The subtle politics of organ donation: A proposal

Journal of Medical Ethics

Volumn 24, Issue 3, 1998, Pages 166-170

  Eaton, Stephanie ^a  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

Author keywords

Free riding; Opting out; Organ donation

Indexed keywords

CALCULATION; HUMAN; MEDICAL DECISION MAKING; MEDICAL ETHICS; ORGAN DONOR; ORGAN TRANSPLANTATION; POLITICS; RECIPIENT; RELATIVE; SHORT SURVEY;

EID: 0031748557     PISSN: 03066800     EISSN: None     Source Type: Journal    
DOI: 10.1136/jme.24.3.166     Document Type: Short Survey

References (13)

1. In practice many countries with opting-out systems still seek to obtain the authorisation of relatives for the use of organs for transplantation. See Haag BW, Stuart FP. The organ donor: brain death, selection criteria, supply and demand. In: Flye MW, ed. Principles of organ transplantation. Philadelphia: W B Saunders Company, 1989: 185.
2. See Kittur DS, Hogan MM, Thukral VK, McGaw LJ, Alexander JW. Incentives for organ donation? Lancet 1991;338: 1441 who report that organ donation in Belgium has increased by 119% in the three years since opting-out legislation was introduced.
3. West R. Organ transplantation. London: Office of Health Economics, 1991:10.
4. For altruistic reasons some potential recipients may prefer to see donated organs go to younger people or to those with dependants and there are, of course, some religious groups who do not accept transplantation.
5. Although transplantation is obviously an expensive medical treatment, it has been noted that over a period of some years, renal transplantation is more economical than continued dialysis. See also reference 3:25.
6. The presumed consent implicit in opting-out systems may also facilitate the speedier recovery of organs from deceased persons, reducing the demand for elective ventilation of cadavers with the additional ethical doubts that this procedure raises.
7. The use of the terms "generous" and "selfish" are of course, value-laden, and oversimplify the motives behind a decision to donate or to refrain from donation. These terms are intended here as a shorthand and to give the flavour of the moral argument.
8. In the hypothetical case of someone who has opted-out and then becomes aware that he/she needs a transplant it is, of course, possible for that person to "change his/her mind" but the changed circumstances will leave some doubt as to the aetiology of the decision. In any case, publicity of such cases may serve to discourage other potential opters-out.
9. Jarvis R. Join the club: a modest proposal to increase availability of donor organs. Journal of Medical Ethics 1995;21:199-204.
10. Only free-riders would be penalised on the perfectly implemented Jarvis proposal as those who refused to donate on, for example religious grounds, would presumably also refuse to accept organs in transplantation.
11. Gillon R. On giving preference to prior volunteers when allocating organs for transplant [editorial]. Journal of Medical Ethics 1995;21:195-b.
12. See Reference 11: 195.
13. Adams J. Risk. London: University College London Press, 1995.