“Mandatory Organ Donation Initiatives”

Last week I began a series of short essays on contemporary issues in bioethics, beginning with the topic "Recent Proposals for Human-Animal Hybrids and the Catholic Response". This week:

"Mandatory Organ Donation Initiatives"

In 2003 the President’s Council on Bioethics published a staff background paper on the topic of “Organ Transplantation: Ethical Dilemmas and Policy Choices”[1] in which the authors describe “a policy of organ conscription or mandatory organ retrieval” as something that “nearly all American[s] would rightfully find unacceptable for different reasons.” The paper continues:

Under such a policy, all cadaver organs would be retrieved regardless of the wishes of the deceased individual or the surviving family; dead bodies would be treated simply as a public resource in the service of the common goal of saving human life.

The staff paper notes that such a policy “by trying to preserve or pursue an absolute but isolated human good … ends up compromising or sacrificing other vital human goods.” Despite this claim that “nearly all” Americans (and by an arguable assumption, nearly all people) would consider mandatory organ donation unreasonable, there have been, in fact, many proponents of such policies, both before and after 2003. Several notable examples are listed below.

In 1992, the New York Times reported that a group founded by a sociologist at George Washington University proposed a national system of mandatory organ donation in which people not wishing to have their organs available for donation must notify a national registry to that effect.[2] The group cited a 1978 Georgia law as a precedent, which allegedly allowed eye or corneal tissue to be removed from a newly dead corpse if it the organ removal was unopposed by living relations and had not been not expressly objected to by the individual prior to death.

Ontario has a history of proposing aggressive organ retrieval legislation. In 1999 Ontario’s Conservative government and House of Commons Health Committee recommended that more pressure be put on individuals to donate their organs.[3] In 2006, an Ontario New Democrat Peter Kormos introduced a bill that proposed automatic organ donation unless people individually objected. Notably, Kormos included in his argument the claim that “Public opinion is changing” on the issue. In the face of such aggressive legislation and rhetoric, Dr. John Shea, a Toronto physician, recently published a report entitled “Organ Donation: The Inconvenient Truth” that highlights the dangers of abuse inherent in organ donation as it is practiced today.[4]

In the UK, in July of this year, Britain’s Chief Medical Officer proposed that organ donation should be made the default choice for all patients.[5] In 2005 the British Medical Association issued a statement that similarly proposed “presumed consent for donation.”[6]

The one reason for making organ donation mandatory (cited in turn by each of the proponents discussed above) is that there are not enough registered organ donors to satisfy patient demand; and this claim is true. However, these same proponents mistakenly claim that the low numbers of organ donation registrants is a byproduct of current policies and legislation that only permit voluntary organ donation. (For a notable case of this false conclusion, see: “The Case for Mandatory Organ Donation” in Wired[7].)

In fact, many individuals choose not to become organ donors because the current practice of organ transplantation, while not morally dubious in theory, in practice often results in medical decisions at-odds with respecting human life and dignity. Enacting legislation that universalizes and forces organ transplantation would do a further injustice to these goods. Instead, the medical establishment and regulatory committees would do better to address the abuses related to organ donation as it is currently practiced, which would in turn promote conscientious voluntary donor registration among individuals. +++