PHIL103: Moral and Political Philosophy

Four categories of donation by living persons can be distinguished: Living Related Organ Donation "blood or emotional": directed donation to a loved one; Altruistic Organ Donation: non-directed donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; Living Non-Related Organ Donation: directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection; and Cross donation where a living donor wants to donate to his blood or emotional relative an organ but blood groups does not match, there is a complete mismatch or cross matching is positive. Two families or more can cross donate if matches exist. Each type of donation prompts distinct ethical concerns. Living Related Organ Donation is presumed to be the most ethical form of organ donation. One can argue that the psychological and non-specific benefits to the donor are real, particularly when a close relative is returned to normal health. There can, however, be no doubt that the physical consequences of living donation are entirely detrimental to the donor. Motives behind the 1st degree living renal donation are understandable and one may assume that the living donation between relatives carries the same altruistic motives. In related organ donation, the donor saves the life and attains the wellbeing of its immediate relative by accepting a physical injury and debilitation to itself. While many related donors fall neatly into this altruistic categorization, unfortunately, there are many examples where the related donors have attained physical, emotional or financial toll from the recipient. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced. In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the person can bow out gracefully. Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves. In cases like these, simply obtaining the informed consent of the relative is insufficient; physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large. Non directed donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life threatening sacrifice for a stranger calls for careful scrutiny.

Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern. Directed donation to stranger raises similar ethical questions with a few additional wrinkles. This type of donation usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising is not illegal, but it has been strongly discouraged by the transplantation community. Two central objections are that the practice is unfair and that it threatens the view that an organ is a "gift of life," not a commodity to be bought and sold. Some argue that just as we have a right to donate to the charities of our choice, so should we be able to choose to whom to give our organs. In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs – rather than those most in need. This strikes some ethicists as unfair. Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals. Hence, the argument goes, these donations are legitimately subject to societ al requirements of fairness, and transplantation centers should refuse to permit the allocation of organs on the basis of anything but morally relevant criteria.

The most ethically problematic cases are those in which the recipient is chosen on the basis of race, religion, or ethnic group. A person with organ damage or organ failure may look for a living donor to donate an organ, allowing the patient to bypass the national waiting pool to receive a cadaveric organ.