Online research in philosophy

An increasingly unbridgeable gap exists between the supply and demand of transplantable organs. Human embryonic stem cell technology could solve the organ shortage problem by restoring diseased or damaged tissue across a range of common conditions. However, such technology faces several largely ignored immunological challenges in delivering cell lines to large populations. We address some of these challenges and argue in favor of encouraging contribution or intentional creation of embryos from which widely immunocompatible stem cell lines could be derived. Further, we argue that current immunological constraints in tissue transplantation demand the creation of a global stem cell bank, which may hold particular promise for minority populations and other sub-groups currently marginalized from organ procurement and allocation systems. Finally, we conclude by offering a number of practical and ethically oriented recommendations for constructing a human embryonic stem cell bank that we hope will help solve the ongoing organ shortage problem.

: The chronic shortage of transplantable organs has reached critical proportions. In the wake of this crisis, some bioethicists have argued there is sufficient public support to expand organ recovery through use of neocortical criteria of death or even pre-mortem organ retrieval. I present a typology of ways in which data gathered from the public can be misread or selectively used by bioethicists in service of an ideological or policy agenda, resulting in bad policy and bad ethics. Such risks should lead us to look at alternatives for increasing organ supplies short of expanding or abandoning the dead donor rule. The chronic problem of organ scarcity should prompt bioethicists to engage in constructive dialogue about the relation of the social sciences and bioethics, to examine the social malleability of the definition of death, and to revisit the question of the priority of organ transplants in the overall package of healthcare benefits provided to most, but not all, citizens.

Recent break-throughs in surgery and the discovery of an effective immunosupressive drug called cyclosporin, have brought a Renaissance in organ transplants. These medical advances have also heightened concern over the already critical shortage of body organs. Several alternatives have been suggested which may help alleviate the organ shortage. One such alternative is to allow commerce in human organs. This article discusses the morality of commercialization of human organs within the framework of several ethical theories.

: 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.

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.