other
people’) and at the same time to seek further acceptance among the wider
whānau and iwi, which was the case when, at the tangi,^5 the whānau felt
once more empowered by the support of others. Without doubt, in the
safety and comfort of the wharenui, they were able to mourn Clifford
and to praise his gift to others. Nevertheless, it is important that had
the whānau not agreed to organ donation, their wishes would have been
respected.
Clifford did indeed have the right to determine what might hap-
pen to his own body organs at death while alive, but upon death this
became a collective right within an autonomous family group that were
strongly connected to the wider cultural collective (‘We had Clifford at
home (the Marae) for one night and the wharenui (meeting house) was
full of people telling stories about him’.). In short, Clifford’s whānau
connected to both the healthcare system and their own people by main-
taining their cultural practices and beliefs within their interpretation
of a social ethic. There should always be room in any organ donation
services for the promotion of a socially focused and culturally inclusive
ethical approach to organ donation.
Conclusion
As is clear from this discussion, while there are shared ethical values
and principles across brain death and end of life in intensive care, the
reality of what happens at the bedside is very different. Yet for all the
clinical differences in managing the dead and dying in intensive care,
there are shared goals: delivery of compassionate care; respect for indi-
vidual autonomy with regard to choices at end of life, including pref-
erence for organ donation; importance of consent and consensus in
treatment decisions; and acknowledgement of the social cultural con-
text of care. As different approaches to organ donation become main-
stream, new challenges will arise for both clinicians and society as a
whole, with continued debate on the ethics of organ donation and end
of life. While organ donation is often theorised and debated alongside
end-of-life care, the relationship of these two at the bedside is not so