Organ Donation

Educating the Public to Encourage Organ Donation?

by Mairi Levitt

Severity of Scope Versus Altruism: Working Against Organ Donation’s Realization of Goals- An Essay

by Michele Battle-Fisher

Published in Online Journal for Health Ethics 7(2) 2011

According to the editor,
"Next, this issue turns to discussions of polarizing ethical questions. Michele Battle-Fisher's essay, Severity of Scope versus Altruism: Working Against Organ Donation's Realization of Goals, addresses the quantification of incidences of End Stage Renal Disease (ESRD). When this public health emergency is quantified by rates, Battle-Fisher, states "that there appears to be less of an incentive to upset rational choice and side with emotion if enlarging health awareness is required to turn the tide of disease." She suggests that a collective empathy toward patients who have ESRD is more likely to emerge if the patient who needs a kidney is personally known to us. While one can argue for use of the scope-severity paradox in reporting public health crises, putting the human face on the condition is certainly warranted. This type of reporting begs for additional research. What difference do you think the reporting of the 'human side' of a disease, the individual story that the public could connect to personally, would make in developing treatments for the disease, in receiving greater amounts of resources for prevention or curing of the disease, or etc?"

The number of incidences of End Stage Renal Disease (ESRD) supports the case that it is a public health emergency. The... more The number of incidences of End Stage Renal Disease (ESRD) supports the case that it is a public health emergency. The burden is often quantified by rates, leaving many people cold and
unresponsive, leading to, as Nordgren and Morris McDonnell (2011) state, “the diminishing identifiably of a large number of victims” snarled in the scope-severity paradox. The subject may identify with the disease or illness, but who are these ill-fated others? It must go beyond recognition that there is an ESRD problem at hand. “Strength in numbers” hurts---according to scope-severity paradox and its close kin, scope insensitivity. There appears to be less of an incentive to upset rational
choice and side with emotion if enlarging health awareness is required to turn the tide of disease. But I argue that this emotive will more likely activate a collective empathy if an ESRD
patient that needs a kidney is personally known to us.

Donation after Circulatory Death: Burying the Dead Donor Rule

by Maxwell J. Smith

Co-authored with Rodríguez-Arias D, Lazar NM. Published in the American Journal of Bioethics, 2011; 11(8): 36-43.

Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo... more Despite continuing controversies regarding the vital status of both brain-dead donors and individuals who undergo donation after circulatory death (DCD), respecting the dead donor rule (DDR) remains the standard moral framework for organ procurement. The DDR increases organ supply without jeopardizing trust in transplantation systems, reassuring society that donors will not experience harm during organ procurement. While the assumption that individuals cannot be harmed once they are dead is reasonable in the case of brain-dead protocols, we argue that the DDR is not an acceptable strategy to protect donors from harm in DCD protocols.We propose a threefold alternative to justify organ procurement practices: (1) ensuring that donors are sufficiently protected from harm; (2) ensuring that they are respected through informed consent; and (3) ensuring that society is fully informed of the inherently debatable nature of any criterion to declare death.

Organ Donation Ethics: Are Donors Autonomous within Collective Networks?

by Michele Battle-Fisher

Battle-Fisher, M. (2010). Organ Donation Ethics: Are Donors Autonomous within Collective Networks?" Online Journal of Health Ethics. 6(2). Retrieved from http://www.ojhe.org/.

The editor-in-chief of OJHE writes:
"Regarding your own body, are organ donors autonomous within collective networks? Michele Battle-Fisher purports that we do care about what our 'network' thinks about our personally held norms of living donation and the sanctity of the body. As such, Battle-Fisher presents that understanding the norms of living organ donation requires an examination of the personal social 'network' surrounding the potential donor.  The cliché, you can't take your organs with you, appears inadequate to elicit an organ donation gift.  Once more, we are challenged to move into the realm of authentic relationships that exude health care."

Can and will a person become an organ donor? Before such an altruistic act will occur, there is the ethic behind the... more Can and will a person become an organ donor? Before such an altruistic act will occur, there is the ethic behind the action. There is an internalization of an ethic that the person agrees or disagrees with organ donation, no matter the variant. There is a large sense of agency and responsibility over the integrity of one’s body. We do care what our “network” thinks about our personally held norms of living donation and sanctity of the body. I present the position that understanding of the norms of living organ donation requires an examination of the personal social “network” surrounding the potential donor. Networks rely on connection which may lead to deliberate consensus building (or a reason to conform in order to limit disharmony). But I argue, even when there is a supportive social environment supporting a particular bioethical value, there will be some level of network level engagement with others in this process (for better or for worse).

Consent for Organ Retrieval Cannot be Presumed

by Mike Nair-Collins

Published in HEC Forum (2009) 21(1): 71-106

The demand for solid human organs far exceeds the supply, and each day patients die waiting for an organ to become... more The demand for solid human organs far exceeds the supply, and each day patients die waiting for an organ to become available. Faced with this critical shortage, the medical and bioethics community surely must ask: What options are available in order to decrease the gap between demand and supply? Intensified efforts at public education and outreach in order to increase the number of donated organs is one option. A second option is to implement a free-market system, in which organs are bought and sold as marketable commodities.  Third, the state might implement a policy of presumed consent. In this case, in the absence of explicit refusal or of evidence that the potential donor would not have wanted to donate her organs, the state presumes that she would have consented to organ donation and recovers her organs.

In this paper, I argue that the concept of presumed consent does not justify the recovery of organs from donors who have not explicitly consented. My argument is based on the following implication: if the majority of explicit consents obtained for organ removal are not informed consents (and hence are not legitimate consents at all), then we cannot presume, had some individual given an explicit consent for organ removal, that it would have been an informed consent. My task in this paper is to convince my reader that the antecedent of the conditional is true.

Reevaluating the Dead Donor Rule

by Mike Nair-Collins

Published in Journal of Medicine and Philosophy 2010; doi: 10.1093/jmp/jhq009

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Abstract.  The dead donor rule justifies current practice in organ procurement for transplantation, and states that organ donors must be dead prior to donation.  The majority of organ donors are diagnosed as having suffered brain death, and hence are declared dead by neurological criteria.  However, a significant amount of unrest in both the philosophical and medical literature has surfaced since this practice began forty years ago.  I argue that, first, declaring death by neurological criteria is both unreliable and unjustified, but further, the ethical principles which themselves justify the dead donor rule are better served by abandoning that rule and instead allowing individuals who have suffered severe and irreversible brain damage to become organ donors, even though they are not yet dead and even though the removal of their organs would be the proximal cause of death.

Death, brain death, and the limits of science

by Mike Nair-Collins

Draft only: Final version published in the Journal of Law, Medicine, and Ethics. See http://www.aslme.org/index.php/death-brain-death-and-the-limits-of-science-why-the-whole-brain-concept-of-death-is-a-flawed-public-policy.html

In 2006, James Bernat published a paper titled, “The whole-brain concept of death remains optimum public policy”, in... more In 2006, James Bernat published a paper titled, “The whole-brain concept of death remains optimum public policy”, in the Journal of Law, Medicine, and Ethics. This manuscript is a response to that paper, in which I challenge Bernat’s claim.

My argument is as follows. When we distinguish the biological concept of death from several other moral and socio-legal concepts of death, we see that brain death is not biological death. This claim has been made before, so I only review the most important argument in its defense. I address Bernat’s various replies and show his reasoning to be unsound.

However, the brain death doctrine was never a factual claim about biological death. Rather, it embodies a value judgment about which individuals are members of the moral community and deserve the typical moral protections afforded such members. Because the claim that brain death is death is put forth as if it were a scientific fact that has been discovered, rather than a value judgment that has been decided, a great deal of confusion results. Namely, public debate about this moral issue is obscured or prevented, informed consent for donation becomes practically impossible, and biologically living donors are killed for the removal of organs, without their consent. Because of these and other moral failings that arise as a result of legally defining ‘death’ in terms of brain death, I conclude, contra Bernat, that the whole-brain concept of death is a seriously flawed public policy.

Cadaver Donation as Ascetic Practice in India

by Jacob Copeman

2006

This article explores emerging ascetic orientations towards utility and death in India. It chronicles the activities... more This article explores emerging ascetic orientations towards utility and death in India. It chronicles the activities of an innovative organization which campaigns for cadaver donation for the purposes of organ retrieval and dissection by trainee doctors. This would entail dispensing with cremation, a mode of cadaver disposal newly characterized as wasteful. In order to counter ‘cremation-lack’, the asceticism of cadaver donation is accentuated by the organization. The group thereby re-interprets classical Hinduism according to the demands of ‘medical rationality’. This produces a novel ‘donation theology’ and additionally serves to demonstrate the ‘asceticism’ by which all voluntary donors of body material are obliged to abide.

Introduction: Blood Donation, Bioeconomy, Culture

by Jacob Copeman

2009

This special issue of Body & Society explores critical issues arising from enactments of blood donation and... more This special issue of Body & Society explores critical issues arising from enactments of blood donation and transfusion in different parts of the world. With articles focusing on Brazil, China, India, the Navajo Nation, Papua New Guinea, Sri Lanka, the United States and elsewhere, description and analysis is presented of a modal and mobile constellation of practices and knowledges, transnational in distribution, but also situationally enacted in particular instances. What comes across is the scope of blood donation: its extraordinary emotive force, the complex methodologies it requires for the mobilization of populations, its ability to stimulate imaginative thought among diverse constituencies, its variations of transactional form, the ways in which it reproduces controversies globally. The scope of blood donation – the remarkable heterogeneity of its enactments and of the associations condensed therein – can perhaps only begin to be captured with the bringing together of such a wide-ranging set of ethnographic accounts as is presented in this special issue.