by Michael Kirsch, MD
Choose the best answer.
To stimulate organ donation, we should provide organ donors with:
* Cold, hard cash
* Upgrades to business class on any flight within the continental United States for 1 year
* College tuition discounts for up to 3 children
* Income tax relief
* First row Bruce Springsteen concert tickets
* A certificate of appreciation
There is a reason that we don’t ask families of kidnapped victims what our policy should be with regard to hostage negotiations. Any family in this situation, including mine, would favor paying the ransom. While this would serve an individual family’s interest, it would conflict with the public’s interest as it would encourage more kidnappings. Thus, the greater good would be compromised.
Similarly, families seeking an organ for a loved one are not the proper source of policy recommendations for organ procurement.
Understandably, they want an organ at any cost. Certainly, if my child needed a liver to survive, I would not want to hear that saving him would amount to an ethical crime against humanity. And, I might not care. For this reason, medical ethical policies should be carefully crafted by thoughtful and dispassionate individuals who can approach the issue from a broad societal perspective. Of course, those who have a personal stake in the game should have a voice at the table, but they should serve as an advisory and informational role. Their views should be considered, but not necessarily adopted. These are heartwrenching and controversial issues, particularly when an individual’s plea for life is deflected off an ethical firewall.
Is purchasing tissues and organs a worthy idea for society? Would it violate ethical standards against exploitation? Would it injure the ethical principle of justice?
Many argue that buying organs should be permitted, just as affluent folks can purchase cosmetic surgery, luxury cars or Caribbean vacations. If they can afford to purchase a kidney from a willing seller, they argue, why shouldn’t the transaction take place?
Organ shortages have resulted in a reconsideration of ethical procurement practices that were heretofore prohibited. Many fear that folks at the end of life are already viewed as organ donors in an effort to save others who are awaiting organ transplantation. One way to increase the donor pool with the stroke of a pen is simply to ‘modify’ the definition of death. In the past, dead meant brain death. Nowadays, cardiac death, a new & improved definition of the end of life, has greatly increased organ donor supply. Is this definition-creep motivated by a desire to increase the donor reservoir? Is this the right thing to do? It takes little imagination to foresee how slippery and vertical this slope can become.
Sick and desperate people awaiting organs have rights too. We must be extremely cautious that our zeal to protect society’s rights is not outweighed by their right to life.
It is illegal to purchase organs in the United States, but other countries have different policies. The Wall Street Journal, John Goodman’s Health Policy Blog and NPR reported that Iran will pay citizens to donate and, as a result, they have no organ shortages. Singapore organ-seekers pay tens of thousands of dollars for an organ. Some nations, such as Sweden and Spain, presume consent to donate organs, unless the invidual has actively opted-out of the program.
In the United States, there is no presumed consent. Israel, in response to a low organ donation rate, has just launched a program to reward willing donors by giving them priority should they ever need a transplant. I just learned about an organization here in the United States called LifeSharers, whose members pledge to donate organs and to give fellow members in need priority access of these organs. The organization charges no fee and currently has over 13,000 members.
Maurice Bernstein queried on his provocative Bioethics Discussion Blog if it should be legal to procure organs from dead individuals without consent from the patient or family. There is a long thread of thoughtful comments from readers.
I think we should provide more incentives to donate, although I do not advocate buying and selling organs on the free market. This would lead directly to economic and physician exploitation of our most vulnerable people. I also vigorously oppose bending the definition of death for the purpose of saving others. One life is not worth more than another. Of course, it’s easier to make principled and categorical statements as a blogger. But, don’t ask me for my high and mighty opinion if my child is on the transplant list. I’d pay the ransom.
What are your thoughts to promote organ donation within the boundaries of medical ethics?
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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