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UB PHI 237 - THE ETHICS OF ORGAN PROCUREMENT

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PHI 237 1st Edition Lecture 16 THE ETHICS OF ORGAN PROCUREMENTDistinguishing Distribution from Procurement Questions- distrubuiton is who gets an organ- procurement – supply doesn’t meet demand1. The ethics of organ procurement have to do with increasing the supply of organs in an ethicallypermissible way. We will consider the doctrine of presumed consent and offering financial incentives. 2. The ethics of organ distribution has to do with deciding who receives organ transplants. We will haveto consider issues of fairness, urgency and efficiency - and how to balance them- How long on waiting list- Doesn’t mean who will die first- Who is likely to get life saving organ- How well a person does with a organ2A. Interesting distribution issues involve whether prisoners (those not on death row in particular)should be given the same priority as the law abiding for organ transplants. You probably wouldn’t denythem other treatments. Is your different reaction here due to scarcity?- Forfeit freedom not healthcare2B. There are also interesting questions whether recovering alcoholics who need livers because of theirdrinking in the past, should be given the same priority as those who are not responsible for their organfailure. Perhaps the debate hinges on whether one thinks alcoholism is a disease or not.- Alcoholism  a disease2C. Should organs go to people who do not believe in donating organs (often for religious reasons)? Theywould be taking organs out of circulation although it is rare that there is a second transplant of an organ- People opposed to giving not getting12D. Should organs go to those whose need is more urgent but are not likely to make as effective use ofthe transplant? - 2A – 2C DO NOT JUDGE CHARACTER WHEN YOU TREAT THEMOrgan Shortage1. The supply of organs does not meet the demand. Thousands die each year on the waiting list for organtransplants. Only 15-20% of the brain dead, who are the biologically ideal donors, become actual donors.- Brain plays central role in regulating body  when brain goes you are dead- If you are brain dead the body can still be persrved-2. Few people have living wills that specify how to dispose of their organs, or carry a donor card orrequest notification of their driver’s license. So the next of kin is usually asked in the midst of their griefand distress to make a decision about the fate of their family member’s organs. 3. Sometimes they cannot be located in time to transplant a viable organ. And even when the patient hasagreed to be a donor, doctors might respect the family’s wishes not to donate to avoid a hassle with thefamily- Patient veto organ donor but wants to family can veto it after patients die3B. The American organ procurement system has a ‘double veto’ aspect to it. The source of thetransplant can veto (refuse to donate) and the family can veto donation even if the patient was willing. 3C. It has been claimed that the double veto violates patient autonomy but T. M. Wilkinson uses analogyof family vetoing request to marry their child to show the double veto be compatible with patientautonomy Strategies to Increase Organ Supplies1 A number of proposals have been put forth with an eye towards increasing organ supply. They rangefrom legally requiring requests of next of kin to be made to offering financial incentives to supply organs.- If you are dr. and patient died under you car  uncomfortable to take organ22 One problem thought to account for low organ supply was that requests of next of kin were often notmade. Doctors and nurses perhaps did not want to bother grieving families. 3. The bioethicst Arthur Caplan championed Required Request of Next of Kin laws. Many states havelegislated that the hospital staff must make a request for organ donation. The hope is that noopportunities will be missed. 4. But neither adherence to the required request laws nor the response to such requests has been whatwas hoped for.5. Different Mandated Choice/Required Response: This approach has everyone make a decision whetherthey will be a donor or not. For instance, each of them could be asked when they turn 18. - Or 216. Routine Salvage: This approach takes organs routinely unless an objection is known and has beendocumented. It does not presume that those not asked would have consented if they had been asked. - If boat sinks in international waters… whoever gets there first can get the treasure- Similar to opt in / opt out for organ donor  default U.S. need to opt in  Europe  need toopt – out-7. Financial Incentives: This need not be just selling organs to the highest bidder. It might involve keepingthe distribution system of vital organs intact, only trying to increase supply by set prices, paying forfuneral costs, estate tax breaks etc. We will come back to this in the last section of the lecture notes.8. Preferred Status: This gives organ donors (or their family members) higher status if they ever need anorgan transplant. - This should be known as fairer 9. Xenografts: This means interspecies donation. Even with the wonder drug cyclosporin A for fighting offimmune system attacks on foreign tissue, there hasn’t been much success with this attempt to increaseorgan supply. But perhaps there will be a scientific breakthrough.3- UNOS10. Another option is to change the criterion of death to the permanent loss of consciousness due to thedestruction of the upper brain. This would make those in permanent vegetative states potential organdonors and anencephalic babies would also serve as a supply of organs. 11. Use prisoners on death row for organ transplants. This has obvious moral problems. - some deaths are justified  for sake of orgnasPresumed Consent:1. This is the approach that assumes people have consented even though they haven’t been asked todonate. They are assumed to have given tacit consent by the fact that they have not explicitly opted out.So unless people declare their opposition to being donors, the hospitals will assume agreement.- Seen as default-2. Proponents (In favor) of presumed consent claim this system is in place in a number of Europeancountries. European systems are described as opting out in contrast to the opting in system of the UnitedState- If you didn’t say no assume implicit consent-3. Veatch and Pitt dispute this claim that so many of the European systems can be accurately


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