Organ Transplants
Organ Transplants (Length 4:20)
When I first started in bioethics about 20 years ago, the numbers of people on the waiting list were 15,000. It’s grown now to where we’ve crossed the 100,000 people–on–the–waiting–list threshold. So, basically, an additional 5,000 people get added to the waiting list each year.
Currently, it’s clear that our current system isn’t working. Our current system is relying on organ–donation cards and driver’s license designations, and it’s simply not working. So some of the options that people have discussed in this country, as well as other countries, is a move toward what’s called the "presumed consent" approach. Right now, we rely on explicit consent from either a donor or the donor’s proxies, and people have to opt in to the system. But in presumed consent, the state basically presumes that you are going to consent to be a donor. There’s a presumption that you will be a donor unless you opt out, so it places a burden of proof on an individual to go to a donor registry and say, "I don’t want to be a donor." Most of the European countries––on the continent, anyway––have a system like that.
That’s one approach that might be a hard sell, politically, in the United States, given our individualistic traditions. So people looking at the individualism of the United States say, "Well, look, the market is the solution for everything, why not have a regulated organ market that could be overseen and doesn’t have to be really nefarious. But you can have a regulated organ market just like we regulate the buying and selling of all sorts of commodities. We’d treat organs as commodities. We’d respect individuals’ liberty. Obviously, they couldn’t remove an organ that would bring about their own death, but they could sell a kidney before their death, perhaps sell some liver lobes and the like. And, again, that would alleviate some of the shortage. Now, people have talked about that has having more––and I think there are some real ethical problems with that––but in terms of political legs, it has more political legs right now in the United States.
There’s a sort of intermediate approach which doesn’t go quite as far as a regulated organ market, and that’s what’s called "rewarded gifting," where you give just small financial incentives to donors or donors’ families. You might give them a tax credit; you might move a family member who’s on a waiting list up the waiting list queue a little bit. You might pay for their funeral expenses or burial expenses or whatever it happens to be. A couple of states, such as Pennsylvania and New Jersey, have started to move in that direction.
There is one other method that, again, people have talked about more on the philosophical than the political level, but that is to change the definition of death. In 1968 when organ transplantation first started moving ahead, the United States did change its definition of death from a cardiopulmonary definition of death to a whole–brain definition of death. And now people say, "Let’s move it to a neocortical or higher–brain definition of death," and that would allow us to retrieve more organs from people that are in comatose conditions and so forth.
So those are kind of the options, and none of them are ethically without problems. Some of them are more politically feasible in the United States. But it is, I think, a very important question given that––as people point out––we have more people die waiting for an organ than we’ve had people die in the war in Iraq over seven years now.