Are There Ethical Ways to Make More Organs Available for Transplant?

The issue of how to increase the supply of available organs for transplant has received a great deal of consideration by health care professionals and policymakers in recent years. In an article titled “The Bioethics of Organ Transplantation”, Arthur Caplan, a Professor of Bioethics at New York University’s Langone Medical Center, examined the ethical considerations around a number of proposals under consideration. The most notable of these was the possibility of organ markets, or the sale of organs from living or deceased donors (with prior consent).

Currently illegal in the United States, providing financial incentives to those who would otherwise not donate their organs seems appealing, at first. But, according to Caplan, the ethical drawbacks, particularly the fact that poor people would be incentivized to donate organs in order to pay their bills, far outweigh the benefits of such a plan. As Caplan writes: 

“…Watching your child go hungry while you lack a job and a wealthy person waves a wad of bills in your face is not exactly a scenario that inspires confidence in the valid choices that the poor would make in a market for body parts.”

Caplan also raises the possibility of making deceased organ donation the default position for all Americans, as several European countries have done. In other words, instead of filling out a form that says you choose to donate organs upon your death, the default would be that everyone’s organs are available for transplantation unless the person has specifically opted out. In countries that have already adopted this model, such as France, Belgium, Austria and Spain, donation rates are as high as 99 percent. 

Another option that has recently become more feasible is xenotransplantation, or transplanting organs from non-human animals. Due to the very high probability of rejection, this option was heretofore considered far too risky and ethically fraught. But with the advent of genetic engineering, scientists can now breed animals that are more genetically similar to humans and less capable of inciting an immune response. (This was the case when doctors at the University of Maryland transplanted a genetically engineered pig heart into a human recipient who went on to live for two months.) Unfortunately, there are huge ethical questions around this approach as well.

Sources

“Bioethics of Organ Transplantation”. Cold Spring Harbor Perspectives in Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC3935394/ 

“Ethical Issues of Transplanting Organs from Transgenic Animals into Human Beings”. Cell Journal Yakhteh. https://pmc.ncbi.nlm.nih.gov/articles/PMC4204195/