The Gift of Life and Starfish on the Beach: The Ethics of Organ Procurement

On 13 January 2002 a man who donated a part of his liver to his brother died from complications hours after the surgery. This is a most unfortunate outcome, and no one should be eager to exploit this tragedy to advance his or her particular agenda. Nevertheless, such situations capture the public's attention, however briefly, and can provide a window of opportunity for reflection. Already the canons of American bioethics are being reasserted to address concerns this case raised about organ donation. The theory of informed consent, a theory premised upon the rights of the individual, is the central doctrine of American bioethics.

A person has a right to consent to or refuse any treatment or invasive procedure. Consent must be fully informed and freely given (i.e., uncoerced). A recent New York Times editorial by Ronald Munson (2002) questioned whether consent to this kind of organ donation (known as living-related donation) is always fully informed. Professor Munson raised the typical concerns regarding familial coercion to donate and reiterated the usual remedies. For instance, to prevent families from pressuring unwilling members into donating their organs, surgeons typically "cover" for the potential donor by saying cryptic things such as "He is not eligible to donate." Of course, this is somewhat deceptive although literally true because the reason that he is not eligible to donate is that he has declined to donate.

The focus of American bioethics has always been on the rights of the individual, rights to consent or to refuse. Bioethicists with more communitarian leanings have sometimes critiqued this approach. That is, one can argue that along with our rights come certain responsibilities, perhaps including a responsibility to donate one's organs after death. Generally, bioethicists have limited themselves to this kind of tacking on of responsibilities to rights. I believe that we must go beyond this kind of "rights plus" thinking to analyze the values involved in organ donation and question whether they are contributing to the common good. Such reflection on organ donation reveals that under the guise of altruism we are uncritically medicalizing our lives and commodifying our bodies, especially as new means of procuring organs are advanced.

How We Typically Think about Organ Donation:
Easy Altruism and the Gift of Life

What should we do about organ donation? Bioethicists have usually assumed that the question to ponder is how to procure more organs for transplantation. We find a problem that seems to be caused by too much freedom and not enough responsibility. In the United States people have freedom over their bodies but fail in their responsibility to donate their organs to their fellow citizens. Thus, we often hear of procedures or proposals, both in the scholarly literature and the public press, that allow for the automatic taking of the organs of a dead person unless stipulated to the contrary (presumed consent policies) (Lindemann Nelson 1994); statutes to prevent familial interference with the documented wish of the deceased to donate; compensation schemes for the families of donors (e.g., money for burial expenses for the donor) (Ubel et al. 2000); policies that allow for living persons, related and nonrelated, to donate all or part of specific organs (Majeske, Parker, and Frader 1996); the purchasing of all or part of specific organs from living persons (Radcliffe-Richards et al. 1998; Finkel 2001); and other ways of increasing donation.

The majority of these proposals (with the notable exception of the buying of organs from living persons in the third world) are looked upon favorably by most ethicists and healthcare professionals who write on these issues. In particular, proposals that promise to increase the number of organs harvested from cadavers are viewed favorably. Why wouldn't they be? To all appearances, the taking of organs is a small, almost negligible burden, and the reception of such an organ...