Should conscription of organs after death be mandatory?

transplant organ donation donors death medecine
Numéro 1

Learn the ropes

What is organ donation?
Organ donation is the medical practice of removing an organ or tissue from a person. Donation can be done post mortem, after a person has died, or by a living donor. Organ donation is the step before transplantation or grafting, which involves replacing the patient’s missing organ. 

Organ donation is to be distinguished from the donation of the body to science. Organ donation is the voluntary offering of one’s body for research and teaching purposes after death, in which case the organs will not be used for transplantation.

Source: Merriam-Webster

Which organs can be transplanted?
A large number of organs can be harvested post mortem. The most common organ is the heart, and to a lesser extent the lungs, pancreas and corneas are removed.

Living organ donation mainly involves the kidney, which is the organ most often transplanted. Liver transplantation is also possible, but less common.

Source: Merriam-Webster

Why are we talking about it today?
According to data of the U.S. government, 113,000 people were waiting for an organ transplant in the U.S. in July 2019. In average, 20 people die each day waiting for a transplant.

Currently, two main streams of public policies regulate post mortem organ donations: the opt-in and the opt-out systems. In the opt-in system, a donor has to sign in to a donor register, while in an opt-out system, only people who do not want to donate their organs must communicate their will, because their consent is presumed.

The opt-out systems are implemented in Spain, Chile, Colombia, France and Belgium (among others). But the question of presumed consent or mandatory organ conscription raise important bioethical questions.

Source: Health Ressources & Services Administration

Numéro 2

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The idea behind the Rift is simple: for each topic of debate, we provide you with an expertise based on a pro-con approach, written by competent and legitimate experts. We want to help you make your own opinion, and guide you on first steps to civic engagement.
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FOR

Taking Routine Salvage Seriously

adam kolber neuroethics ethics organ conscription donors medecine study

Adam Kolber

Professor of Law, Brooklyn Law School

papers.ssrn.com

Suppose an out-of-control train is about to crash into four unsuspecting people in its path. You can slow the train down enough to save the four by pushing a dead body into the train’s path. Should you? I think you are not only permitted but required to use the body to stop the train. Surely it is more important to save four living people than keep one corpse from being crushed. This is so even if the family members of the deceased beg you not to and tell you that the deceased had a religious preference that his corpse remain intact. After all, there are an average of four times the number of family members who would be begging you to push the body to save their loved ones (not to mention the pleas the four people themselves would make if they knew the train was coming).

Donation is only permitted once a person has been declared dead

It is, therefore, curious that countries like the United States generally require family members of deceased potential organ donors to consent to transplantation. Given the severe organ shortage, when a person dies with organs available for transplantation, those organs can save several lives (such as those on the train tracks). And donation is only permitted once a person has been declared dead (like the corpse that can stop the train). Unlike the splattered corpse, however, the bodies of organs donors appear normal and can have open-casket funerals. The case for mandatory organ donation is strong because even if we have autonomy interests in our remains, they do not outweigh the interests that multiple people have in continuing to live. 

Autonomy interests do not outweigh the interests that multiple people have in continuing to live

Does this mean governments should switch to a policy of mandatory organ retrieval? Perhaps. We can imagine a still better solution, however, in which all organs are donated voluntarily. Then we could save lives without interfering with autonomy. We might have to incentivize those donations with money or priority to receive an organ in exchange for a commitment to donate upon death. It’s not clear, however, whether such programs could induce enough donations to rival the routine salvage of all useable organs. So while a program of mandatory organ retrieval may at first seem repulsive to our moral sensibilities, it may compare favorably to altruistic approaches when such approaches lead to many unnecessary deaths.

AGAINST

Conscripting organs would violate our rights

Martin Wilkinson professor of politics auckland new zealand conscription of organs donating organs

Martin Wilkinson

Professor of Politics, University of Auckland, New Zealand

www.arts.auckland.ac.nz

Conscripting organs from dead bodies means taking them even when the people whose bodies they were strenuously objected while they were alive. As practical politics, conscription looks as if it hasn’t a chance. I don’t know any jurisdiction where it has been genuinely considered. All the ones I know of allow people to veto the retrieval of their own organs and most allow families a veto as well. Still, one can see the principle behind conscription. Dead people do not need their organs any more and nowhere has enough organs for transplanting into people who must instead die or lead miserable lives. Don’t the needs of the living outweigh the wishes of the dead? It is a powerful question but, even so, I think conscription would be wrong.

People have rights over their bodies

Treating the seriously ill is of great value but it is not a goal that should override all others. Sometimes it is not worth giving up education, public beauty, or even the pleasures of consumption for the sake of better health. That is how as individuals we can sensibly go on driving holidays that raise our mortality risk, or as a society we can subsidise art with money that could have gone on life-extending health care. If we are willing to give up some life-extending even for the sake of pleasure alone, still more should we for the sake of respecting rights of bodily control.

It would be wrong forcibly to take the spare kidney from those with two to give to those with none

People have rights over their bodies and adults at least should be the ones to decide whether their bodies will be used for the benefit of others. If they say `no’, then no. They have the right to decide even when their needs are lesser ones. Obviously living people have this right. Most people have two working kidneys and can get by with one while other people have no working kidneys; but it would be wrong forcibly to take the spare kidney from those with two to give to those with none. I say the same is true of taking organs from us after we die. These are our bodies and we have the right to veto the use of them after our deaths as well as during our lives.

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