Abstract
This essay appreciatively and critically engages the late Robert Veatch’s extensive and important contributions to transplantation ethics, in the context of his overall ethical theory and his methods for resolving conflicts among ethical principles. It focuses mainly on ways to obtain and allocate organs from deceased persons, with particular attention to express donation, mandated choice, and presumed consent/routine salvaging in organ procurement and to conflicts between medical utility and egalitarian justice in organ allocation. It concludes by examining the unclear relations between Veatch’s ideal moral theory and his nonideal moral theory, especially in organ allocation.
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Notes
This information about Veatch’s different roles and activities in organ transplantation comes largely from Transplantation Ethics [1, pp. xvi–xvii, 306n2; 2, pp. xix–xx, 302n2] and UNOS’ “In Memoriam: Robert Veatch, Ph.D.” [3].
Even though Veatch co-authored the second edition of Transplantation Ethics with Lainie Ross, and the second edition thus represents their shared ideas, this essay will refer to these as Veatch’s ideas for economy of writing.
Space limitations prevent the development of this point here. Rather than arguing that we should adopt “rewarded gifting,” I only want to suggest that Veatch’s rigid categories sometimes prevent him from grasping the complexity and richness of current or proposed policies and practices in organ procurement. He treats “rewarded gifting” in the chapter on “Markets for Organs,” under “Variations on the Market Model: ‘Rewarded Gifting’” [2]. However, depending on how it is conceived and implemented, “rewarded gifting” can easily and accurately be described as a “variation on the donation model.” It is necessary to distinguish systems for the transfer of organs (donation/gift versus sales/purchases) from the motivations of individual participants in these systems. Participants in any system of post-mortem organ transfer may act on a variety of motives, including but not limited to altruism. Our ordinary experiences of giving gifts and making donations are sufficient to establish that our motives are often mixed in those practices. The offer of rewards, including modest financial rewards, may provide incentives for donation without undermining the donation system or transmuting it into a market. I develop these points more fully elsewhere [13, pp. 186–193].
Much of this presentation of these moral frameworks derives from Public Bioethics [13].
In a 2019 US survey, 56.3% of respondents indicated support (“strongly support” or “somewhat support”) for a policy of presumed consent, an increase of 5.2 percentage points from 2012. However, in 2019, 34.4% indicated they would opt out under such a policy, up from 23.4% in 2012. Opting out would block post-mortem familial organ donation. For survey data from 2019, see “National Survey of Organ Donation Attitudes and Practices, 2019” [19]. For a summary and interpretation of survey data from 2005 and 2012, see Childress, Public Bioethics [13]. Many of the same questions were used across these surveys (2005, 2012, and 2019) to allow comparisons of trends at different times.
In 1991, the Ethics Committee of the Organ Procurement and Transplantation Network (OPTN), which the United Network for Organ Sharing (UNOS) operates under a contract with and under the oversight of the federal government, approved a report on principles of organ and tissue allocation, which had been prepared by a subcommittee chaired by Robert Veatch who was also its primary drafter [2, 24, 25]. In 2010, a revised version was approved by the Board of Directors of the OPTN [25]. It underwent further review and update in 2015 and is available as a “White Paper” on the OPTN website [25].
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Childress, J.F. Robert Veatch’s transplantation ethics: obtaining and allocating organs from deceased persons. Theor Med Bioeth 43, 193–207 (2022). https://doi.org/10.1007/s11017-022-09574-3
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DOI: https://doi.org/10.1007/s11017-022-09574-3