This collection features comprehensive overviews of the various ethical challenges in organ transplantation. International readings well-grounded in the latest developments in the life sciences are organized into systematic sections and engage with one another, offering complementary views. All core issues in the global ethical debate are covered: donating and procuring organs, allocating and receiving organs, as well as considering alternatives. Due to its systematic structure, the volume provides an excellent orientation for researchers, students, and practitioners alike to enable a deeper (...) understanding of some of the most controversial issues in modern medicine. (shrink)

Since its inception, the institution of postmortem organ transplantation has faced the problem of organ shortage: Every year, the demand for donor organs vastly exceeds supply, resulting in the deaths of approximately 8,000 individuals in the United States alone.1 This is in large part due to the fact that the United States, for the most part, operates under an “opt-in” policy in which people are given the opportunity to voluntarily opt-in to organ donation by registering as organ donors.2 In the (...) United States, a person’s organs will not be removed for transplantation purposes unless she has registered as a donor or her family gives their consent for organ removal.3 Jointly, these policies generate a situation where we do not retrieve as many organs as we could. (shrink)

Human body material removed post mortem is a particularly valuable resource for research. Considering the efforts that are currently being made to study the biochemical processes and possible genetic causes that underlie cancer and cardiovascular and neurodegenerative diseases, it is likely that this type of research will continue to gain in importance. However, post mortem procurement of human body material for research raises specific ethical concerns, more in particular with regard to the consent of the research participant. In this paper, (...) we attempt to determine which consent regime should govern the post mortem procurement of body material for research. In order to do so, we assess the various arguments that could be put forward in support of a duty to make body material available for research purposes after death. We argue that this duty does in practice not support conscription but is sufficiently strong to defend a policy of presumed rather than explicit consent. (shrink)

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. (shrink)

Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options in (...) specific ways for the sake of others. (shrink)

Transnational reproductive travel is symptomatic of insufficient supplies of reproductive resources, including donor gametes and gestational surrogacy services, and inequities in access to these within domestic health-care jurisdictions. Here, we argue that an innovative approach to domestic policy making using the framework of the National Self-Sufficiency paradigm represents the best solution to domestic challenges and the ethical hazards of the global marketplace in reproductive resources.

The question, what measures to address the shortage of transplantable organs are ethically permissible? requires careful attention because, apart from its impact on medical practice, the stance we espouse here reflects our interpretations of human freedom and mortality. To raise the number of available organs, on utilitarian grounds, bioethicists and medical professionals increasingly support mandatory procurement. This view is at odds with the Catechism of the Catholic Church, according to which ‘[o]rgan donation after death is a noble and meritorious act’ (...) but ethically impermissible absent consent. Those who concur with this position, but would oppose conscription on independent philosophical grounds, have not yet found a voice in the Western tradition comparable in strength to the utilitarian basis of the policy’s support, for Kantian and Aristotelian ethics, too, lend themselves to a requirement that we make our organs available to others when they can no longer serve ourselves. One finds an ethical wedge against conscription in an unexpected philosophical locale: the ‘fundamental ontology’ of Heidegger’s Being and Time, where pertinent individual choices arc protectively over what happens post mortem. Heidegger’s perspective on this issue thus meshes, not with other philosophical voices, but with Catholic doctrine—a surprising convergence of atheistic and theistic approaches to our flourishing whose ground I address in the article’s conclusion. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

In this paper, I argue for the following points. First, all of us have a presumptive moral obligation to be organ donors if we are in the relevant medical circumstances at the time of death. Second, family members should not have the right to interfere with the fulfillment of that obligation. Third, the ethical basis for that obligation is reciprocity. If we want a sufficient number of organs available for transplantation, then all must be willing donors. Fourth, that likelihood is (...) diminished if individuals are entirely free to refuse to be organ donors but still would demand to be organ recipients. Fifth, although individuals would be ethically obligated to be organ donors, we still need to permit them to refuse to be organ donors. Sixth, to encourage individuals to stay within the organ donation system, we should have as a just and ethically justified policy denying individuals an organ transplant in the relevant medical circumstances if they have chosen to exit the organ donation system. Individuals would not be permitted to be organ recipients if they were unwilling to be organ donors. This is what it means to be part of what Rawls in Political liberalism (15-22) would refer to as a “fair system of social cooperation.” We refer to this as the “reciprocity requirement.”. (shrink)

The first question I discuss in this paper is whether we have a duty of rescue to make our organs available for transplantation after our death, a duty we owe to patients suffering from organ failure. The second question is whether political obligations, in particular the obligation to obey the law, can be derived from natural duties, possibly duties of beneficence. Such duties are normally seen as merely imperfect duties, not owed to anyone. The duty of rescue, however, is a (...) perfect one, mainly because it applies to us when we are in a unique position to provide urgent help to a person in need. The basic idea of a natural duty account of political obligation is that such unique positions can be artificially created by institutionalized coordination schemes. The remaining problem is how any particular coordination scheme could claim our allegiance rather than any other. This problem can be solved in different ways in the organ donation case, and in respect to a limited set of political obligations, mainly negative ones. A natural duty account is best seen as a constitutive part of a multiple principle theory of political obligation. (shrink)

In this paper I explore a new approach to the ethics of animal experimentation by conceiving of it as a form of rescue. The notion of rescue, I suggest, involves some moral agent performing an action or series of actions, whose end is to prevent or alleviate serious harm to another party, harm that otherwise would have occurred or would have continued to occur, had that moral agent not intervened. Animal experiments that are utilized as a means to alleviate human (...) illnesses mirror the structure of rescue cases and this means that we can and should apply principles of rescue to illuminate the moral status of animal experimentation. To do this I consider various principles of rescue that might justify animal experimentation. I’ll argue that all of these rescue principles are either not independently plausible, or else they fail to imply that animal experimentation is morally justified. This suggests that it is quite difficult to morally justify animal experimentation when conceived as a form of rescue. (shrink)