ethics of organ donation - past, present and future
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Organ donation, Past, Present and FutureBobbie FarsidesProfessor of Clinical and Biomedical EthicsBrighton and Sussex Medical School
Declaration of Interests
Member of the Department of Health Taskforce on Organ Donation and and Specialist Advisor to House of Lords European Affairs Sub-committee currently investigating organ donation issues
Views expressed today are my own unless otherwise stated
The significance of transplantation
The ancient dream of successful organ transplantation was finally realised 50 years ago, on December 23, 1954, at the Peter Brent Brigham Hospital in Boston. Over the subsequent half century, the separate disciplines of clinical transplantation and transplant immunology have made remarkable progress. The story of the convergent evolution of these two fields represents one of modern medicine’s most important advances.
Doyle, Lechler and Turka Journal of the American Society of Nephrology 15
Pp 2965-2971, 2004
Why buy into organ donation?
Life saving
Life enhancing
Cost effective
Emotively powerful
Ethical interest in organ donation
Early focus on the recipient
Involvement in research -
Refusal of treatment – ordinary extraordinary means distinction
Allocation of scarce resources
Shift of emphasis to the donor Altruism – influence of Richard
Titmuss’s The Gift Relationship (1970)
Criteria of death - brain stem death
Advance statements
Consent
Cultural issues
Definitions and rituals around death
Evolving models of communication
Communitarianism versus individualism
Body part scandals
A philosophical battleground?
Consequentialists versus Deontologists
The meaning of best interests
Current issues
What do we do in the face of scarcity – a resource allocation issue?
Opting inMandated choiceRequired requestOpting outLive donationUnrelated live donationMarketSurvival lottery
How do we distribute the available benefits?
Efficiency
Fairness
Blame and responsibility
Reciprocity
What can we do?
This is a practical and empirical question which formed a large part of the work of the Taskforce
What ought we to do?
Requires a wider debate
What are we entitled to do in order to increase and fairly distribute the benefits associated with organ donation?
What can we require of others in order to secure these benefits?
The others
Potential donors
Families
Health Care professionals
Communities
Future
Round full circle to the age of pioneers and new frontiers
Major challenge for health care professionals and citizens
The age of looking forward and hopefully working together
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