Organ Donation Opportunities for Action (2006) / Chapter Skim
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3 Perspectives and Principles
3 Perspectives and Principles
Pages 77-92
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From page 77... ...
(The terms "ethical" and "moral" are used interchangeably in this report.) To identify standards "commonly found in the United States," the committee has examined current practices, policies, laws, opinion surveys, and cultural and religious traditions as interpreted by the spokespeople for relevant organizations and other experts (e.g., philosophers, theologians, anthropologists, and sociologists)
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From page 78... ...
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.
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From page 79... ...
Common Stake in a Trustworthy System Everyone in the national community has a common stake in the creation and maintenance of an effective and trustworthy system for providing timely access to transplantable organs and, if organs are scarce, in increasing the number of organs recovered and distributing them fairly. The committee's charge focuses on increasing the number of individuals and families who donate organs.
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From page 80... ...
Less obviously, but also significantly, perceptions of unfairness in the system of allocation and distribution may have a negative impact on the rates of organ donation. In particular, people may be less willing to sign donor cards or to donate deceased family members' organs if they believe, for instance, that celebrities have an unfair advantage in obtaining organ transplants or believe that they themselves would have little chance to obtain needed transplants because of bias or a lack of health insurance.
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From page 81... ...
Lack of insurance coverage and inability to pay for a transplantation out of pocket effectively preclude many uninsured potential recipients from receiving extrarenal transplants. Although patients in the United States with end-stage heart failure must have health insurance or other financing to receive a heart transplant, a recent study found that 23 percent of organ donors are uninsured (King et al., 2005)
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From page 82... ...
It is difficult for many people to grasp that there is a single definition of death but that there are two ways to determine that death has occurred, that is, by the use of neurologic criteria and by the use of circulatory criteria (Chapter 5)
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From page 83... ...
Although the committee understands the moral logic of such proposals, it does not favor this approach. Abandoning the dead donor rule would constitute such a radical departure from the existing legal and ethical framework of organ transplantation that it would exacerbate public cynicism and distrust, no matter how carefully the clinical practices were monitored (DuBois, 1999; DuBois and Schmidt, 2003)
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From page 84... ...
The committee believes that these motivations are all morally acceptable and compatible and that a system of organ recovery and distribution may properly appeal to all of them.1 Confusion has marred much of the discussion of altruism in relation to donation of organs from deceased donors (deceased organ donation) , perhaps because of an assumption that a donation or gift system (under state versions of the Uniform Anatomical Gift Act)
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From page 85... ...
This proposition, if it were true, would preclude the use of any sort of incentive, or appeal to self-interest, such as giving people who have recorded their intention to donate preferred status as recipients. It also implies that organ procurement organizations should be ascertaining families' motivations for donation, a task that they do not currently undertake as long as financial compensation does not appear to be involved.
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From page 86... ...
Respect for Human Dignity The policies and practices related to organ donation and recovery must respect the dignity of each human being whose body is being used as a source of organs. The major concern here is that the deceased person not be regarded simply as a "thing" being used instrumentally for the benefit of others.
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From page 87... ...
Legal recognition of the living person's prerogatives in making binding decisions regarding organ donation after death is also well aligned with the widespread recognition of the binding force of advance directives in health care, under which a legally competent adult may prescribe end-of-life healthcare decisions in the event that he or she has permanently lost decisional capacity. As discussed in Chapter 4, the committee regards deceased organ donation to be an integral part of end-of-life care.
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From page 88... ...
Nonetheless, because many potential donors fail to express their wishes regarding donation, families are often the default decision makers about donation. Because families are often the best source of information regarding the values and wishes of a dying or a deceased person, their expressions of the deceased person's preferences should be respected when those preferences are otherwise unknown.
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From page 89... ...
For instance, some critics of opt-out policies contend that they would unfairly burden conscientious objectors or socially disadvantaged individuals by requiring them to take the initiative not to become organ donors. By contrast, some proponents of these policies argue that it is only fair for the majority to effectuate its will through such a policy.
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From page 90... ...
For other proposals, the first question to be asked is whether they would probably increase the number of transplantable organs over the long run as well as the short run. Estimating the effects of a new policy or program on the organ supply is a difficult challenge, because the outcome depends heavily on the ways in which the proposed change would affect the attitudes and perceptions of potential donors and their families.
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From page 91... ...
1987. Some moral connections between organ procurement and organ distribu tion.
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From page 92... ...
1996. Organ donors and nondonors: An American dilemma.
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