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Organ Transplantation

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’.Read More »Uterine transplants: applaud, and then shut up

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?

Read More »Is your mobile phone part of your body?

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.
Read More »Kidneys and the Ultimatum Game

Organs and obligations

Simon Rippon has recently argued here that markets in organs lead to harms, harms which may be outweighed by benefits, but which must nevertheless be taken into account in deciding whether such markets should be legal. He has argued that there are harms to specific third parties and harms to society at large. I’m not persuaded by his arguments that these harms arise. 

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The Cost of Non-Cash Incentives for Organs

The Times newspaper featured an editorial proposing changes in the organ procurement system last week by Sally Satel, a scholar from the American Enterprise Institute, a conservative think tank. I thought the first few lines were especially revealing about Satel’s attitude to market transactions – she reports that she desperately needed a kidney herself, but dreaded “the constricting obligation that would surely come with accepting” an altruistic donation. She therefore “wished [she] could buy a kidney just to avert the emotional debt.”

Read More »The Cost of Non-Cash Incentives for Organs

Organ Donation Euthanasia

by Dominic Wilkinson and Julian Savulescu

There are 8000 patients on transplant waiting lists in the UK. Every year 400 patients die while waiting for an organ to come available.
We are all far more likely to be in need of an organ transplant than to be a donor. Most of us expect that if we needed a transplant that someone would donate one. On the basis of the ethical golden rule – do unto others as you would want them to do for you, we should all think seriously about whether and how we could donate our organs if we no longer need them.

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For Sale: Body Parts?

The Nuffield Council on Bioethics has recently published a consultation paper entitled Give and Take? Human Bodies in Medicine and Research: https://consultation.nuffieldbioethics.org/fileLibrary/pdf/Human_bodies_in_medicine_and_research_consultation_paper.pdf The paper seeks responses from individuals or groups on a wide range of issues relating to the use of human bodies or body parts in medical treatment and research. Section 6 is on… Read More »For Sale: Body Parts?

The real scandals in organ donation consent

Headlines in a number of newspapers in the last day or two have claimed scandalous failures in organ donation consent in the UK. According to ‘Sky News’, organs were “taken without consent”, while the Sun claims that “NHS doctors took the wrong organs from the bodies of donors”. But it is important to put these claims in context. There are some bigger and more serious scandals when it comes to organ donation consent.

Read More »The real scandals in organ donation consent