In concluding these reflections on organ and tissue transplantation, I hope to be able to provide some guidance to the ethical deliberations of potential organ and tissue donors and recipients as well as policy makers and clinicians:
All of us are potential donors. That is to say, we all have the ability to choose whether or not we will allow our organs and tissue to be transplanted into another person’s body after we die. Some of us will also be confronted with the possibility of donating an organ or other non-regenerative tissue while we are still living.
Deciding to be an organ and tissue donor can be a generous and praiseworthy thing to do. However, it is important to recognize that the decision is not simple. In the case of donation after death, it is not simply a question of choosing whether or not you will permit another person to benefit from having your organs after you die. A potential donor must consider what the process of transplantation would entail for herself and for her family and friends. It is possible, given current standards of clinical practice, that vital organs could be removed before the donor is dead. It is likely that the donor’s family would have to say their last goodbyes with the heart of their loved one still beating. Funeral plans would be complicated and likely delayed.
These considerations need not prevent one from choosing to donate organs and tissue after death. As noted in Part II of this series, Joseph Ratzinger, before he became Pope Benedict XVI, was a card-carrying organ donor. Still, the decision to donate must be an informed decision if it is to be a good decision. The potentially negative effects of that decision must be weighed against the potentially positive ones.
All of us are also potential recipients of organ or tissue transplants. However, some have more potential than others. Many people are in immediate need of transplanted organs and are on waiting lists or are otherwise actively seeking potential donors. For those who do receive transplants, it is important that they receive them with gratitude. This may seem obvious and it will come naturally to many transplant recipients. Still, there is a danger of forgetting that a transplanted organ is a gift from another person of a part of his or her own body.
The identity of the donor will often be unknown to the recipient. However, when a potential recipient does know the potential living donor (a close relative, for example), the risks incurred by the donor should be of concern to the recipient. Potential recipients should only accept the donated organ if the risk to the donor is reasonably proportioned to the benefits expected by the recipient. Potential recipients should also take care that the donor is not under undue pressure so that the transplant will truly be an act of giving and not a case of exploitation.
In a democracy like the United States, every citizen is a policy maker. We have a political voice when it comes to governmental regulation of matters relating to organ and tissue transplantation. When talking about public policy and governmental regulation, it is good to remember that not everything that is unethical should be made illegal. There is a limit to how much government should intervene in the decisions people make.
Nevertheless, government certainly does have a duty to protect the lives of the innocent. This duty is carried out when a country like the United States requires that vital organs may only be removed from dead donors and that death must be determined from the irreversible cessation of either respiration and blood circulation or complete brain activity. How clinical practice should be regulated in order to enforce such legislation remains an open question. Government also protects the lives of the innocent when it prevents human embryos from being destroyed for the purpose of extracting stem cells for research.
Governments are also responsible for the just management of their own programs. When, for example, governments invite their citizens to consent to be organ donors, they should also provide complete and accessible information about what organ donation involves. In addition, governments should protect the conscience rights of clinicians involved in transplantation.
Clinicians who administer the transplantation of organs and tissue should be guided by many of the considerations that have already been articulated. They have the moral duty to diagnose the deaths of potential donors by accurate and thorough testing. Moreover, when clinicians diagnose the death of a patient who looks to be alive (breathing, heart beating), the diagnosis of death should be explained to the family in a way that is both convincing and compassionate.