Israel has come up with a new answer. In Israel, many orthodox Jews will accept an organ but have religious objections to donating one. It has one of the lowest organ donation rates. So there is a move to change this: sign a donor card, and you and your family move up in line for a transplant if one is needed.
Art Caplan described this as “reciprocal altruism”, a euphemism for preventing free-riding. Free-riding goes on all the time in organ transplantation. There is a vast shortage of organs yet many people in Western societies are prepared to accept one without committing to giving one.
In an article written with Dominic Wilkinson which will appear soon in Bioethics, we argue that people who will have treatment withdrawn and die could opt, previously while competent, to elect to have their organs removed before they become unusable by what we call “organ-donation euthanasia”.
A more extreme, though equally rational, suggestion would be to restrict organ transplantation to those who commit to donating organs (with the exception of children and other incompetents). If such a proposal were widely distributed and publicised, it would be fair.
The alternative would be to remove everyone’s organs after their death, unless they had rejected this explicitly. Such proposals have been accepted in Spain, France, Belgium, Austria – so called presumed consent or opt-out. Such a proposal still allows free-riders. The fair version of such a proposal would be not to allow those who opt-out for whatever reason, including religious reasons, to receive transplants, unless there no altruists who are suitable for that organ.
We should stop being soft on organs and take a hard line on free-riders. For too long they have enjoyed the benefits of organ transplantation without being prepared to contribute.
Lifesharers is a voluntary organisation which distributes organs amongst its members, who agree to donate, and distributes organs to those outside only if there are no compatible recipients amongst its members. It is a model of rational fairness.
No willingness to contribute an organ? You should be treated as a lowest priority recipient.