is of whether organ transplant is really an ethical procedure at all in the larger societal sense. If it were individuals' money alone paying for it, one could say that it's strictly a matter of individuals' choice of how to spend their resources on behalf of themselves or their children; but as it really stands, the expenses of organ recipients are borne by everyone in the form of higher costs and higher insurance premiums.

I'm not saying that I'm against organ transplant per se. But I am saying that it is generally assumed to be an ethical slam-dunk, without real attention paid to the intellectual underpinning of that concept. If transplanting an organ costs $200,000 (which is a naively low number if you're talking about long-term costs), what justifies that expenditure when there are millions who do not get basic care due to lack of insurance? What if the transplant is as a treatment for an incurable disease, and that transplant can also be expected to fail within a few years (e.g. lung transplants in cystic fibrosis patients)? I don't say this to be cynical or cruel, just to point out that the most basic question of organ transplantation's ethical justification isn't nearly as obvious as this article and most lay people assume.

Full disclosure: as a pediatric oncologist, my wife's job intimately involves transplantation of bone marrow for several different diseases and disorders. Like I said, I'm not looking to bite off the hand that helps feed me, just pointing out that some of the questions on this issue don't get asked nearly often enough.

I agree with Sawbones' points -- there are many unpleasant sides in the organ-donation debate, including the one highlighted in this article regarding the definition of death. As Sawbones noted, another is the question of utility for the proposed donation -- who should be eligible for a transplant? Should priority be given to younger patients who, at least in expectation, have a longer life ahead of them? Granted, I don't know much about the technicalities of the transplant waiting-list, but I don't think that older patients routinely get bumped in favor of the younger and more virile. My experience as a resident of PA suggests something entirely different -- our then governor, Bob Casey, got bumped to the top of the list for a transplant (I don't remember exactly what he received), igniting a huge debate within the state (and probably without) about his fitness to receive. For one, it was seen as a move governed more by politics than by medicine, but I also remember seeing people on tv complaining because they had relatives on the waiting list who were younger, and they felt, therefore, more deserving than Casey, who at that point was no spring chicken.

Personally, I'm not an organ donor because I don't want any aspect of my care to be governed by the looming decision to harvest my organs. I know hospitals are supposed to separate care and transplant teams, but does anyone really think that the doctors treating patients are not acutely aware of the implications of the death of their donation-ready patients? I'm sure many will think I'm being paranoid and conspiracy driven, but then I read an article like this, and I wonder how far doctors would be willing to push the definitions to get more organs. For me, I don't want to be on the losing side of that equation.

cardinalash:

Personally, I'm not an organ donor because I don't want any aspect of my care to be governed by the looming decision to harvest my organs. I know hospitals are supposed to separate care and transplant teams, but does anyone really think that the doctors treating patients are not acutely aware of the implications of the death of their donation-ready patients? I'm sure many will think I'm being paranoid and conspiracy driven, but then I read an article like this, and I wonder how far doctors would be willing to push the definitions to get more organs. For me, I don't want to be on the losing side of that equation.

If you needed an organ, would you accept one? Do you think you are as entitled to one as somebody who has been an organ donor his/her whole life?

My mother was the recepient of a kidney transplant because someone on their driver's license was registered as a donor. If it wasn't for that person my mother would have still have to go to dialysis 3 times a week for 2-3 hours each time. As a child I saw how having kidney failure can effect your quality of life. She did not drink, smoke, or do drugs. We do not why her kidneys failed. She had her transplant more than 10 years ago and is still happy and healthy. She works as a nurse in a post/pre op surgery unit for heart patients.

As far as I know the transplant waiting list is done by how well your blood type, and a number of how other factors match up. If anything ever happened to me and everything was done to keep me alive. I would gladly donate my organs to someone else. You could be giving not just one person, but also a family a way to have a better life.

KB01:

cardinalash:

Personally, I'm not an organ donor because I don't want any aspect of my care to be governed by the looming decision to harvest my organs. I know hospitals are supposed to separate care and transplant teams, but does anyone really think that the doctors treating patients are not acutely aware of the implications of the death of their donation-ready patients? I'm sure many will think I'm being paranoid and conspiracy driven, but then I read an article like this, and I wonder how far doctors would be willing to push the definitions to get more organs. For me, I don't want to be on the losing side of that equation.

If you needed an organ, would you accept one? Do you think you are as entitled to one as somebody who has been an organ donor his/her whole life?

I don't want to get into a huge fight here, but, honestly, I think that the whole "organ donors are more deserving than non-donors" issue is a canard. Being on an organ-donor list suggests a future preference along the lines of "Should I, in the future, become unable to continue using my organs, I wish that these organs should go to another." Certainly an admirable position, but one that (theoretically) only takes effects once the donor is deceased. Thus, if said person ever needed a transplant, one would assume they would be alive, and thus they would not yet have given anything but a future promise in return for their transplant. Call me cynical, but there would still be room for declining to donate in the future as the decision would not yet have been fully enacted. What real measures are there to prevent people from signing up to become organ donors in order to receive preferential placement on a transplant list then failing to donate their organs later? Would doctors take back the received organs if the patient reneged on his commitment?

As a second point, are most people in need of organ donation themselves good candidates to be future donors? I'm not a doctor, nor do I pretend to be some sort of amateur expert, but it doesn't seem to me that there would be much overlap in the donor/recipient pool, particularly for the major organs that are most desperately needed to prevent others from losing their lives. It seems to me that the sorts of catastrophic diseases that wreak havoc on one's body, thus generating the need for a transplant, would likely damage the other organs to a degree that they would be unfit for transplant. Again, I don't know for sure, but this certainly seems likely, and it's not something I've seen addressed on these boards by people calling for preferences based on willingness to donate.

It's a noble thought to attempt to create a system that rewards potential donors in some fashion, though I would note that any form of other material compensation is still verboten (why in-kind transfers are permitted but other material rewards are not boggles the mind). Nevertheless, I don't think that the notion that donors are more deserving stands up to rigorous debate.

As for me personally, I don't know what I would do if ever faced with the situation of needing a transplant, but I don't see how making a costless commitment to donate after death entitles someone to a greater preference. Again, this idea that organ donors are a privileged class belies the entire premise behind organ donation, which is that you don't need the organs that you are giving up and thus cannot be incentivized by relying on their value. When you need a transplant, you would not part with your organs; when you are ready to be donor, you will never need a transplant.

And, to forestall some of the firestorm this may generate, I realize that I'm intentionally ignoring the issue of people donating kidneys, lobes of livers, bone marrow, and the like that can be taken from healthy individuals without sacrificing the donors' lives. These, in my view, are an entirely different kind of donation scheme, and finding a partner who will swap a kidney with you in the future does seem like a possible solution, though I would want to find someone who was willing to explicitly enter a contract with me rather than putting up my own kidney in the hopes that someone in a pool of willing donors might (or might not) be a match.

This basically ignores all of the points made in the previous post. The questions about utility, about selection of recipients, etc., do not go away just because your story had a happy ending. I am glad for you and for your mother, but it does not change the fact that there are ethical questions that these kinds of happy stories are all too commonly used to gloss over.

Sawbones:

This basically ignores all of the points made in the previous post. The questions about utility, about selection of recipients, etc., do not go away just because your story had a happy ending. I am glad for you and for your mother, but it does not change the fact that there are ethical questions that these kinds of happy stories are all too commonly used to gloss over.

When you mentioned about insurance it would seem that treatment for chronic diseases would outweigh the cure. Dialysis is 2-3 times a week along with medications everyday. After a kidney transplant (if successful) the number of medications goes down from when you were receiving dialysis. I would guess to say this puts lets of a burden insurance providers.