Online research in philosophy

: The topic of organ transplantation is examined from the perspective of three authors: Robert Bellah, Jeremy Rifkin, and Margaret Jane Radin. Introduced by reflections on the development of the justification of organ transplantation within the Roman Catholic community and the various themes raised by the historical study in Richard Titmuss's The Gift Relationship, the paper examines how and in what ways the possible commodification of organs will affect our society and the impacts this may have on the supply of organs.

During 2006, a total of 130,527 Americans spent time on organ waiting lists; 7,191 of them died waiting. According to the U.S. Organ Procurement and Transplantation Network, 104,778 people are awaiting organs as this is being written (www.optn.org/data/; accessed November 4, 2009); every ninety minutes or so, one of them will die.In Spain, however, waiting list time is much shorter, and accordingly, very few die for the want of an organ; roughly thirty-five people per million provide organs in Spain upon their deaths, a rate that dwarfs participation in the United States (usually cited at roughly twenty-two people per million)—and close to everywhere else as well. Among the benefits reaped by the Spanish: during ..

When one thinks about organ transplantation, the organs that usually come to mind are the heart, or possibly the kidney, the most commonly transplanted organ (UNOS 2008). Transplantations are generally regarded as necessary to the life of the person receiving the transplant or to physiologically improving that life: the transplant is seen as making the recipient “whole” once more (Lederer 2008). While many have commented on the various ethical issues brought forth by the clinical practice of organ transplantation, here we are concerned with the idea of becoming whole from organ transplantation. The idea of wholeness that a transplant renders can extend beyond the physiological to the individual, the familial, and ..

The dead donor rule justifies current practice in organ procurement for transplantation and states that organ donors must be dead prior to donation. The majority of organ donors are diagnosed as having suffered brain death and hence are declared dead by neurological criteria. However, a significant amount of unrest in both the philosophical and the medical literature has surfaced since this practice began forty years ago. I argue that, first, declaring death by neurological criteria is both unreliable and unjustified but further, the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death.

Anticipating the reevaluation of the Dutch organ procurement system, in late 2003 the Rathenau Institute published a study entitled ‘Gift or Contribution?’ In this study, the author, Govert den Hartogh, carries out a thorough moral analysis of the problem of organ shortage and fair allocation of organs. He suggests there should be a change in mentality whereby organ donation is no longer viewed in terms of charity and the volunteer spirit, but rather in terms of duty and reciprocity. The procurement and allocation of donor organs should be seen as a system of mutually assured help. Fair allocation would imply to give priority to those who recognize and comply with their duty: the registered donors. The idea of viewing organ donation as an undertaking involving mutual benefit rather than as a matter of charity, however, is not new. Notwithstanding the fact that reference to charity and altruism is not required in order for the organ donation to be of moral significance, we will argue against the reciprocity-based scenario. Steering organ allocation towards those who are themselves willing to donate organs is both an ineffective and morally questionable means of attempting to counter the organ shortage.

Many people in desperate need of an organ will die on waiting lists for transplantation or face increased morbidity because of their wait. This circumstance is particularly troubling since many viable organs for transplantation go unused when individuals fail to participate in their local organ donation system. In this paper, I consider whether participating in organ transplantation should be considered a form of a rescue of others from the great harms caused by a shortage in transplantable organs. Specifically, I consider whether cadaver organ transplantation is a case of an easy rescue. If so, participation in cadaver organ transplantation will be a duty rather than a supererogatory act.1 This question is important in illuminating individual duties to participate in organ transplantation. Moreover, as I will argue, it has repercussions for community-wide policies for enrolling individuals in transplantation schemes.

In the first section of this paper, I tie cadaver organ transplantation to the duty to rescue others from great harm when it is easy to do so. Given the number of persons who will die or be greatly harmed without transplanted organs, the transfer of organs upon death is seemingly similar to other, classical cases of easy rescue. In the second section, I consider objections to this proposal on the ground that cadaver organ transplantation is structurally dissimilar to classical rescue cases, especially given uncertainty over when and to whom organs will be transplanted, if they are transplanted at all. In the third section, I consider the objection that cadaver organ transplantation is a demanding, rather than easy, rescue. While I grant that cadaver organ transplantation will be demanding for some persons, I argue that there remain many cases where it will be an easy rescue. In the final section, I consider the policy implications of my argument. In particular, I argue that understanding cadaver organ transplantation as a duty should shift the debate over opt-out, opt-in, and mandatory choice procedures for participating in organ transplantation upon death. While different systems will be appropriate for different communities, understanding transplantation as a duty in some cases helps to justify an opt-out system.

: The March 2003 issue of the Kennedy Institute of Ethics Journal was devoted to cadaveric organ procurement. All the discussed proposals for solving the severe organ shortage place a higher value on respecting individual and/or family autonomy than on maximizing recovery of organs. Because of this emphasis on autonomy and historically high refusal rates, I believe that none of the proposals is likely to achieve the goal of ensuring an adequate supply of transplantable organs. An alternative approach, conscription of cadaveric organs for transplantation, reverses the rank order of these priorities by placing greater value on maximizing recovery of organs than on respect for autonomy. Although conscription of organs initially may appear to be a radical and even ridiculous proposal, careful consideration reveals that it might well solve the organ shortage in an ethically acceptable way.

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a gift of life and a commodity exchange. The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources.