Ethics and organ donation

Each year many thousands of people have their lives saved as a result of human-to-human transplants. However, each year many thousands of people die who would have lived had they received a transplant. Indeed, the majority of people waiting for a transplant never receive one; they die first.

The purchase of human organs – a market-led ‘solution’ to the shortage – is, in general, illegal. The qualification ‘in general’ is necessary, as some countries permit the sale of human eggs, sperm and blood. None, though, allow the purchase of organs for transplants.

Organ shortfall

The reason that most people waiting for an organ transplant never receive one is simply that there are not enough human organs to go around. There are three main reasons for this:

• The number of people who would benefit from a transplant continues to rise. In part, this is because of advances in transplant surgery that mean that more organs (for example lungs) can now be transplanted than used to be the case. In part, too, this is because a greater range of medical conditions can now be treated by transplantation than used to be the case.
• Only a very small proportion of deaths result in organs that are suitable for transplants. Deaths from motor vehicle accidents provide a high proportion of suitable organs. However, thanks to improvements in road safety (such as seat belts, improved car design, better road layouts and greater use of motor cycle helmets), the number of people killed in such accidents is reducing in those countries where transplant surgery is numerically significant.
• Many countries (including New Zealand) have some sort of ‘opt in’ rather than ‘opt out’ system (such as in Spain) for organ donation. This can mean that for an organ to be used in a transplant operation, the dead person needs previously to have expressed a wish for their organs to be used for transplantation, a doctor must ask relatives to consent to this and no close relative objects to the transplant.

There is little doubt that the adoption of an ‘opt out’ rather than an ‘opt in’ system for organ donation would significantly increase (probably by a factor of about three) the number of lives saved each year through organ donation.

Ethical frameworks

We can conduct an ethical analysis of ‘opt in’ versus ‘opt out systems for organ donation using the five frameworks of consequentialism/utilitarianism, autonomy, rights and responsibilities, virtue ethics and multiple perspectives.

Follow up by reading this article Frameworks for ethical analysis and then see the Ethics thinking toolkit.

Within a utilitarian framework, there seems to be a strong argument in favour of an ‘opt out’ system. Any unease this might cause some people is surely outweighed by the many people who would gain extra years of life (not even taking into account their relatives and friends who would be glad of this too).

Within a rights/duties framework, there also seems to be quite a strong argument in favour of an ‘opt out’ system since anyone who objects to their organs being used in transplants can still ensure that they are not, while there is the argument that society has a duty to provide as many people as possible who need transplants with them.

Religious arguments do not seem to have featured very prominently, yet almost all countries have an ‘opt in’ system. Perhaps the political flack from introducing an ‘opt out’ system would be too great.

Written by Professor Michael Reiss, Institute of Education, University of London.