tal propositions. One can find strong disagreements, to be sure, but most of these disputes center on what a particular standard or principle may entail rather than on the existence or validity of the standard itself.

Some of the principles identified below have been articulated or codified in an explicit way by legislators; public bodies, such as commissions; ethicists; theologians; and others. In other cases, however, the committee has identified a latent understanding that provides a commonly accepted foundation for existing policy and practice or a constraint on the range of acceptable solutions for improving the present system. In this sense, the task of identifying “ethical, religious, and moral standards commonly found in the United States” is inescapably interpretive. However, in the committee’s judgment, the principles identified below represent a genuine consensus and provide a solid framework for evaluating the proposals that have been laid before the committee.

The committee uses these principles to distinguish, as its charge requires, “ethically acceptable” proposals from “ethically controversial” ones—and, indeed, from ethically unacceptable ones (i.e., those that would represent a clear and radical departure from the “ethical, religious, and moral standards commonly found in the United States”). The committee was also charged with further evaluating “ethically controversial” proposals by considering their possible impact on existing donation efforts (for instance, what impact would nonmonetary or monetary incentives have on altruistic donations?), on public perceptions of organ donation, on “disadvantaged or disproportionately affected groups” (including both ethnic minorities and socioeconomically disadvantaged groups), and on living donation. The committee was directed to consider and recommend any “particular alterations” that could reduce the “ethical problems” in controversial proposals. Finally, the committee is expected to evaluate different proposals in terms of their cost-effectiveness, feasibility, and practicality.


This section provides a brief sketch of the guiding perspectives and principles that the committee used in discharging its task. The report’s subsequent discussion of different proposals to increase the number of transplantable organs will further amplify the substantive and procedural principles summarized below (Box 3-1). Overall, the committee believes that any policies crafted to increase the rate of organ donation must be compatible with these perspectives and principles. What these principles imply and how much weight and strength they have will be clarified in the evaluation of specific proposals. For instance, it may be unclear at the outset, before the detailed analysis and assessment, what these propositions imply for a specific proposal about the use of incentives to motivate families

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