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...