Branded Organs

Christmas is, of course, the season for gift-giving, but I've not seen a lot of coverage recently regarding organ donation as the gift of life. One story that has been in the news is that of a surgeon who carved his initials on a patient's liver. The BBC provides an ethical analysis here.

Heart Transplant Survival Record

A British heart transplant patient has entered the record books, surviving 31 years (and counting) since receiving a heart transplant in 1982. A clear demonstration of the potential benefits that a transplant can bring.

Moorlock on Queue-Jumping

An interesting (short and for-public) piece by Greg Moorlock here on the merits and problems of an Israeli-style priority for donors scheme here. It also connects back to our previous discussion of families, noting that the family veto will almost certainly have to be abolished if priority schemes are to work. Very relevant for what we've recently been discussing and highly recommended.

Benefits of Live Donation

A heart-warming story about an 'altruistic' (or live) kidney donor receiving a letter of thanks from the family she helped here. It's good to see donation get regular good press, rather than only being covered when there are scandals.

For the record, the scare quotes round 'altruistic' in the first sentence are not intended to question Ms Pretty's obvious altruism; rather, I find it odd that live donors who donate to strangers (rather than relatives) are referred to as 'altruistic donors', given the commonplace belief that all donations should be altruistic - a reasoning which is often appealed to in order to resist incentives for donors.

If you're interested in this issue, there's a nice piece by Greg Moorlock discussing the altruism requirement in the Journal of Medical Ethics (open access). The next meeting of the RSE project, on Saturday 14th September, will focus on incentives and inducements, so look out for further posts on that theme.

Record Transplants in UK

A record number of organ transplants took place in 2012, the BBC reports. The increase of 6% on the previous year is largely attributed to an increase in the number of registered donors, which suggests that the limiting factor on transplants was indeed donations, rather than space in operating theatres. Of course, a dramatic increase in the number of donors may see some other factor, such as space in operating theatres, become the new limiting factor. But, for now, it seems that our focus should be on increasing decisions to donate, whether from individuals or their families.

'Dad has gone from Sick to Superman'

Organ donation doesn't simply save lives, in the sense of keeping people (barely) alive, but it allows them to lead much fuller, more normal lives, as this inspiring story of a father swimming from Alcatraz to shore to celebrate five years since his double lung transplant shows. It's a great example of how much of a difference a transplant can make to the recipient's quality of life, but also comes with important reminders about the limits of what transplants can achieve "The current average survival period of a lung recipient in the US and Europe is five years. Statistics say that the current 10-year survival rate of a lung transplant patient is 30%, meaning that only one out of every three patients will celebrate their 10th anniversary". Still, even five more years of healthy life is a considerable achievement, and especially valuable for someone like Gavin Maitland with young children.

Holby City Controversy

I don't watch Holby City, but it seems that a current story about organ donation has generated some bad publicity, after breaching several guidelines, including a donation proceeding after the withdrawal of consent. According to this BBC article, "This is an ongoing story and in the weeks to come viewers will see the main character Mo face up to the fallout of her actions".

Given that relatives of donors often report some comfort (from knowing good came out of their personal tragedy), while those who refuse consent often report regret, I hope viewers see some of this in the later storyline.

Organ Donation Debated on Ciao!

The opt-in/opt-out issue has been selected as 'current debate' (for the latter half of July, so now over) on consumer review/opinion site Ciao. See the entries here. I'm pleased to see that most appear to be in favour - though on closer inspection some are only really in favour of organ donation and are sceptical of opt-out.

The Role of the Family

Just 3-4 weeks ago we (that is, members of my RSE project on organ donation) were discussing the role of the family in decisions over donation - for instance whether next of kind should be able to override the wishes of the deceased individual (in either direction). Now it's national news!

Welsh Assembly Votes on Opt-Out Donation

The BBC reports here. As usual, 'opt out' is conflated with 'presumed consent'. The role of family is also raised - this is technically separate from whether we have an opt in or opt out system, though since family have different effects in each it is relevant.

Donor Registration on Facebook

I was interviewed on Facebook's drive to increase organ donation a couple of times by a Canadian journalist (the results can be found here and here).

I've just seen this report, suggesting that there did seem to be a boost in donation rates following the Facebook initiative. I've not read the actual academic article, but I assume the authors at least attempted to show causation, rather than mere correlation.

RSE Project featured in The Herald

Monday's event on the role of the family in donation decisions is mentioned here. What's not so clear from this brief piece is that the family can override the deceased's wishes in either an opt in or an opt out system. This piece may come across as concerned with an objection to an opt out system, which is not the intention.

Northern Ireland Consults on Opt-Out

Northern Ireland has just launched a public consultation on proposals to switch from an Opt-In to an Opt-Out system. I was particularly pleased to see that the BBC article on this made no mention of 'presumed consent' - an idea that I've criticised elsewhere. Instead, the proposal is put in straightforward terms: it makes donation easier for those who want to donate, while allowing a refusal for those that do not. Notably, however, the proposal is for a 'soft opt-out' in which the next of kin retain a veto: "However, it proposes to make little change to the current key role played by the family in the final decision in relation to donation of organs. A family would still be consulted for additional medical information and asked about any unregistered objection to donation.".

Commemorating Donors

If I understand this story correctly, it seems that over £10,000 is being spent on a stained glass window to commemorate organ donors (£6,800 from the Tayside NHS Board Endowment Fund, plus £3,500 from Revival). It's an interesting question whether this is money well spent, or whether it could be used to fund potentially life-saving (or improving) treatment.

I think a common immediate reaction would be that it's a 'waste' of NHS (and other) money that could have been spent more productively. But, who knows, perhaps such gestures will encourage more people to donate, if only by generating publicity? I'd be interested to know whether any empirical work had been done on such matters. I don't, however, think its justification depends entirely on these instrumental considerations though. Arguably, norms of gratitude and reciprocity may make it appropriate to do something to recognise the gift of donors.

Bioethical Expertise

There's an interesting, though perhaps slightly obscure, Guardian column on the notion of expertise in bioethics here. The author, Nathan Emmerich, suggests that we should be wary of making professional bioethicists into a 'priestly caste'. I'd suggest that professional bioethicists may be better than priests, but I think he has a point about moral knowledge/expertise and deference.

The moral or political philosopher doesn't have the kind of expertise that delivers answers that others must simply defer to. I frequently stress to my students that an argument from authority is worthless and that they need to assess what they read critically. Does this mean that there is no such thing as moral expertise? Well, not exactly - it all depends what you mean by 'expertise'.

All of us are capable of thinking deeply and careful about important moral questions. Those who research, or have studied, moral philosophy have an advantage in that they have spent more time than most engaged in such reflection and will presumably be familiar with certain argumentative moves (e.g. slippery slopes) and common fallacies. Thus, we might hope, they will be less likely to reach the conclusions that they do on the basis of bad reasoning and so, hopefully, less likely to reach bad conclusions.

To the worry that relying on moral experts is undemocratic, I think the appropriate response is the broadly Millian one, that the value of free speech is that it allows bad arguments to be confronted by better ones. Experts shouldn't be able to silence ordinary people in virtue of their expertise - our basis for trust in their judgements should rest on the fact that they cannot be defeated by opposing arguments. (There is, of course, a problem here is saying who wins an argument; the quality of public debate is often lamentably poor.)

I don't think that anything I say here challenges Emmerich's position. He concludes "Expert bioethicists cannot allow themselves to become a priestly caste. They must engage with the public and, in doing so, become more fully engaged by and with their concerns", which is not to say that there is no expertise in bioethics, but only that expert bioethicists must engage with the public. That's something I wholeheartedly agree with and one of the purposes of this blog, to facilitate engagement and exchange of view.

David Hunter has his own response to Emmerich on the BMJ blog.

Nudge, Nudge

I discovered a 'new' (as in, new to me) weblog about nudging here, run by a group of geographers (mostly) from Aberystwyth. I've not thoroughly explored yet, but it looks interesting. In particular, of relevance here, are their comments on organ donation. (Richard Thaler's own favoured position is 'prompted choice', rather than 'presumed consent'.) Another interesting point is that the term 'nudge' was suggested by the publisher. Perhaps this explains why Thaler and Sunstein (infamously) don't clearly define it...

This all came to my attention because one of the blog authors, Jessica Pykett, is speaking at Stirling next week.

Regrowing Livers

The fact that livers can regrow means that it's sometimes possible to take a liver lobe from a healthy donor, transplant it to someone suffering liver failure, and for both to end up with a fully functioning liver - as reported here. Recent evidence, however, suggests that this same ability means that some people's need for a transplant is only temporary, since their damaged livers may repair themselves.

Despite the focus on transplants saving lives, it shouldn't be forgotten that it's preferable if people don't need a transplant at all, saving them from major operations and a lifetime of immunosuppressant drugs. Perhaps the gap between supply and demand can be reduced, in part, by reducing demand. And, of course, it's preferable that livers that are available for transplant go to those that really need them (long term).

Back From the Dead?

I think stories like this, about people being brought back from the dead, fuel unease about posthumous organ donation. People quite reasonably worry that, if they register as donors, they will be left for dead, when they could have been saved/revived.

It's worth emphasising that the story here is about cardiac death ("Most people regard cardiac arrest as synonymous with death, he says. But it is not a final threshold"). The definition of death used for organ donation is brain death. As the article goes on to say, "[Dr Jerry] Nolan stops short of saying that Carol was brought back from the dead. Hospitals do not declare death, he says, until they have ruled out all processes that can be reversed."

Nonetheless, this article serves to highlight the ambiguity and confusion surrounding death. Of course, public misunderstanding is somewhat to be expected, given current medical practice - e.g. the family may be informed that, since their relative is [brain] dead, doctors intend to turn off life support, in order to 'let them die'.

In the words of Dr Nolan, as quoted in the article, "We used to think death was a sort of sudden event - we stop the oxygen going to the brain and after a few minutes that was that. But actually, we know that the dying process at the cellular level goes on for a period of time". Our understanding of, and attitudes towards, death and dying are obviously crucial for organ donation (provided, of course, we continue to accept the assumption that it is only permissible to take organs from the dead, except in special circumstances).

Lab-grown Kidney

The reason for encouraging organ donation is to enable life-saving (and life-improving) transplants, but future technological breakthroughs might make this unnecessary. If scientists could produce artificial organs in labs, then we wouldn't need other people to donate their organs, since it would be possible to grow new organs to meet the demand.

This optimistic image may have come a step closer today, with the news that scientists have successfully grown a rat kidney. This is, however, only one step along a rather long road. The BBC article points to several unknowns, such as how long this artificial kidney will last. There's also the issue of cost: even if organs could be grown on-demand, if the technology is much more expensive than traditional transplants, then the latter are likely to continue. Finally, it seems that this particular mechanism requires an old organ in order to grow a new one, so this method will never avoid the need for donation in any case. That, I assume, is something that scientists will keep working on; in the meantime, donation is as useful as ever.

An Economist's Perspective

Economist Tim Harford considers some of the measures to increase organ procurement and suggests the importance of asking people to give their consent. (Thanks to Chris Bertram for directing me to this, on Twitter.)

I think Harford is right to say that many people, given the opportunity, will consent, so it's a good thing to ask people's views when, for instance, they apply for driving licences. It's unclear, however, whether this is sufficient to address the organ shortage. It's interesting that one reason he offers for 'rejecting presumed' is that it will not assure relatives of their loved one's wishes. As he asks, rhetorically, "If we fill our donor registry with auto-enrolled donors, will that really persuade distraught families to support transplants?"

This is all very well, but the unspoken assumption here is that family consent should be needed, along with that of individuals. Granted, perhaps in the opt-out system he was considering, this makes sense: the family should have the option to express an objection that the deceased may have had but never registered (a 'soft opt-out'). The danger, however, is that such systems potentially allow the family to override the wishes of the deceased. There have been a number of papers (for instance, this one) arguing that, even in an opt-out system, we ought not to consult the family: that the absence of objection from the deceased should be sufficient to license donation.

The appropriate role, if any, of families and next of kin is something we intend to explore in the next RSE Workshop.

Grayling on Respect for the Dead

There's a piece by A. C. Grayling criticising the notion of respect for the dead in the Independent. It isn't directly related to organ donation, since it's really concerned with the (im)propriety of speaking ill of Margaret Thatcher, but it occurs to me that 'respect for the dead' is a more general notion.

It's often assumed that we ought to respect someone's wishes concerning what happens to their organs after they die, hence why we give people the opportunity to record their wishes through donor registers and the like. It's sometimes pointed out that we don't think this respect, if demanded at all, is an absolute demand on us. Imagine a militant vegetarian who said that, after their death, they would like their rotting body to be left outside their local McDonalds, or something. We wouldn't feel any obligation to comply with these wishes, since we also accept that people's rights over their bodies can be circumscribed on grounds of public health (or perhaps even decency).

Unsurprisingly, there's much controversy about the implications of this for organ donation. Burying or cremating someone with their organs, which could have been used to save lives of those needing transplants, could be said to be similarly objectionable. That is, there's a case that could be made that, given what's at stake here, we ought to be prepared to override the wishes of the deceased. I'm not endorsing this position, just pointing out that we need to confront issues of the respect owed to the dead.

UK Donor Increase

Organ donation is in the news today. Since the Organ Donation Taskforce, which reported in 2008, there's been a significant increase in the number of registered donors and, consequently, in the number of transplants performed.

This is welcome news, but it shouldn't blind us to the fact that demand still exceeds supply, with three people dying each day in the United Kingdom because of a lack of transplant organs (figure from the BBC article, linked above). It's important to consider ways in which we might continue to do even better, including for instance an opt-out system.

It's also notable that, according to the first article, "Last year, 125 families overruled an individual's intention to donate". The UK's present system allows relatives of the deceased to override his/her expressed wishes. Whether this is justifiable or not ought, I think, to be more debated. It's an issue that we intend to examine in the next RSE workshop.

Reassessing the Need for Altruism

An interesting looking paper, forthcoming in the Journal of Medical Ethics, which questions the need for donors to be motivated by altruism. I explored some similar issues in a recent paper of my own. I assume that we'll be looking at motivations in a future workshop.

First Project Meeting

The RSE-funded project on Organ Donation and Transplantation Policy officially began last month. Since the plan is to use this blog to document and publicise developments, I thought I'd mention that the first meeting of collaborators takes place this Saturday (6th April) at the University of Stirling. This meeting hasn't been widely advertised, since it is largely for collaborators to meet, get to know each other, and plan for future workshops - nonetheless, if anyone reading would like to attend then please get in touch with me.

Policy Engagement

This isn't specifically to do with organ policy, but this recent Guardian feature covers ten tips for academics seeking to engage with policymakers. I hope we can, for the most part, follow this advice in the course of the coming year (and beyond) of the RSE project.

Munthe on Harvesting from Living Donors

This new piece by Walter Glannon challenges the almost universally accepted Dead Donor Rule (DDR), arguing that it can be ethically permissible to harvest organs from a donor before their death, provided that this does not harm them. An interesting, and provocative, thesis. I suspect that most of those who would resist harvesting organs from living donors could in fact accept this conditional, but would hold that removing someone's vital organs is always a harm.

Christian Munthe has offered some alternatives reasons to be sceptical of Glannon's conclusions on his blog, here. Munthe accepts that Glannon is right about the ethics - it is morally permissible to remove the person's organs in this case - but points out that we cannot simply conclude, from this, that the Dead Donor Rule is unjustified. The law is a somewhat blunt instrument, so sometimes it must prohibit all actions of a certain kind because not to do so would result in harm, even if some actions of the prohibited kind are morally permissible. Relaxing the Dead Donor Rule, Munthe suggestions, might weaken socially useful prohibitions on killing in other cases, and thus the law justifiably prevents harvesting from living donors, in order to prevent greater evil.

I'm not sure what I think of this particular case - I'm inclined to agree with Munthe, but haven't yet read Glannon's piece (only Munthe's summary of it) - but it's a useful reminder of the general point that law or policy cannot simply be ethics; we need to attend to institutional matters.

Transplanting Disease

It's well known that organ transplants can save lives. It is, sadly, also true that they can cost lives - and not only through surgery. I reported last year on the case of a young woman who died of lung cancer after receiving a smoker's lungs. In the US, one man has died and three others are receiving treatment after being given organs from a donor who died of rabies in 2011. Again, this is a tragic case, but - lest donation rates be harmed by negative publicity - it's worth stressing the concluding statement that the benefits of organ donation generally outweigh the risks: even those who die due to an infected transplant may well have died without it.

Warm Transplants

Organs need to be transplanted very quickly, since they soon deteriorate when deprived of oxygen. The normal procedure is to cool them to prevent this deterioration, though this freezing may itself cause damage. Surgeons in London have recently achieved a first: the transplant of a 'warm' liver.

Here, the liver was kept alive, and at body temperature, artificially, being supplied with oxygenated blood and nutrients. This allows the liver to be preserved for up to 24 hours, rather than having to be transplanted within 10-12 hours: so speed is still important, but this is a considerable increase in the timeframe.

Priority for Donors

Last night, the following query was posted on the Philos-L mailing list:

In a recent book, "The Ethics of Transplants", Janet Radcliffe Richards proposes that organ donors should get preferential treatment on the donor waiting list compared to those who refuse to donate their organs. This seems to be to be a relatively commonsense, "anti-hypocrisy" measure. Indeed, it is so commonsense that I cannot help but feel that this proposal has been made elsewhere. Unfortunately, I have reached a dead-end in researching this idea; most discussion regarding hypocrisy in organ donation, sadly, revolves around organ selling.
Can someone point me in the direction of other bioethicists who have proposed a similar position regarding punishing those who refuse post-death organ donation?

I'm no expert on where this idea first came from, but I sent him a recent paper of mine from Bioethics which touches on the issue and has a couple of relevant references (in footnotes 21-22). Apparently, such a priority scheme already exists in Israel. An ethical analysis of this policy appeared in the journal Transplantation last year: here.

Needless to say, this is the kind of policy proposal that I'm very interested in exploring...

Double Arm Transplant for Iraq Veteran

I recently posted on the UK's first hand transplant. That's a worthy story in itself, but one American Iraq veteran and quadruple amputee recently received a double arm transplant. Medical advances really can be life-changing, as well as life-saving. As ever though, there are serious questions about who gets to benefit given resource scarcity. These distributive questions are primarily moral questions, as are certain questions about how resources (such as the supply of donor organs) can be increased. (Since I first saw this, the story has been picked up by the BBC here.)

Mixed Defaults

Since organ policy is a devolved matter, the Welsh Assembly has been pushing ahead with plans to switch to an opt-out policy. It emerged recently, however, that certain body parts - including hands, limbs, and faces - will not be included.

What does this mean? As far as I can see, it means that if you die without having registered any preferences over the use of your bodily remains, then your kidneys may be used but your hand may not be used. If you object to the use of your kidney, then you need to opt out of kidney donation. But if you're happy to have your hand used, then you need to opt in to hand donation. And, if for some reason, you're happy for your hand but not your kidney to be used, you need to opt in for hand donation and opt out of kidney donation.

There's no logical or principled reason why the default shouldn't take this mixed form but it seems to me to be undesirable in practice. Firstly, many people are now going to have to register preferences if they want their bodies treated according to their wishes (though this may not be such a bad thing). But it seems to invite potential confusion over what body parts will and will not be used and under what conditions.

Traditional opt in and opt out systems have a clear default: either everything will not be used or everything may be used (respectively). It's fair enough to allow individuals a choice over which parts to opt out or in, so that they can if they wish register as a kidney donor but not a hand donor. But I don't see the point of mixed defaults, which merely complicate and confuse the status quo.

Altruistic Donation

The UK's first altruistic liver transplant (that is, one from a live donor to a stranger) was performed last month. The unusual thing about the liver is that one can donate a liver lobe and then one's liver can re-grow so, unlike donating a kidney, one may be no worse off in the long term. In the short term, however, the donor may suffer as a result of the operation, which in this case took four hours and left a 6" scar, as well as the risk of infection and/or psychological problems. This pieces also highlights the risk of death: approximately 0.5%.

Given these costs, it's unsurprising that Dr Aluvihare - transplant specialist at King's College Hospital - is quoted as saying "I personally have some reservations about altruistic donations. I believe if we did everything we can to improve the supply of donations after death we wouldn't have a need for this type of donation". So the case for favouring posthumous donation isn't simply that people's organs are of little use to them after they die, but also that the costs of removing those organs are much lower.

Defeasible Refusals of Consent

It's a widely accepted view in medical ethics that doctors should not do anything to patients without their informed consent. (There are some exceptions, of course, for patients unable to consent, e.g. minors or the unconscious.) A patient's consent is not binding, because they cannot force a doctor to treat them, but their non-consent is, in the sense that if they refuse a treatment the doctor is not permitted to administer it.

Yesterday I was completing a reference form for a former student hoping to go to graduate study when I read this: "Please tick here if you do not consent for us to disclose the information provided in this reference, to the applicant. If requested by the individual to release this information, we will take your consent preference into account when considering all of the circumstances and deciding if it is appropriate."

It struck me as interesting that, in this case, an explicit refusal of consent was taken as something to be considered, but not as binding. Of course, what's at stake in the two cases (medical treatment and privacy) is different. Some universities do allow applicants to waive any right to see their references, but the referee's wish not to have their comments disclosed to the candidate is (in almost all circumstances) less important than someone's wish not to be operated on.

In the case of organ donation, someone's organs can (under current UK law/practice) be used without their consent, since their next of kin can make the decision after their death. Families rarely go against the recorded wishes of the deceased, where these are known, but since many people do not make their preferences known, it's inevitable that some will have their organs used though they would not have wanted this.

This is one reason why those who do not wish their organs to be used might support a switch to an opt-out donor system: though it imposes upon them the burden of registering their wishes, it allows them to record their objection (which arguably should then be binding, whatever the views of their next-of-kin).

CFP: Panel at ALSP 2013 conference

Further to the general Call For Papers, I am organising a panel on Organ Donation and Transplantation Policy at the 2013 ALSP conference, which takes place on 24th and 25th June at the University of Stirling.

Interested parties working on related topics – such as medical consent, family vetoes, nudges and incentives, etc applied to organ donation – are invited to submit abstracts to the conference in the usual manner, indicating (in the abstract and not simply in the email) that they wish to be considered for this panel. (Submissions in other areas are, of course, still welcome; the panel will only run during parallel sessions.)

This panel forms part of a project supported by a workshops grant from the Royal Society of Edinburgh. Thanks to this grant, a limited number of panel members will be offered a subsidy towards the usual costs of registration and accommodation at the conference. This subsidy will be no more than 50% of those costs (possibly less) and does not include travel. No one will be expected to register before costs and details of any subsidy are confirmed; those who we cannot subsidise are still welcome to attend at their own expense (and to present, if their abstract is accepted).

Proposals for papers or panels in other areas falling under the conference theme are still welcome; please see the original call (linked above) or website.

Why Don't People Register as Donors?

So far this blog has mainly focused on current news items, but I thought this piece from 2005 was interesting enough to deserve comment. Thanks to Christopher Hourigan for bringing it to my attention, in a piece in the British Journal of General Practice, October 2005.

Though surveys usually show a majority of people are in favour of organ donation, actual registration rates are much lower. (Of course, actual donation rates are lower still - people often don't die in ways that facilitate the use of their organs.) Why is this? Of course, there are many reasons, and one shouldn't discount the possibility that people who say they are in favour of donation in surveys aren't really so, at least in their own case. But it's worth investigating people's reasons.

According to the survey reported by the BBC, just over 50% of those who hadn't registered as donors hadn't thought about the issue. While this needn't license using their organs anyway, it does suggest that they didn't have serious objections to the practice. Most of this people, if they had thought about the issue, and were typical of those who had, probably would choose to register. So, one obstacle to donor registration appears to be apathy or, perhaps more accurately, an understandable squeamishness in thinking about death. Drives to increase donor registration should encourage people to think and talk about these issues.

Perhaps even more interesting is that 30% of respondents said they 'hadn't got round to it'. These people want to donate their organs and, it seems, their wishes would be respected by an opt-out scheme.

Only 10% report an objection to the use of their organs. Interestingly, many of these objections appeared to be based on false beliefs or misconceptions. This doesn't mean that the objection can simply be ignored, but it does suggest that these people might change their views - and consent to organ donation - if they were properly informed.

Looking at the reasons why people do and do not register as donors can help inform registration policy. Stirling psychologist Ronan O'Carroll has been doing some interesting work in this area, some of which I hope to report on in a later post. I'd be interested in more recent studies like that discussed here, if anyone has any.

Hand Transplants

I'm not sure if this is technically an organ transplant - it's certainly not one of the cases that one usually thinks of - but Mark Cahill recently received the UK's first hand transplant.

The BBC article includes a useful history of organ transplants (cornea 1905; kidney 1954; heart 1967; hand 1998). It does, however, make the slightly odd claim that "Hand transplants raise more ethical questions than other transplants, such as the heart, as they improve the quality of life rather than saving a life".

This is puzzling because, while many transplants do save (i.e. prolong) lives, many simply improve the quality of the recipient's life, for instance a kidney transplant spares someone having to undergo dialysis. In this recent example (which I already linked to here) a donor is said to help four people but, as Norfolk coroner William Armstrong is quoted as saying in the article, "One life has been saved and the quality of three other lives have been immeasurably enhanced". Mr Savory's heart saved the life of someone who might otherwise have died, but his lungs and kidneys 'merely' improved the quality of life of three people not it seems in immediate risk of death. This still seems a very worthwhile achievement and not to raise particular ethical questions.

One feature of hand transplants - like face transplants but unlike internal organs such as kidneys - is their visibility, as illustrated by the case of Clint Hallam, who received the world's first hand transplant (pictured at the end of the BBC article). In his case it seems that while he hasn't physically rejected the transplant, he has psychologically: he feels that the hand isn't really part of him. This is a particular danger, it seems, for external transplants and something that may raise distinctive ethical questions.

A Sad, But Positive, Story

One person's death can help many others, as this example of a Norfolk man whose heart, lungs, and kidneys were donated, saving one life and improving the quality of three others. It's good to see positive coverage of the benefits of organ donation - hopefully it will encourage more people to register as donors.

Manipulating Waiting Lists

There's controversy in Germany over allegations that waiting lists for liver transplants were manipulated by doctors falsely listing patients as dialysis cases.

As noted in the BBC article "Competition between transplant centres may be to blame, experts say. There is a worldwide shortage of organ donors - a factor that may have exacerbated competition". Unfortunately there's a danger that negative publicity surrounding donation and transplants may put some people off registering as donors. This is a more serious problem where stories concern things like taking organs without proper consent, but even knowing organs won't necessarily go to the neediest cases may discourage altruistic donors. This, of course, creates a Catch-22 situation, since it's the shortage of organs that leads to nefarious practices in the first place.

My interests are primarily in the acquisition of organs, but it's important to remember that this may be linked with the distribution of said organs in practice, though of course analytically distinct.