Organ Transplantation

Artificial organs: “good guys” finish last to technology

It is hardly a keen insight to note that there are a lot of problems in the world today, and that there are also lots of suggested solutions. Often these can be classified under three different labels:

  • “Good guy” solutions which rely on changing individual people’s attitudes and behaviours.
  • Institutional solutions which rely on designing good institutions to address the problem.
  • Technological solutions which count on technology to resolve the problem.

In this view, it is tremendously good news that scientists are getting closer to producing artificial organs. If this goal is achieved, it will be a technological solution to the problem of transplant organ shortages – and technological solutions tend to be better than institutional solutions, which are generally much better than “good guy” solutions. The “good guy” solution to organ donation was to count on people to volunteer to donate when they died. Better institutions (such as an opt-out system where you have to make a special effort not to be a donor, rather than a special effort to be a donor) have resulted in much improved donation rates. But cheap artificial organs would really be the ultimate solution.

Of course I don’t denigrate the use of getting people on your side, nor the motivations of those who sincerely want to change things. But changes to people’s attitudes only tend to stick around as long term solutions if this is translated into actual institutional or technological changes.

Take slavery, for instance. Continue reading

Obligatory Ventilation: why Elective Ventilation should not be elective

On the BBC’s Moral Maze this evening, the question of elective ventilation was discussed at some length. (For those who missed it, the program is still available here). There were several striking features of that discussion, but one argument that stood out was the argument against elective ventilation based on the importance of respecting the autonomy of patients, and the absence of consent, This has been the basis of previous ethical concerns about Elective Ventilation.

But actually, it seems to me that the consent/autonomy argument is completely upside down.* Patient autonomy provides one of the strongest arguments in favour of elective ventilation. So strong, in fact, that the proposed form of Elective Ventilation should arguably not be ‘elective’. It is morally obligatory that we embrace Elective Ventilation. Continue reading

Back from the grave: Should we allow Elective Ventilation?

Mary is 62 years old. She is brought to hospital after she collapsed suddenly at home. Her neighbour found her unconscious, and called the ambulance. When they arrived she was deeply unconscious and at risk of choking on her own secretions. They put a breathing tube in her airway, and transported her urgently to hospital.

When Mary arrives she is found to have suffered a massive stroke. A brain scan shows very severe bleeding inside her brain. In fact the picture on the scan and her clinical state is described by the x-ray specialist as ‘devastating’. She is not clinically brain dead, but there is no hope. The emergency department doctors have contacted the neurosurgical team, but they have decided not to proceed with surgery as her chance of recovery is so poor.

In Mary’s situation, the usual course of events is to contact family members urgently, to explain to them that there is nothing more that can be done, and to remove her breathing tube in the emergency department. She would be likely to die within minutes or hours. She would not be admitted to the intensive care unit – if called, the ICU team would be likely to say that she is not a “candidate” for intensive care. However, new guidance from the National Institute of Clinical Effectiveness, released late last year, and endorsed in a new British Medical Association working paper, has proposed a radical change to this usual course of events. Continue reading

Nothing to lose? Killing is disabling

In a provocative article forthcoming in the Journal of Medical Ethics (one of a new series of feature articles in the journal) philosophers Walter Sinnott Armstrong and Franklin Miller ask ‘what makes killing wrong?’ Their simple and intuitively appealing answer is that killing is wrong because it strips an individual of all of their abilities – acting, moving, communicating, thinking and feeling.

So what, you might ask? If this is right, say Sinnott-Armstrong and Miller, it means that it would be just as bad to commit an act that caused someone to be in a permanent vegetative state, as it would to kill them. Continue reading

Settling the Final Reckoning for Organ Donors

In the news this week, the Nuffield Council on Bioethics suggests that the NHS should test the idea of paying for the funerals of organ donors who have previously signed the organ donor register, in order to try to encourage more of the public to sign up. When I was asked to write about this proposal for the BBC’s web site, I found with surprise that I could think of no plausible ethical objections to it. This despite the fact that I’ve previously written here and elsewhere about the dangers of introducing a cash market for donor organs, and even about the dangers of other kinds of non-cash incentives. If the council’s proposal were found in trials to be both practically effective in increasing donations, and also affordable, then my clear view is  that it should be implemented in the UK.

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Uterine transplants: applaud, and then shut up

By Charles Foster

It was reported this week that 56 year old Eva Ottosson is planning to give her 25 year old daughter, Sara, the uterus in which Sara herself gestated. Sara suffers from Mayer Rokitanksy Kustner Hauser Syndrome: she was born without a uterus.

Predictably the newspapers loved it. And, equally predictably, clever people from the world’s great universities queued up to be eloquently wise about the ethics of the proposal.

But if ethics are concerned with what we should do, there was really nothing worthwhile to be said about Eva Ottosson’s altruism (bar the usual uninteresting caveats about dangerousness and resource allocation), except: ‘Fantastic’. Continue reading

Hypothetically donated organs

Every day three people die in the UK while waiting in the transplant queue. In the face of the urgency to increase the organs available, some propose introducing economic incentives. A more moderate solution consists in choosing a public policy with an appropriate default option, that is, a condition that is imposed on individuals when they fail to make a decision. A default option influences policy-outcomes in two ways: a) it can have a direct impact on people’s choices because they might interpret it as the option recommended by society; b) the effort involved in making a decision as opposed to accepting one –e.g. filling a form, having to think about one’s death, etc.- nudges people towards the default option.

Regarding organ transplantation, legal systems are divided between opt-out systems in which everybody is an organ donor unless she has registered not to be, and the so called opt-in systems that consider that nobody is an organ donor unless they have registered to be one. Countries with an opt-out system like Austria, Belgium or Spain tend to have higher organ donation rates. This fact is often used as a strong argument in favour of taking consent as the default option. Unlike the countries mentioned, UK has an opt-in policy. However, the Welsh are trying to pass a piece of legislation that would allow them to establish an opt-out system. Their initiative reopens the debate about the pros and cons of the two systems. Those who oppose introducing an opt-out system in the UK make the following claims:

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Trading Organs for Freedom

In Mississippi, sisters Jamie and Gladys Scott are to be let out of prison on the condition that Gladys donates a kidney to Jamie. (See also an article in the Guardian) They are both serving life sentences for being accessories to armed robbery, and would otherwise not be eligible for parole until 2014. Jamie Scott is severely ill with diabetes and high blood pressure, and requires frequent dialysis. She has been given parole on medical grounds, while Gladys has been granted parole on the condition that she give one of her kidneys to Jamie within a year. Receiving payment in exchange for organs is illegal in the US. But is there a relevant moral difference between trading one of your kidneys for money, and trading it for your freedom?

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Is your mobile phone part of your body?

by Rebecca Roache

The Frontline reports that sensors carried on the body of mobile phone users could soon be used to boost the UK’s mobile phone network coverage.  If only half of the 91% of the UK population who owns a mobile phone carried such sensors, then nearly half of the UK population would become part of a ‘body-to-body’ mobile phone network.

When technology becomes as wearable and ubiquitous as this, it raises some interesting questions about what sort of things people are, and about the division between the body and the surrounding environment.  What, after all, is a body?  At first glance, a person’s body is that mass of flesh, blood, and bone that we point to when we point to him or her: all very simple and straightforward.  Things get more complicated when we consider someone who has received an organ transplant.  Does a transplanted organ become part of the body of the person who receives it?  I would say so.  Assuming that the transplant is successful, it functions just like the organ it replaces; and an injury to the transplanted organ would be considered an injury to the recipient.  What about artificial devices that replace or supplement organs, like cochlear implants: do these count as body parts too?  I would imagine that most of us would be less willing to view such things as body parts.  However, if transplanted organs are to count as parts of the recipients’ bodies, refusal to accept cochlear implants as body parts seems mere prejudice.  Both enable the recipient’s body to perform a familiar and normal bodily function; and whilst a transplanted organ is – unlike a cochlear implant – undeniably a body part, it is pre-transplant no more a part of the recipient’s body than a cochlear implant.  So, perhaps we should consider cochlear implants to be body parts too.  If we accept something like a cochlear implant as a body part, though, what else might we feel bound to include?  What about less permanent replacement body parts, like false teeth and prosthetic limbs?  Tools that are not intended to replace body parts, but which nevertheless enable certain people to perform something like a familiar and normal bodily function, like wheelchairs?  Tools that enable people to perform functions that are not familiar and normal bodily functions, like pencils and screwdrivers?  Where do we draw the line between the body and the surrounding environment?

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Kidneys and the Ultimatum Game

Frequently in life there is some good available if you and I can agree on some split of that good between us. If we cannot agree the good never comes into existence. This fact can be modelled by what is called the ultimatum game. In the ultimatum game somebody offers us £100 to split between us just in case we agree on the split. The rule is that I propose and you dispose. If you accept we get the money split as agreed and if you reject it we both get nothing. Since you are better off whatever positive offer I make, it looks as if it is rational to accept even as little as £1.
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