Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-18T13:22:02.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Compulsory Organ Retrieval: Morally, But Not Socially, Justified

Published online by Cambridge University Press:  07 December 2017

PHILIP M. ROSOFF
Get access Rights & Permissions [Opens in a new window]

Abstract:

The number of patients with organ failure who could potentially benefit from transplantation continues to exceed the available supply of organs. Despite numerous efforts to increase the number of donors, there remains an enormous mismatch between demand and supply. Large numbers of people still die with potentially transplantable organs remaining in situ, most frequently as a result of family objections. I argue that there are no persuasive moral arguments against mandated organ retrieval from all dead individuals who meet clinical criteria. However, because of continuing endemic prejudice in United States society and its healthcare system and the distrust this engenders, I conclude that proceeding with a policy of compulsory organ retrieval, even if morally unobjectionable, would not be warranted.

Keywords

organ failuretransplantationcompulsory organ retrieval
Type
Special Section: Open Forum
Information
Cambridge Quarterly of Healthcare Ethics , Volume 27 , Issue 1 , January 2018 , pp. 36 - 51
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Sheehy, E, Conrad, SL, Brigham, LE, Luskin, R, Weber, P, Eakin, M, et al. Estimating the number of potential organ donors in the United States. New England Journal of Medicine 2003;349(7):667–74;CrossRefGoogle ScholarPubMed Klassen, DK, Edwards, LB, Stewart, DE, Glazier, AK, Orlowski, JP, Berg, CL, et al. The OPTN deceased donor potential study: Implications for policy and practice. American Journal of Transplantation 2016;16(6):1707–14.CrossRefGoogle ScholarPubMed

2. Thornton, JD, Sullivan, C, Albert, JM, Cedeño, M, Patrick, B, Pencak, J, et al. Effects of a video on organ donation consent among primary care patients: A randomized controlled trial. Journal of General Internal Medicine 2016;31(8):832–39.CrossRefGoogle ScholarPubMed

3. Siminoff, L, Mercer, MB, Graham, G, Burant, C. The reasons families donate organs for transplantation: Implications for policy and practice. Journal of Trauma 2007;62(4):969–78;CrossRefGoogle ScholarPubMed Siminoff, LA, Saunders Sturm, CM. African-American reluctance to donate: Beliefs and attitudes about organ donation and implications for policy. Kennedy Institute Ethics Journal 2000;10(1):59–74.Google ScholarPubMed

4. US National Center for Health Statistics FastStats for 2013; available at http://www.cdc.gov/nchs/fastats/deaths.htm (last accessed 14 June 2017).

5. Data obtained from Association of Organ Procurement Organizations, Data on donation and transplantation, 2017; available at http://www.aopo.org/related-links-data-on-donation-and-transplantation/ (last accessed 12 Apr 2017).

6. Shepherd, L, O’Carroll, RE, Ferguson, E. An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: A panel study. BMC Medicine 2014;12(1):131–44;CrossRefGoogle ScholarPubMed Matesanz, R, Marazuela, R, Coll, E, Mahíllo, B, Domínguez-GB. About the opt-out system, live transplantation and information to the public on organ donation in Spain… Y Olé! American Journal of Transplantation 2017;17(6):1695–6.CrossRefGoogle Scholar

7. Stoler, A, Kessler, JB, Ashkenazi, T, Roth, AE, Lavee, J. Incentivizing authorization for deceased organ donation with organ allocation priority: The first 5 years. American Journal of Transplantation 2016;16(9):2639–45.CrossRefGoogle ScholarPubMed

8. Rodrigue, JR, Krouse, J, Carroll, C, Giery, KM, Fraga, Y, Edwards, E, et al. A department of motor vehicles intervention yields moderate increases in donor designation rates. Progress in Transplantation 2012;22(1):18–24;CrossRefGoogle ScholarPubMed Harrison, TR, Morgan, SE, King, AJ, Williams, EA. Saving lives branch by branch: The effectiveness of driver licensing bureau campaigns to promote organ donor registry sign–ups to African Americans in Michigan. Journal of Health Communication 2011;16(8):805–19.CrossRefGoogle ScholarPubMed

9. Matas, AJ, Hippen, B, Satel, S. In defense of a regulated system of compensation for living donation. Current Opinion in Organ Transplantation 2008;13(4):379–85;CrossRefGoogle ScholarPubMed Williams, KL, Finley, M, Rohack, JJ. Just say no to NOTA: Why the prohibition of compensation for human transplant organs in NOTA should be repealed and a regulated market for cadaver organs instituted. American Journa of Law and Medicine 2014;40:275–329;Google Scholar Satz, D, Why Some Things Should Not Be for Sale: The Moral Limits of Markets. New York: Oxford University Press; 2010.CrossRefGoogle Scholar

10. Ghahramani, N, Karparvar, Z, Ghahramani, M, Shadrou, S. International survey of nephrologists’ perceptions and attitudes about rewards and compensations for kidney donation. Nephrology Dialysis Transplantation 2013;28(6):1610–21;CrossRefGoogle ScholarPubMed Tong, A, Chapman, JR, Wong, G, Craig, JC. Perspectives of transplant physicians and surgeons on reimbursement, compensation, and incentives for living kidney donors. American Journal of Kidney Diseases 2014;64(4):622–32.CrossRefGoogle ScholarPubMed

11. Wilkinson, TM. Ethics and the Acquisition of Organs. Oxford, New York: Oxford University Press; 2011;CrossRefGoogle Scholar Consent and the use of the bodies of the dead. Journal of Medicine and Philosophy 2012; Rosenblum AM, Horvat LD, Siminoff LA, Prakash V, Beitel J, Garg AX. The authority of next-of–kin in explicit and presumed consent systems for deceased organ donation: An analysis of 54 nations. Nephrology Dialysis Transplantation 2012;27(6):2533–46; Siminoff LA, Agyemang AA, Traino HM. Consent to organ donation: A review. Progress in Transplantation 2013;23(1):99–104.

12. Feinberg, J. Harm to Others. The Moral Limits of the Criminal Law Series, vol. 1. New York: Oxford University Press; 1987;CrossRefGoogle Scholar see note 11, Wilkinson 2011; Hamer CL, Rivlin MM. A stronger policy of organ retrieval from cadaveric donors: Some ethical considerations. Journal of Medical Ethics 2003; 29(3):196–200.

13. Bruzzone P. Religious aspects of organ transplantation. Transplantation Proceedings 2008;40(4):1064–7.

14. Faden, RR, Beauchamp, TL. A History and Theory of Informed Consent. New York: Oxford University Press;1986;Google Scholar Beauchamp, TL, Childress, JF. Principles of Biomedical Ethics, 7th ed. New York: Oxford University Press; 2013.Google ScholarPubMed

15. Dukeminier J, Jr., Sanders D. Organ transplantation: A proposal for routine salvaging of cadaver organs. New England Journal of Medicine 1968;279(8):413–9; Loewy EH. Of community, organs and obligations: routine salvage with a twist. Theoretical Medicine 1996;17(1):61–74; Kluge E-HW. Improving organ retrieval rates: Various proposals and their ethical validity. Health Care Analysis 2000;8(3):279–95; Spital A, Erin CA. Conscription of cadaveric organs for transplantation: Let’s at least talk about it. American Journal of Kidney Diseases 2002;39(3):611–5; Harris J. Law and regulation of retained organs: The ethical issues. Legal Studies 2002;22(4):527–49; Harris J. Organ procurement: dead interests, living needs. Journal of Medical Ethics 2003;29(3):130–4; Spital A. Conscription of cadaveric organs: We need to start talking about it. American Journal of Transplantation 2005;5(5):1170–1; Spital A. Conscription of cadaveric organs for transplantation: A stimulating idea whose time has not yet come. Cambridge Quarterly of Healthcare Ethics 2005;14(1):107–12; Spital A. Conscription of cadaveric organs for transplantation: Time to start talking about it. Kidney International 2006;70(3):607–8; Hershenov DB, Delaney JJ. Mandatory autopsies and organ conscription. Kennedy Institute of Ethics Journal 2009;19(4):367–91; Wisnewski JJ. When the dead do not consent: A defense of non-consensual organ use. Public Affairs Quarterly 2008;22(3):289–309.

16. See note 15, Hershenov, Delaney 2009.

17. See note 15, Harris 2003; Spital 2005; Spital 2006, Spital, Erin 2002; Spital A, Taylor JS. Recovery of cadaveric organs for transplantation: Consistent, fair, and life-saving. Clinical Journal of the American Society of Nephrology 2007;2(2):300–303; Spital A, Taylor JS. Reconsidering the consent requirement for organ recovery after death. Transplantation 2008;86(11):1632–3; Spital A, Taylor JS. Routine recovery: An ethical plan for greatly increasing the supply of transplantable organs. Current Opinion in Organ Transplantation 2008;13(2):202–6.

18. Fabré C. Confiscating cadaveric organs. In: Whose Body Is It Anyway? Justice and the Integrity of the Person. Oxford, New York: Clarendon Press, Oxford University Press; 2006:89–94.

19. See note 12, Feinberg 1987, at chap. 2; see note 11, Wilkinson 2012 at chap 3 and 4; Giordano S. Is the body a republic? Journal of Medical Ethics 2005;31(8):470–5; McGuinness S, Brazier M. Respecting the living means respecting the dead too. Oxford Journal of Legal Studies 2008;28(2):297–316; Levenbook BB. Harming someone after his death. Ethics 1984;94(3):407–19; see note 15, Kluge 2000.

20. Solomon RC. Is there happiness after death? Philosophy 1976;51(196):189–93.

21. For example, see Panero J. Outsmarting Albert Barnes. Philanthropy Magazine 2011; available at: http://www.philanthropyroundtable.org/topic/donor_intent/outsmarting_albert_barnes. (last accessed 20 June 2017).

22. This is sometimes referred to as the problem of the subject, meaning that harming requires a subject to be the object or the target of the harm. This generally requires that the individual be alive, and some also believe that the individual should be conscious so that the harm can be experienced. On the other hand, those who hold that the dead can be harmed attempt to dodge this complication; Callahan JC, On harming the dead. Ethics 1987;97(2):341–52. The origin of this view is often attributed to the ancient Greek philosopher Epicurus who, in his Letter to Menoeceus wrote “Death, therefore, the most awful of evils, is nothing to us, seeing that, when we are, death is not come, and, when death is come, we are not. It is nothing, then, either to the living or to the dead, for with the living it is not and the dead exist no longer.” Epicurus, "Letter to Menoeceus" (Cambridge, MA: MIT); available at: http://www.philanthropyroundtable.org/topic/donor_intent/outsmarting_albert_barnes (last accessed 16 Aug 2107). Also see Silverstein HS. The evil of death. The Journal of Philosophy 1980;77(7):401–24.

23. Partridge E, Posthumous interests and posthumous respect. Ethics 1981;91(2):243–64.

24. See note 15, Spital 2005; see note 17, Spital, Taylor 2007.

25. See note 15, Harris 2002; Harris 2003.

26. Miller FG, Truog RD. The incoherence of determining death by neurological criteria: A commentary on “Controversies in the determination of death”, a white paper by the President’s Council on Bioethics. Kennedy Institute Ethics Journal 2009;19(2):185–93; Truog RD. Brain death – too flawed to endure, too ingrained to abandon. Journal of Law, Medicine & Ethics 2007;35(2):273–81.

27. See note 15, Spital 2005.

28. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Reports 2016;118:358–65.

29. Rosoff PM. Institutional futility policies are inherently unfair. HEC Forum 2013;25(3):191–209; Rosoff PM. TADA is still unfair. The American Journal of Bioethics 2015;15(8):56–8.

30. See note 19, McGuinness, Brazier 2008.

31. Olick RS, Braun EA, Potash J. Accommodating religious and moral objections to neurological death. Journal of Clinical Ethics 2009;20(2):183–91.

32. The Bible speaks to this natural course of events in Genesis 3:19 (King James Version), “In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return.”

33. See note 18, Fabré 2006.

34. Religious Freedom Restoration Act of 1993, Public Law No: 103–141.

35. See note 34. Religious Freedom Restoration Act of 1993.

36. Jaffe ES. “She’s Got Bette Davis[’s] Eyes”: Assessing the nonconsensual removal of cadaver organs under the takings and due process clauses. Columbia Law Review 1990;90(2):528–74, at 528.

37. Colavito V. New York Organ Donor Network, Inc., 486 F.3d 78 (2007). See Mapow DA, Do people have ownership over their body parts and if so, can the state control their ultimate disposition in the interest of public health and safety. Rutgers Journal of Law and Religion 2014;16:114–44, for a different view.

38. Rotholz V. City of New York, 151 Misc. 2d 613 (1992); Colavito V. New York Organ Donor Network, 8 N.Y. 3d 43 (2006).

39. See note 9, Satz 2010, at chap. 9; Voo TC, Holm S. Organs as inheritable property? Journal of Medical Ethics 2013;40:57–61; Andrews LB. My body, my property. The Hastings Center Report 1986;16(5):28–38.

40. See note 23, Partridge 1981.

41. In Re Whitmore 47 N.Y.S. 2d 143 (1944).

42. Harter TD. Overcoming the organ shortage: Failing means and radical reform. HEC Forum 2008;20(2):155–82.

43. Rosoff PM. Rationing Is Not a Four-Letter Word: Setiing Limits on Healthcare. Cambridge, MA: MIT Press; 2014; chap. 2 and 3.

44. Cookson R, McCabe C, Tsuchiya A. Public healthcare resource allocation and the rule of rescue. Journal of Medical Ethics 2008;34(7):540–4; Hughes J, Walker T. The rule of rescue in clinical practice. Clinical Ethics 2009;4(1):50–4; Schöne-Seifert B. The ‘rule of rescue’ in medical priority setting: Ethical plausibilities and implausibilities. Rationality, Markets and Morals. 2009; available at http://www.rmm-journal.com/downloads/030_schoene_seifert.pdf (last accessed 4 Apr 2017).

45. Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ. Disparities in liver transplantation before and after introduction of the MELD score. JAMA 2008;300(20):2371–8.

46. Degenholtz HB, Thomas SB, Miller MJ. Race and the intensive care unit: Disparities and preferences for end-of-life care. Critical Care Medicine 2003;31(5, Suppl.):S373–8; Loggers ET, Maciejewski PK, Paulk E, DeSanto-Madeya S, Nilsson M, Viswanath K, et al. Racial differences in predictors of intensive end-of-life care in patients with advanced cancer. Journal of Clinical Oncology 2009;27(33):5559–64.

47. Russell E, Robinson DH, Thompson NJ, Perryman JP, Arriola KR. Distrust in the healthcare system and organ donation intentions among African Americans. Journal of Community Health 2012;37(1):40–7.

48. Wailoo K, Livingston J, Guarnaccia P, eds. A Death Retold. Chapel Hill: University of North Carolina Press; 2006; see note 43, Rosoff 2014, at chap. 6.

49. Thaler RH, Sunstein CR. Nudge : Improving Decisions About Health, Wealth, and Happiness. New York: Penguin Books; 2009.