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Analysis of the Normative Arguments That Dominate the Policy Arena About Necessity and Legitimacy of Legal Restrictions in Living Donor Transplantation

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Regulations Regarding Living Organ Donation in Europe

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Abstract

Chapter “Comparative Analysis of European Transplant Laws Regarding Living Organ Donation” has just shown that almost all of the countries considered established specific legal rules for LOD. However, only some regulations are similar, substantial differences exist as well. The countries especially differ with respect to restricting LOD. Several arguments are brought forth in favour of restricting LOD, but also against restricting LOD. Those will be analysed in this chapter.

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Notes

  1. 1.

    Cf. Evans, Vol. 15 Journal of Medical Ethics 17, 19 (1989); Fateh-Moghadam, (2011); cf. Radcliffe Richards, in Weimar/Bos/Busschbach (ed.) (2011), p. 41.

  2. 2.

    German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, in Vol. 46 Neue Juristische Wochenschrift 3399, 3400 (1999).

  3. 3.

    Art. 2 (1) Charter of Fundamental Rights of the European Union.

  4. 4.

    Ibid., Art. 3 (1).

  5. 5.

    Price (2010), p. 196.

  6. 6.

    EULOD WP 2 (2012), DOW: Deliverable 4, p. 4.

  7. 7.

    Nielsen, in Price/Akveld (ed.) (1997), p. 73.

  8. 8.

    Cf. Bakker, in Price/Akveld (ed.) (1997), p. 27; Beauchamp/Childress (2001), p. 12 ff.; cf. Donnelly/Price (ed.) (1997), p. 51 f.; cf. Lamb, in Price/Akveld (ed.) (1997), p. 43 f.; cf. Schroth, in Schroth et al. (ed.) (2006), p. 79 ff.

  9. 9.

    Beauchamp/Childress (2001), p. 113; Bechstein/Moench, Vol. 24 Transplant International 1162, 1163 (2011); Potts/Evans, in Weimar/Bos/Busschbach (ed.) (2008), p. 377.

  10. 10.

    Bakker, in Price/Akveld (ed.) (1997), p. 26; Bechstein/Moench, Vol. 24 Transplant International 1162, 1163 (2011); Fateh-Moghadam, in Rittner/Paul (ed.) (2005), p. 132; cf. Hessing, in Price/Akveld (ed.) (1997), p. 99; cf. Land, Vol. 2 Transplant International 168, 169 (1989); Wagner/Fateh-Moghadam, Vol. 56 Soziale Welt 73, 78 (2005).

  11. 11.

    P. 8 f.

  12. 12.

    This principle says that, in case the person concerned consents, no injury is done (Benke/Meissel/Luggauer (1997), p. 406; Daar et al., Vol. 11 Transplantation Review 95, 101 (1997); Lieberwirth (2007), p. 302).

  13. 13.

    Cf. Fateh-Moghadam, in Rittner/Paul (ed.) (2005), p. 134; Schroth, in Schroth et al. (ed.) (2006), p. 86.

  14. 14.

    Cf. Cronin, Vol. 343 British Medical Journal (2011); cf. Land, Vol. 2 Transplant International 168, 169 f. (1989); Pöltner (2002), p. 97.

  15. 15.

    Beauchamp/Childress (2001), p. 57 f.; Hügli/Lübcke (ed.) (1997), p. 71; Pieper, in Korff (ed.) (2000), p. 289.

  16. 16.

    Beauchamp/Childress (2001), p. 57 f.; Pieper, in Korff (ed.) (2000), p. 289; cf. Prechtl/Burkhard (2008), p. 56; Ritter (ed.) (1971), p. 701.

  17. 17.

    Mittelstraß (ed.) (2005), p. 319; Ritter (ed.) (1971), p. 708.

  18. 18.

    Christman (2011); Dworkin (1988).

  19. 19.

    Ritter (ed.) (1971), p. 707.

  20. 20.

    Beauchamp/Childress (2001), p. 57 f.

  21. 21.

    Feinberg, in Christman (ed.) (1989).

  22. 22.

    Benn (1988); cf. Lamb, in Price/Akveld (ed.) (1997), p. 48.

  23. 23.

    Dreier, in Dreier (ed.) (2004) , before Art. 1 GG at 75, Art. 2 II at 20; Gessmann (ed.) (2009), p. 72; Hügli/Lübcke (ed.) (1997), p. 71; cf. Joint Working Party of The British Transplantation Society and The Renal Association (2011), p. 25; Pöltner (2002), p. 94.

  24. 24.

    Feinberg (1986), p. 54.

  25. 25.

    Feinberg (1986); cf. Gutmann, in Schroth et al. (ed.) (2006), p. 219 f.; cf. Wagner/Fateh-Moghadam, Vol. 56 Soziale Welt 73, 83 (2005).

  26. 26.

    Dworkin (1993); cf. Glannon, Vol. 343 British Medical Journal (2011).

  27. 27.

    Gutmann, in Schroth et al. (ed.) (2006), p. 220.

  28. 28.

    Bundestag printed paper 15/5050 (2005), p. 34; Forkel, Vol. 23 JURA 73, 73 (2001); Gutmann/Schroth (2002), p. 110; cf. Joint Working Party of The British Transplantation Society and The Renal Association (2011), p. 25.

  29. 29.

    Fateh-Moghadam et al., Vol. 22 Medizinrecht 19, 20 (2004); Gutmann, Vol. 15 Medizinrecht 147, 147 (1997); Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 441 (2002).

  30. 30.

    Ermecke (1961), p. 250.

  31. 31.

    Bundestag printed paper 15/5050 (2005), p. 34; cf. Elsässer, Vol. 12 Transplantationsmedizin 184, 185 (2000); Ermecke (1961), p. 250 f.

  32. 32.

    Cf. Donnelly/Price (ed.) (1997), p. 51.

  33. 33.

    Kant, in Gregor (ed.) (1998), p. 547.

  34. 34.

    Price (2010), p. 207; cf. Donnelly/Price (ed.) (1997), p. 50

  35. 35.

    Cf. Kant (1968 [1797]), p. 555; Seelmann, in Amelung/Beulke/Lilie (ed.) (2003), p. 853–867. I am indebted to A. Pascalev for this notice.

  36. 36.

    See e.g. Singer, Vol. 69 Ethics, 202, 202 ff. (1959).

  37. 37.

    Information from T. Gutmann.

  38. 38.

    Cf. Gründel, Vol. 5 Zeitschrift für Transplantationsmedizin 70, 72 (1993); Roff, Vol. 33 Journal of Medical Ethics 437, 440 (2007); Sharp/Randhawa/Kaur-Bola, in Weimar/Bos/Busschbach (ed.) (2011), p. 114.

  39. 39.

    Dor et al., 2011 Transplantation 1, 3; cf. Elsässer, Vol. 12 Transplantationsmedizin 184, 185 f. (2000).

  40. 40.

    Bundestag printed paper 15/5050 (2005), p. 34; Weber (1999), p. 164.

  41. 41.

    Rawls (1993).

  42. 42.

    Eyal, in Zalta (ed.) (2011).

  43. 43.

    The exact meaning of this and what these countries require in detail can be looked up in chapter “Comparative Analysis of European Transplant Laws Regarding Living Organ Donation”.

  44. 44.

    P. 28 ff.

  45. 45.

    Gutmann, Vol. 52 Neue Juristische Wochenschrift 3387, 3388 (1999); Gutmann/Schroth, in Oduncu/Schroth/Vossenkuhl (ed.) (2003), p. 277; Parzeller/Henze/Bratzke, 87 Kritische Vierteljahresschrift 371, 383 (2004).

  46. 46.

    Hilhorst et al., Vol. 24 Transplant International 1164, 1165 (2011).

  47. 47.

    Dickens/Fluss/King, in Chapman/Deierhoi/Wright (ed.) (1997), p. 98; cf. Gutmann/Schroth (2002), p. 49; Pfeiffer (2004), p. 45; Weber (1999), p. 164.

  48. 48.

    P. 48 ff.

  49. 49.

    The Hippocratic Oath states, inter alia:” I will apply dietetic measures for the benefit of the sick according to my ability and judgement; I will keep them from harm and injustice.” See e.g. Edelstein (1943).

  50. 50.

    Beauchamp/Childress (2001), p. 113 ff.; cf. Joint Working Party of The British Transplantation Society and The Renal Association (2011), p. 25.

  51. 51.

    Beauchamp/Childress (2001), p. 116.

  52. 52.

    Bakker, in Price/Akveld (ed.) (1997), p. 30; Daar et al., Vol. 11 Transplantation Review 95, 100 (1997); Swiss Dispatch of 12. September 2001 on a Federal Law on Transplantation of Organs, Tissues and Cells, p. 30.

  53. 53.

    Bundestag printed paper 15/5050 (2005), p. 35; Esser, in Höfling (ed.) (2003), p. 247; Norba (2009), p. 56; Papachristou et al., Vol. 78 Transplantation 1506, 1506 (2004); Schreiber (2004), p. 18; Schutzeichel (2002), p. 100; Ugowski (1998), p. 24.

  54. 54.

    Bakker, in Price/Akveld (ed.) (1997), p. 28; Glannon, Vol. 343 British Medical Journal (2011); cf. Kirste, Vol. 81 Der Chirurg 778, 786 (2010); Schroder et al., Vol. 18 Progress in Transplantation 41, 41 (2008).

  55. 55.

    George (2006).

  56. 56.

    Daar et al., Vol. 11 Transplantation Review 95, 102 (1997).

  57. 57.

    Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 440 f. (2002).

  58. 58.

    Beauchamp/Childress (2001), p. 113 ff.

  59. 59.

    Cf. Gutmann, in Schroth et al. (ed.) (2006), p. 246 f.

  60. 60.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1165 (2011).

  61. 61.

    George (2006); Potts/Evans, in Weimar/Bos/Busschbach (ed.) (2008), p. 377 ff.

  62. 62.

    Potts/Evans, in Weimar/Bos/Busschbach (ed.) (2008), p. 378.

  63. 63.

    Gutmann/Land, Vol. 384 Langenbeck‘s archives of surgery 515, 516 (1999).

  64. 64.

    Cf. Gutmann/Schroth (2002), p. 109; cf. Price (2000), p. 227.

  65. 65.

    Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 183 (2011).

  66. 66.

    Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 440 (2002).

  67. 67.

    Health Council of the Netherlands (2003); Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 380; Matas et al., in Gutmann et al. (ed.) (2004), p. 195; Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 183 (2011); Veatch (2000), p. 189.

  68. 68.

    Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 183 (2011); Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 440 (2002).

  69. 69.

    Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 442 (2002).

  70. 70.

    Ibid.

  71. 71.

    Ibid.

  72. 72.

    Cf. Hohmann (2003), p. 25.

  73. 73.

    Cf. American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2925 (2000); cf. Gutmann/Schroth (2002), p. 111; cf. Hippen, Vol. 30 Journal of Medicine and Philosophy 593, 612 (2005); Roff, Vol. 33 Journal of Medical Ethics 437, 440 (2007).

  74. 74.

    American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2925 (2000); Joint Working Party of The British Transplantation Society and The Renal Association (2011), p. 28; Pellegrino (2006); cf. Price (2000), p. 227.

  75. 75.

    Donnelly/Price (ed.) (1997), p. 54.

  76. 76.

    Elliot, Vol. 21 Journal of Medical Ethics 91, 95 (1995); Gutmann/Schroth (2002), p. 111; cf. Pellegrino (2006).

  77. 77.

    Cf. Bechstein/Moench, Vol. 24 Transplant International 1162, 1162 (2011); Delmonico/Surman, Vol. 76 Transplantation 1257, 1259 (2003); cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1165 (2011).

  78. 78.

    Information from C. Rudge.

  79. 79.

    United Network for Organ Sharing, Vol. 24 Transplantation Proceedings 2236, 2236 ff. (1992).

  80. 80.

    Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 380.

  81. 81.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1169 (2011); cf. Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 442 (2002).

  82. 82.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1169 (2011).

  83. 83.

    Cf. Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 442 (2002).

  84. 84.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1169 (2011).

  85. 85.

    This thesis has special importance for split-liver living donation and other types of LOD with higher peri- and postoperative risks for the donor (Information from T. Gutmann).

  86. 86.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1169 (2011), considering the case if a living kidney donor who, after having donated a kidney anonymously, also wanted to donate part of his liver; Neuberger, Vol. 24 Transplant International 1159 (2011).

  87. 87.

    Cf. Wagner/Fateh-Moghadam, Vol. 56 Soziale Welt 73, 83 (2005); cf. Gutmann, Vol. 52 Neue Juristische Wochenschrift 3387, 3388 (1999); Hilhorst et al., Vol. 24 Transplant International 1164, 1165 (2011).

  88. 88.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 380.

  89. 89.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 380; cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1166 (2011).

  90. 90.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 380.

  91. 91.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 381; cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1164 (2011).

  92. 92.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 381. In the United Kingdom, e.g., in 2009–2010, 920 directed LODs were performed and only 16 unspecified LODs (NHS Blood and Transplant (2010)). A survey was conducted on 113 kidney transplant units and 39 liver transplant by EULOD WP 2. Their results show that unspecified living kidney donation has occurred in 41 centres, and that only 8 unspecified living liver donations have been performed. (EULOD WP 2 (2012), DOW: Deliverable 4, p. 10 f.).

  93. 93.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 381.

  94. 94.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1166 (2011).

  95. 95.

    Cf. ibid., p. 4.

  96. 96.

    American Medical Association, Vol 284 Journal of the American Medical Association 2919, 2920 (2000).

  97. 97.

    Delmonico/Surman, Vol. 76 Transplantation 1257, 1259 (2003).

  98. 98.

    Böckenförde, in Münkler/Fischer (ed.) (2002), p. 44 ff.; Folke Schuppert/Neidhardt (2002), p. 21; Hasenöhrl (2005); Münkler/Fischer, in Münkler/Fischer (ed.) (2002), p. 9.

  99. 99.

    Böckenförde, in Münkler/Fischer (ed.) (2002), p. 62; Hasenöhrl (2005).

  100. 100.

    Hasenöhrl (2005); cf. Münkler/Fischer, in Münkler/Fischer (ed.) (2002), p. 11.

  101. 101.

    University of Alaska (2003).

  102. 102.

    German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 3b; cf. Walter, in Spickhoff (ed.) (2011), p. 2388, who also refers to the judgement of the German Federal Constitutional Court.

  103. 103.

    Cf. German Federal Constitutional Court [Bundesverfassungsgericht], 22 January, 2011, Case No. 1 BvR 699/06, at 47.

  104. 104.

    Schneider (2006).

  105. 105.

    Gutmann, in Middel et al. (ed.) (2010), p. 28.

  106. 106.

    Council of Europe Committee of Ministers, Resolution CM/Res(2008)4 on adult-to-adult living donor liver transplantation, 4b; World Health Organization (2010), WHO Guiding Principles on Human Organ Transplantation, Guiding Principle 3. Interestingly, in a version of the WHO Guding Principles on Human Organ Transplantation from 1991, it was written that “adult living person may donate organs, but in general such donors should be genetically related to the recipients.”

  107. 107.

    Cf. Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 181 (2011); cf. Persson et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 271; cf. Roff, Vol. 33 Journal of Medical Ethics 437, 439 (2007).

  108. 108.

    Silva/Wright, in Weimar/Bos/Busschbach (ed.) (2008), p. 291 ff.

  109. 109.

    Cf. Adams et al., Vol. 74 Transplantation 582, 587 (2002); Dew et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 213; Matas et al., in Gutmann et al. (ed.) (2004), p. 195; cf. Virzì et al., Vol. 39 Transplantation Proceedings 1791, 1793 (2007).

  110. 110.

    Cf. den Hartogh (2008), p. 85; Schneider (2004).

  111. 111.

    Donnelly/Price (ed.) (1997), p. 51, 65; cf. Glannon, Vol. 343 British Medical Journal (2011); Kasiske et al., Vol. 7 Journal of the American Society of Nephrology 2288, 2295 f. (1996); cf. Kranenburg et al., Vol. 38 Psychological Medicine 177, 178 (2008); Lamb, in Price/Akveld (ed.) (1997), p. 46; cf. Price, in Price/Akveld (ed.) (1997), p. 121.

  112. 112.

    Bundestag printed paper 15/5050 (2005), p. 35.

  113. 113.

    Ross et al., Vol. 74 Transplantation 418, 420 (2002).

  114. 114.

    Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 442 (2002).

  115. 115.

    A good overview about the several motives to donate can be seen at Lennerling et al., Vol. 19 Nephrology Dialysis Transplantation 1600, 1600 ff. (2004); Price, in Price/Akveld (ed.) (1997), p. 115 ff. also lists several possible motives to donate an organ.

  116. 116.

    Gutmann/Schroth, in Oduncu/Schroth/Vossenkuhl (ed.) (2003), p. 276.

  117. 117.

    Glannon/Ross, Vol. 11 Cambridge Quarterly of Healthcare Ethics 153, 155 f. (2002); den Hartogh (2008), p. 81; Forsberg et al., Vol. 8 Pediatric Transplantation 372, 378 (2004); cf. Kluge, Vol. 19 Hastings Center Report 10, 12 (1989); Ross, in Weimar/Bos/Busschbach (ed.) (2008), p.185; cf. Spital, Vol. 12 Cambridge Quarterly of Healthcare Ethics 116, 116 (2003).

  118. 118.

    To emphasise this, the following statement can serve as an example: “If we’ve got five people here, all of whom could efficiently use one of my kidneys, and one of them is my daughter, I not only don't think I have to randomise the choice among those five, I think I ought not randomise the choice among the five. That is to say I think there are certain kinds of special obligations that weigh in a way that some sort of general altruism doesn't” (Meilaender (2006)).

  119. 119.

    Elliot, Vol. 21 Journal of Medical Ethics 91, 94 (1995); Land, Vol. 2 Transplant International 168, 170, 172 (1989); Papachristou et al., Vol. 78 Transplantation 1506, 1509 (2004); cf. Spital, Vol. 12 Cambridge Quarterly of Healthcare Ethics 116, 116 (2003).

  120. 120.

    Elliot, Vol. 21 Journal of Medical Ethics 91, 94 (1995).

  121. 121.

    German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 76; Kruse (1986), p. 257.

  122. 122.

    Papachristou et al., Vol. 78 Transplantation 1506, 1509 (2004); Walter et al., Vol. 11 Medical Science Monitor 503, 504 (2005).

  123. 123.

    Papachristou et al., Vol. 78 Transplantation 1506, 1508 (2004).

  124. 124.

    These rights are, for example, included in the Charter of Fundamental Rights of the European Union.

  125. 125.

    Cf. Bundestag printed paper 15/5050 (2005), p. 34 f.

  126. 126.

    Information from T. Gutmann.

  127. 127.

    Hilhorst et al., Vol. 24 Transplant International 1164, 1167 (2011).

  128. 128.

    Information from T. Gutmann.

  129. 129.

    Ibid.

  130. 130.

    Hilhorst et al., Vol. 24 Transplant International 1164, 1167 (2011).

  131. 131.

    Hilhorst et al., Vol. 24 Transplant International 1164, 1167 (2011); Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 381; cf. Neuberger, Vol. 24 Transplant International 1159, 1160 (2011).

  132. 132.

    Neuberger, Vol. 24 Transplant International 1159, 1160 (2011).

  133. 133.

    Evans, Vol. 15 Journal of Medical Ethics 17, 19 (1989).

  134. 134.

    Ibid.

  135. 135.

    Massey et al., Vol. 10 American Journal of Transplantation 1445, 1445 ff. (2010).

  136. 136.

    Cf. Hilhorst et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 383.

  137. 137.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 167 (2006).

  138. 138.

    Cf. German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 77.

  139. 139.

    German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 77; Gubernatis (2002). Several other arguments in favour of the principle of subsidiarity of LOD have already been listed in chapter “Comparative Analysis of European Transplant Laws Regarding Living Organ Donation”.

  140. 140.

    Edelmann, Vol. 50 Versicherungsrecht 1065, 1068 (1999); Gutmann, Vol. 15 Medizinrecht 147, 152 (1997); Swiss Dispatch of 12. September 2001 on a Federal Law on Transplantation of Organs, Tissues and Cells, p. 195.

  141. 141.

    Several further points of criticism have already been presented in chapter “Comparative Analysis of European Transplant Laws Regarding Living Organ Donation”.

  142. 142.

    Cf. Gutmann (2006), p. 81 f.; Gutmann, in Middel et al. (ed.) (2010), p. 32 f.

  143. 143.

    Edelmann, Vol. 50 Versicherungsrecht 1065, 1068 (1999).

  144. 144.

    Gutmann/Schroth (2002), p. 80.

  145. 145.

    Eyal, in Zalta (ed.) (2011); cf. Faden/Beauchamp (1986), p. 152 ff.; Information from T. Gutmann.

  146. 146.

    Donnelly/Price (ed.) (1997), p. 58; Price, in Price/Akveld (ed.) (1997), p. 112.

  147. 147.

    Fateh-Moghadam et al. in Schroth et al. (ed.) (2006), p. 120; cf. Schneewind/Sedlmayer, in Schroth et al. (ed.) (2006), p. 16; Wagner/Fateh-Moghadam, Vol. 56 Soziale Welt 73, 79 (2005).

  148. 148.

    Article 13 1. Directive 2010/53/EU of the European Parliament and of the Council of 7 July 2010 on standards of quality and safety of human organs intended for transplantation.

  149. 149.

    Cf. Lilie/Krüger, Vol. 81 Der Chirurg 787, 788 (2010).

  150. 150.

    den Hartogh, in Weimar/Bos/Busschbach (ed.) (2008), p. 221.

  151. 151.

    Beauchamp/Childress (2001), p. 93.

  152. 152.

    Cf. Fateh-Moghadam et al., Vol. 22 Medizinrecht 19, 28 (2004).

  153. 153.

    Gutmann/Schroth (2002), p. 37.

  154. 154.

    Schutzeichel (2002), p. 107.

  155. 155.

    Land, in Oduncu/Schroth/Vossenkuhl (ed.) (2003), p. 225.

  156. 156.

    Bakker, in Price/Akveld (ed.) (1997), p. 28; Forsberg et al., Vol. 8 Pediatric Transplantation 372, 377 (2004); Ross et al., Vol. 74 Transplantation 418, 419 (2002).

  157. 157.

    Bock (1999), p. 118; cf. Dworkin, Vol. 33 The Modern Law Review 353, 359 (1979); Erim et al., Vol. 35 Transplantation Proceedings 909, 909 (2003); Evans, Vol. 15 Journal of Medical Ethics 17, 19 (1989); Gutmann et al., Terasaki (ed.) (1995), p. 356; Gutmann/Schroth (2002), p. 62; Heuer/Conrads, Vol. 15 Medizinrecht 195, 201 (1997); Keller, Vol. XXXII Stetson Law Review 855, 869 (2003); Lilie/Krüger, Vol. 81 Der Chirurg 787, 788 (2010); Sanner/Dew/Busschbach, in Weimar/Bos/Busschbach (ed.) (2008), p.195; Schreiber, in Rittner/Paul (ed.) (2005), p. 63.

  158. 158.

    Cf. Choudhry, Vol. 29 Journal of Medical Ethics 169, 170 (2003); Ross et al., Vol. 74 Transplantation 418, 419 (2002).

  159. 159.

    Schutzeichel (2002), p. 108 f.

  160. 160.

    Ibid.

  161. 161.

    Cf. Lennerling/Forsberg/Nyberg, Vol. 76 Transplantation 1243, 1244 (2003); Ross et al., Vol. 74 Transplantation 418, 419 (2002).

  162. 162.

    Gutmann (2006), p. 26; cf. Price (2000), p. 295.

  163. 163.

    Forsberg et al., Vol. 8 Pediatric Transplantation 372, 374 (2004).

  164. 164.

    Fateh-Moghadam, in Schroth et al. (ed.) (2006), p. 170; Gutmann/Schroth (2002), p. 114; Gutmann (2004), p. 8; Schroth, in Schroth et al. (ed.) (2006), p. 84; cf. Spital, Vol. 12 Cambridge Quarterly of Healthcare Ethics 116, 116 (2003). See also Eyal, in Zalta (ed.) (2011).

  165. 165.

    Gutmann/Schroth (2002), p. 114 f.; cf. Gutmann, in Schroth et al. (ed.) (2006), p. 246 f.; cf. Price (2000), p. 298.

  166. 166.

    Gutmann, in Schroth et al. (ed.) (2006), p. 247.

  167. 167.

    Price (2000), p. 298.

  168. 168.

    WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, 2008, Commentary on Guiding Principle 3.

  169. 169.

    American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2921 (2000); cf. Cotler et al., Vol. 9 Liver Transplantation 637, 640 (2003); Dworkin, Vol. 33 The Modern Law Review 353, 359 (1979). Cotler et al. performed a study in which they asked surgeons what, according to their view, should be told to the potential recipients and the families if a potential donor withdraws his consent. The result was that 87 % stated that they would give a medical or technical excuse, while only 9 % suggested to tell the truth and only 4 % would give no explanation (Cotler et al., Vol. 9 Liver Transplantation 637, 640 (2003)). However, the suggestion to provide a medical excuse to relief the donor is also criticised. It is stated that “[p]eople all the time have to make decisions which, […], will evoke predictable unwelcome reactions from others, and this fact may or may not be relevant information for them. Such unwelcome reactions are simply part of the normal context of decision-making, […]” (den Hartogh, in Weimar/Bos/Busschbach (ed.) (2008), p.226).)

  170. 170.

    Bundestag printed paper 13/4355 (1996), p. 20; see also German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 3b.

  171. 171.

    Cf. Roff, Vol. 33 Journal of Medical Ethics 437, 439 (2007).

  172. 172.

    Cf. Henderson et al., Vol. 3 American Journal of Transplantation 203, 203 (2003); cf. Kranenburg et al., Vol. 38 Psychological Medicine 177, 178 (2008); cf. Massey et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 370 f.

  173. 173.

    Cf. German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 25; Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 200 (2005); Landolt et al., Vol. 76 Transplantation 1437, 1441 (2003); cf. Massey et al., Vol. 10 American Journal of Transplantation 1445, 1445 (2010); cf. Spital, Vol. 71 Transplantation 1061, 1063 (2001).

  174. 174.

    Cf. Jendrisak et al., Vol. 6 American Journal of Transplantation 115, 119 (2006); Massey et al., Vol. 10 American Journal of Transplantation 1445, 1450 (2010).

  175. 175.

    Hoyer, in Weimar/Bos/Busschbach (ed.) (2008), p. 234.

  176. 176.

    Kranenburg et al., Vol. 38 Psychological Medicine 177, 177 ff. (2008).

  177. 177.

    Gutmann (2006), p. 28 ff.

  178. 178.

    Choudhry, Vol. 29 Journal of Medical Ethics 169, 169 (2003).

  179. 179.

    Cf. Choudhry, Vol. 29 Journal of Medical Ethics 169, 169 (2003); cf. Gutmann, Vol. 27 Zeitschrift für Rechtspolitik 111, 113 (1994) who primarily refers to the distinction between genetic and emotional relatives; Gutmann/Schroth (2002), p. 63; Price (2000), p. 328; cf. Sanner/Dew/Busschbach, in Weimar/Bos/Busschbach (ed.) (2008), p. 194 f.

  180. 180.

    Cf. Gutmann/Schroth (2002), p. 94; Schneider (2004). In the United States, a gender disparity has been observed as well (Bloembergen et al., Vol. 7 Journal of the American Society of Nephrology 1139, 1139 f. (1996); Kayler et al., Vol. 73 Transplantation 248, 248 ff. (2002); US Department of Health & Human Services (2011); cf. Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 592 (2005). It can be assumed that this does not apply to the illegal market, though, since all pictures known show men (Information from C. Rudge).

  181. 181.

    Fuggle et al., Vol. 89 Transplantation 694, 696 (2010).

  182. 182.

    Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 592 (2005).

  183. 183.

    Schneider (2004); Sheper-Hughes, Vol. 7 American Journal of Transplantation 507, 508 (2007).

  184. 184.

    Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 227; cf. Bloembergen et al., Vol. 7 Journal of the American Society of Nephrology 1139, 1143 (1996); Bundestag printed paper 15/5050, p. 36; Kirste (2004), p. 39; cf. Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 593 (2005).

  185. 185.

    Schneewind et al., Vol. 12 Transplantationsmedizin 164 ff. (2000).

  186. 186.

    Biller-Andorno, Vol. 5 Medicine, Health Care and Philosophy 199, 202 (2002); cf. Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 594 (2005).

  187. 187.

    Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 227.

  188. 188.

    Schneider (2004).

  189. 189.

    Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 226; Gilligan (1982), e.g. p. 155 & p. 162; cf. Gutmann/Schroth (2002), p. 94; cf. Lennerling et al., Vol. 19 Nephrology Dialysis Transplantation 1600, 1603 (2004); cf. Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 594 (2005).

  190. 190.

    Schneider (2004).

  191. 191.

    AOK Bundesverband (2004), p. 3; Bundestag printed paper 15/5050 (2005), p. 17; Robert Koch-Institut (ed.) (2003), p. 17.

  192. 192.

    Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 226; Russel/Mentzel, Vol. 130 The Journal of Social Psychology 309, 309 (1990).

  193. 193.

    Schneewind et al., Vol. 12 Transplantationsmedizin 164 ff. (2000); cf. Schroth, in Schroth et al. (ed.) (2006), p. 81 f.

  194. 194.

    Achille/Vaillancourt/Beaulieu-Pelletier, in Weimar/Bos/Busschbach (ed.) (2008), p. 321; Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 227.

  195. 195.

    Biller-Andorno/Kling, in Gutmann et al. (ed.) (2004), p. 227.

  196. 196.

    Ibid.

  197. 197.

    Bloembergen et al., Vol. 7 Journal of the American Society of Nephrology 1139, 1143 (1996); cf. Kayler et al., Vol. 73 Transplantation 248, 252 (2002).

  198. 198.

    Bloembergen et al., Vol. 7 Journal of the American Society of Nephrology 1139, 1143 (1996); Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 593 (2005).

  199. 199.

    Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 592 f. (2005).

  200. 200.

    Information from C. Rudge.

  201. 201.

    Sheper-Hughes, Vol. 7 American Journal of Transplantation 507, 508 (2007).

  202. 202.

    Robert Koch-Institut (ed.) (2003), p. 17; Thiel/Nolte/Tsinalis, Vol. 37 Transplantation Proceedings 592, 594 (2005).

  203. 203.

    Cf. Gutmann (2006), p. 52.

  204. 204.

    Biller-Andorno, Vol. 5 Medicine, Health Care and Philosophy 199 (2002).

  205. 205.

    Ibid.

  206. 206.

    Gutmann/Schroth (2002), p. 115; Gutmann (2006), p. 26.

  207. 207.

    Bundestag printed paper 15/5050 (2005), p. 40, 42 f., 48, 73 f.; cf. Schroth, in Schroth et al. (ed.) (2006), p. 82, who immediately after presenting this argument invalidates it.

  208. 208.

    Bundestag printed paper 15/5050 (2005), p. 40, 42 f., 48, 73 f.

  209. 209.

    Information from T. Gutmann.

  210. 210.

    Gutmann/Schroth (2002), p. 115.

  211. 211.

    Ummel/Achille, in Weimar/Bos/Busschbach (ed.) (2011), p. 304.

  212. 212.

    Schneider (2004).

  213. 213.

    Ummel/Achille, in Weimar/Bos/Busschbach (ed.) (2011), p. 304.

  214. 214.

    Donnelly/Price (ed.) (1997), p. 78; Fox/Swazey (1999), p. 35.

  215. 215.

    Virzì et al., Vol. 39 Transplantation Proceedings 1791, 1793 (2007). Other studies, in contrast, showed that the donor even in case the donation failed stated that he would donate again (Otto, in Rittner/Paul (ed.) (2005), p. 60).

  216. 216.

    Ummel/Achille, in Weimar/Bos/Busschbach (ed.) (2011), p. 304; Waterman et al., Vol. 16 Progress in Transplantation 17, 17 (2006).

  217. 217.

    Fox/Swazey (1999), p. 40; Sanner, in Weimar/Bos/Busschbach (ed.) (2008), p. 283.

  218. 218.

    Fox/Swazey (1999), p. 40.

  219. 219.

    Forsberg et al., Vol. 8 Pediatric Transplantation 372, 372 (2004).

  220. 220.

    Fox/Swazey (1999), p. 40; cf. Joint Working Party of The British Transplantation Society and The Renal Association (2011), p. 39; cf. Sharp/Randhawa/Kaur-Bola, in Weimar/Bos/Busschbach (ed.) (2011), p. 113.

  221. 221.

    Cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1165 (2011); cf. Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011); cf. Fox/Swazey (1999), p. 31; cf. Massey et al., Vol. 10 American Journal of Transplantation 1445, 1450 (2010).

  222. 222.

    Matas, in Gutmann et al. (ed.) (2004), p. 199.

  223. 223.

    Price (2000), p. 300.

  224. 224.

    Massey et al., Vol. 10 American Journal of Transplantation 1445, 1450 (2010); Matas, in Gutmann et al. (ed.) (2004), p. 199.

  225. 225.

    Cf. Evans, Vol. 15 Journal of Medical Ethics 17, 18, (1989); German Federal Constitutional Court [Bundesverfassungsgericht], 11 August, 1999, Case No. 1 BvR 218/98, at 3b.

  226. 226.

    Cf. First, Vol. 29 Transplantation Proceedings 67, 69 (1997); cf. Gohh et al., Vol. 16 Nephrology Dialysis Transplantation 619, 621 (2001).

  227. 227.

    Epstein/Danovitch, Vol. 24 Nephrology Dialysis Transplantation 357, 358 (2009).

  228. 228.

    Daar et al., Vol. 11 Transplantation Review 95, 100 (1997).

  229. 229.

    Gutmann/Schroth (2002), p. 16, p. 121 f.; cf. Schreiber, in Rittner/Paul (ed.) (2005), p. 64.

  230. 230.

    Evans, Vol. 15 Journal of Medical Ethics 15, 19 (1989).

  231. 231.

    Danovitch, in Weimar/Bos/Busschbach (ed.) (2011), p. 392; cf. Gutmann, Vol. 15 Medizinrecht 147, 150 (1997); Gutmann (2011), p. 2 f.; cf. Swiss Dispatch of 12. September 2001 on a Federal Law on Transplantation of Organs, Tissues and Cells, p. 98.

  232. 232.

    This type of LOD has already been described in chapter “Comparative Analysis of European Transplant Laws Regarding Living Organ Donation”.

  233. 233.

    Bundestag printed paper 15/5050 (2005), p. 42, 73 f.

  234. 234.

    Menikoff, Vol. 29 The Hastings Centre Report 28, 28 (1999).

  235. 235.

    Menikoff, Vol. 29 The Hastings Centre Report 28, 28 (1999); Price (2010), p. 227 f.

  236. 236.

    German Federal Social Court [Bundessozialgericht], 10 December, 2003, Case No. B 9 VS 1/01 R, in Vol. 9 Juristenzeitung 464, 466 (2004); Gutmann/Schroth (2002), p. 15; Gutmann (2006), p. 33; Neft, Vol. 13 Neue Zeitschrift für Sozialrecht 519, 521 (2004); Nickel/Preisigke, Vol. 22 Medizinrecht 307, 308 (2004); Schroth, Vol. 9 Juristenzeitung 469, 470 (2004).

  237. 237.

    Hohmann (2003), p. 86.

  238. 238.

    de Klerk (2010), p. 14; Gutmann/Schroth (2002), p. 118; Veatch (2000), p. 187.

  239. 239.

    de Klerk (2010), p. 14.

  240. 240.

    Gutmann (2006), p. 33.

  241. 241.

    With regard to LOD, the aspect of whether the allocation is just and equal would only become relevant if the amount of unspecified LODs increases (Cf. Segev/Montgomery, Vol. 8 American Journal of Transplantation 1051, 1051 (2008)).

  242. 242.

    Cf. Bakker, in Price/Akveld (ed.) (1997), p. 29, who also states right away that it seems very unlikely that a surgeon would condemn a patient on the waiting list when he has the option for a LOD; German Association of Dialysis Patients’ motion before the German Federal Constitutional Court, 1999.; cf. Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 201 (2005).

  243. 243.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 211 (2005).

  244. 244.

    Information from T. Gutmann.

  245. 245.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 210 (2005).

  246. 246.

    Donnelly/Price (ed.) (1997), p. 127; Hilhorst in Weimar/Bos/Busschbach (ed.) (2008), p. 133.

  247. 247.

    This has already been clarified above on p. 170 ff.

  248. 248.

    Biller-Andorno, Vol. 5 Medicine, Health Care and Philosophy 199 (2002).

  249. 249.

    More precisely, 14% of the people who are waiting for a kidney transplant are South Asian, even though they comprise only 4% of the general population. The situation is similar with regard to African-Caribbean. Over 7% of the people waiting for a kidney transplant have this ethnicity, while they are only 2% of the general population (Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 62 f.; cf. Morgan/Deedat/Kenten, in Weimar/Bos/Busschbach (ed.), p. 100).

  250. 250.

    Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 62 f.; cf. Morgan/Deedat/Kenten, in Weimar/Bos/Busschbach (ed.), p. 100; Randhawa, in Weimar/Bos/Busschbach (ed.) (2008), p. 393.

  251. 251.

    Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 64; Randhawa, in Weimar/Bos/Busschbach (ed.) (2008), p. 399 ff.

  252. 252.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 403.

  253. 253.

    Randhawa, in Weimar/Bos/Busschbach (ed.) (2008), p. 392. With regard to this it has to be considered that non-Caucasians and Caucasians have a different genetic background. This often causes different tissue types, so that HLA matching is more difficult (Randhawa, in Weimar/Bos/Busschbach (ed.) (2008), p. 392).

  254. 254.

    Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 64; Randhawa, in Weimar/Bos/Busschbach (ed.) (2008), p. 394.

  255. 255.

    The United States is usually not considered here, but will be regarded at this point of time exceptionally to show the inequality of LODs with regard to minorities.

  256. 256.

    Arnason, Vol. 21 Hastings Center Report 13, 13 (1991); Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 403; First, Vol. 29 Transplantation Proceedings 67, 67 (1997); Myaskovsky et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 366; cf. Segev/Montgomery, Vol. 8 American Journal of Transplantation 1051, 1051 (2008). From 1988 until now, 79,530 Caucasians became living organ donors and 14,017 African Americans (US Department of Health & Human Services (2011)).

  257. 257.

    Ayanian et al., Vol. 341 The New England Journal of Medicine 1661, 1663 (2011); Myaskovsky et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 368.

  258. 258.

    Cf. Ayanian, Vol 341 New England Journal of Medicine 1661, 1663 (2011); Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 161 f. (2006).

  259. 259.

    Cf. First, Vol. 29 Transplantation Proceedings 67, 67 (1997); Myaskovsky et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 367.

  260. 260.

    Segev/Montgomery, Vol. 8 American Journal of Transplantation 1051, 1052 f. (2008).

  261. 261.

    Ayanian et al., Vol. 341 The New England Journal of Medicine 1661, 1668 (2011).

  262. 262.

    Roodnat et al., Vol. 89 Transplantation 1263–1269 (2010).

  263. 263.

    Maasdam et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 109.

  264. 264.

    Ibid., p. 110.

  265. 265.

    Cf. Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011); cf. Roodnat et al., Vol. 89 Transplantation 1263, 1268 (2010).

  266. 266.

    Cf. Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011).

  267. 267.

    Cf. Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011); Maasdam et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 110; Roodnat et al., Vol. 89 Transplantation 1263, 1267 (2010).

  268. 268.

    Cf. Maasdam et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 110.

  269. 269.

    Abouna, e.g., states that “[c]urrently most Islamic countries approve organ donation from living related donors” (Abouna, in Weimar/Bos/Busschbach (ed.) (2008), p. 320); cf. Bruzzone, in Weimar/Bos/Busschbach (ed.) (2008), p. 327; Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011).

  270. 270.

    Cf. Danovitch, in Weimar/Bos/Busschbach (ed.) (2011), p. 394.

  271. 271.

    Ismail et al., Vol. 14 Medicine, Health Care and Philosophy (2011).

  272. 272.

    Cf. Arnason, Vol. 21 Hastings Center Report 13, 15 (1991).

  273. 273.

    Price (2010), p. 221.

  274. 274.

    Cf. Gutmann, in Schroth et al. (ed.) (2005), Sec. 8, at 7; Swiss Dispatch of 12. September 2001 on a Federal Law on Transplantation of Organs, Tissues and Cells, p. 145.

  275. 275.

    Swiss Dispatch of 12. September 2001 on a Federal Law on Transplantation of Organs, Tissues and Cells, p. 145.

  276. 276.

    American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2924 (2000); Lamb, in Price/Akveld (ed.) (1997), p. 49.

  277. 277.

    Cf. Price (2000), p. 336.

  278. 278.

    WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, 2008, Guiding Principle 4.

  279. 279.

    Bundestag printed paper 15/5050 (2005), p. 42; Price (2010), p. 221; Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 152 (2006); Veatch (2000), p. 192.

  280. 280.

    Ross et al., Vol. 336 The New England Journal of Medicine 1752, 1755 (1997).

  281. 281.

    Ibid., 1754.

  282. 282.

    Bundestag printed paper 15/5050 (2005), p. 42.

  283. 283.

    Siegmund-Schultze (1999), p. 215.

  284. 284.

    Cf. Ross et al., Vol. 336 The New England Journal of Medicine 1752, 1755 (1997).

  285. 285.

    Gutmann/Schroth (2002), p. 118; Gutmann (2006), p. 32.

  286. 286.

    Cf. Gutmann (2011), p. 4.

  287. 287.

    Cf. Gutmann (2011), p. 4; Ross, for example, states that “[w]hile many individuals may have been disappointed that they could not help their potential intended recipient, some may have been relieved” (Ross, in Weimar/Bos/Busschbach (ed.) (2008), p. 184).

  288. 288.

    Donors with blood type 0 are universal donors and can donate to their intended recipient, no matter whether he has blood type A, B or AB if there is no positive cross-match (Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 159 (2006)).

  289. 289.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 155 f.

  290. 290.

    Bundestag printed paper 15/5050 (2005), p. 47; Fortin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 422 f.; Price (2010), p. 222.

  291. 291.

    Bundestag printed paper 15/5050 (2005), p. 47.

  292. 292.

    Ross, in Weimar/Bos/Busschbach (ed.) (2008), p.186.

  293. 293.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 157 (2006).

  294. 294.

    Ibid., p. 157 f.

  295. 295.

    Fortin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 423; Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 157 f. (2006).

  296. 296.

    Ross, in Weimar/Bos/Busschbach (ed.) (2008), p.186.

  297. 297.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 158 (2006); Ross, in Weimar/Bos/Busschbach (ed.) (2008), p. 186.

  298. 298.

    Fortin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 422.

  299. 299.

    Cf. Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 158 (2006).

  300. 300.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 154 (2006).

  301. 301.

    Bundestag printed paper 15/5050 (2005), p. 42.

  302. 302.

    Cf. Riedel, in Rittner/Paul (ed.) (2005), p. 75.

  303. 303.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 401.

  304. 304.

    Gutmann (2006), p. 37.

  305. 305.

    Cf. Montgomery et al., Vol. 368 The Lancet 419, 419 (2006); Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 184 (2011); cf. Roodnat et al., Vol. 10 American Journal of Transplantation 821, 821 (2010); Zuidema et al. state with regard to the Dutch cross-over programme that approximately 50 % of the enrolled donor-recipient couples remain unmatched (Zuidema et al., in Weimar/Bos/Busschbach (ed.) (2008), p. 307).

  306. 306.

    Gutmann (2006), p. 35 f.

  307. 307.

    Ibid., p. 38.

  308. 308.

    Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 184 (2011).

  309. 309.

    Dor et al., 2011 Transplantation 1, 1 f.

  310. 310.

    Cf. Henderson et al., Vol. 3 American Journal of Transplantation 203, 203 (2003).

  311. 311.

    P. 176 f.

  312. 312.

    P. 169.

  313. 313.

    Massey et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 370; Price (2010), p. 213; Taylor et al., in Gutmann et al. (ed.) (2004), p. 206.

  314. 314.

    Bundestag printed paper 15/5050 (2005), p. 74.

  315. 315.

    Ibid., p. 45.

  316. 316.

    Bundestag printed paper 15/5050 (2005), p. 44; cf. Riedel, in Rittner/Paul (ed.) (2005), p. 73.

  317. 317.

    Bundestag printed paper 15/5050 (2005), p. 44. This has been stated with regard to deceased donation as well, namely that promoting unspecified LOD, what would be necessary to actually gain a considerable amount of people to perform unspecified LOD, would have a negative effect on the acceptance and willingness with regard to deceased donation (Riedel, in Rittner/Paul (ed.) (2005), p. 73).

  318. 318.

    Gutmann/Schroth, in Oduncu/Schroth/Vossenkuhl (ed.) (2003), p. 276.

  319. 319.

    Cf. Fortin/Dion-Labrie/Doucet, in Weimar/Bos/Busschbach (ed.) (2008), p. 353; cf. Glannon, Vol. 343 British Medical Journal (2011); Gutmann (2006), p. 40.

  320. 320.

    Cf. Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 183 (2011); Price (2010), p. 214.

  321. 321.

    Price (2010), p. 214.

  322. 322.

    Gutmann (2006), p. 29 f.

  323. 323.

    First, Vol. 29 Transplantation Proceedings 67, 68 (1997); Price (2000), p. 316.

  324. 324.

    Cf. Danovitch, in Weimar/Bos/Busschbach (ed.) (2011), p. 391, who states as an experience from the United States that “[r]ates of related donation have remained steady while unrelated, non-commercially motivated donation has become a widely accepted modality.”

  325. 325.

    Gutmann (2006), p. 44.

  326. 326.

    Ibid., p. 24.

  327. 327.

    Bundestag printed paper 15/5050 (2005), p. 48.

  328. 328.

    Bundestag printed paper 15/5050 (2005), p. 48; Riedel, in Rittner/Paul (ed.) (2005), p. 74 f.

  329. 329.

    Dor et al., 2011 Transplantation 1, 3; cf. Glannon/Ross, Vol. 11 Cambridge Quarterly of Healthcare Ethics 153, 154 (2002); Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 197 (2005); Wright et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 413.

  330. 330.

    Cf. Veatch, Vol. 23 Journal of Medicine and Philosophy 456, 456 (1998) (with regard to directed deceased donation).

  331. 331.

    Ross, Vol. 30 The Journal of Law, Medicine and Ethics 440, 441 (2002); cf. Spital, Vol. 76 Transplantation 1252, 1253 (2003).

  332. 332.

    The view of the Committee of the Dutch Health Council is stated in Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 199 (2005).

  333. 333.

    Ibid., p. 201.

  334. 334.

    Cf. Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 404; cf. Roff, Vol. 33 Journal of Medical Ethics 437, 438 (2007); cf. Truog, Vol. 353 New England Journal of Medicine 444, 445 (2005).

  335. 335.

    Cf. Ankeny, Vol. 10 Cambridge Quarterly of Healthcare Ethics 387, 395 (2001); cf. Kluge, Vol. 19 Hastings Center Report 10, 12 ff. (1989); cf. Spital, Vol. 76 Transplantation 1252, 1254 (2003); cf. Veatch, Vol. 23 Journal of Medicine and Philosophy 456, 461 (1998) (with regard to directed deceased donation).

  336. 336.

    The view of the Committee of the Dutch Health Council is stated in Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 202 (2005).

  337. 337.

    Cf. Epstein, in Weimar/Bos/Busschbach (ed.) (2011), p. 139; Truog, Vol. 353 New England Journal of Medicine 444, 445 (2005).

  338. 338.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 198 (2005).

  339. 339.

    Gutmann (2006), p. 45.

  340. 340.

    Cf. Ankeny, Vol. 10 Cambridge Quarterly of Healthcare Ethics 387, 393 (2001); cf. Kluge, Vol. 19 Hastings Center Report 10, 13 (1989); cf. Spital, Vol. 76 Transplantation 1252, 1255 (2003).

  341. 341.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 205 f. (2005).

  342. 342.

    Hilhorst, in Weimar/Bos/Busschbach (ed.) (2008), p. 138 f.

  343. 343.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 205 (2005).

  344. 344.

    Cf. Spital, Vol. 76 Transplantation 1252, 1255 (2003); Truog, Vol. 353 New England Journal of Medicine 444, 445 (2005); Veatch, Vol. 23 Journal of Medicine and Philosophy 456, 461 (1998) (with regard to directed deceased donation).

  345. 345.

    Veatch, Vol. 23 Journal of Medicine and Philosophy 456, 462 (1998) (with regard to directed deceased donation).

  346. 346.

    Cf. Spital, Vol. 76 Transplantation 1252, 1252 (2003).

  347. 347.

    Cf. Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 186; Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 201 (2005).

  348. 348.

    Cronin et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 403.

  349. 349.

    Hilhorst, Vol. 8 Ethical Theory and Moral Practice 197, 202 (2005).

  350. 350.

    Ibid.

  351. 351.

    Ibid., p. 203.

  352. 352.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 402; Roodnat et al., Vol. 10 American Journal of Transplantation 821, 822 (2010); Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 166 (2006).

  353. 353.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 166 (2006).

  354. 354.

    Bundestag printed paper 15/5050 (2005), p. 48; Gutmann (2006), p. 39; Health Council of the Netherlands (2007); Price (2010), p. 224; cf. Ross/Zenios, Vol 4 American Journal of Transplantation 1553, 1553 (2004).

  355. 355.

    Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 83 (2006); Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 159 (2006). That causes that they can donate to their intended recipient, regardless of whether he has blood type A, B or AB unless there is a positive cross-match (Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 159 (2006)).

  356. 356.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 166 (2006).

  357. 357.

    Cf. Bundestag printed paper 15/5050 (2005), p. 48; cf. Gutmann (2006), p. 39; cf. Health Council of the Netherlands (2007); Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 185 (2011); cf. Price (2010), p. 224; Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 161 f. (2006); cf. Ross/Zenios, Vol 4 American Journal of Transplantation 1553, 1553 (2004).

  358. 358.

    Rawls (1971); Rawls (1975), p. 94; cf. Ross, in Weimar/Bos/Busschbach (ed.) (2008), p. 187; see also Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 84 (2006) with regard to list-paired exchange, though.

  359. 359.

    Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 166 f. (2006).

  360. 360.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 402; cf. Ross, in Weimar/Bos/Busschbach (ed.) (2008), p. 187; Roodnat et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 386; Wright et al., in Weimar/Bos/Busschbach (ed.) (2011), p. 413.

  361. 361.

    Montgomery et al., Vol. 368 The Lancet 419, 419 ff. (2006).

  362. 362.

    Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 185 (2011).

  363. 363.

    Weimar et al., Vol. 368 The Lancet 987, 987 (2006).

  364. 364.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 402.

  365. 365.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 402; Roodnat et al., Vol. 10 American Journal of Transplantation 821, 825 (2010).

  366. 366.

    Cronin, in Weimar/Bos/Busschbach (ed.) (2011), p. 402.

  367. 367.

    Gutmann, in Schroth et al. (ed.) (2006), p. 249.

  368. 368.

    American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2923 (2000); den Hartogh (2008), p. 119; Hilhorst in Weimar/Bos/Busschbach (ed.) (2008), p. 136; Morrissey, Vol. 6 American Journal of Transplantation 434, 434 (2006); Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 159 (2006); Veatch (2000), p. 187.

  369. 369.

    As already mentioned, in more than 2/3 of the incompatible cross-over pairs, the recipient has blood type 0. If one of those pairs is considered for the list-paired-exchange, the recipient with blood type 0 is given priority for the next matching blood-type 0 organ donated post-mortem. As a consequence, the organs donated post-mortem that are available to other patients on the waiting list with this blood type decrease. Like unspecified non-directed donation catalysing cascade exchanges, this also leads to a disadvantage for patients on the waiting list with blood type 0, who do not have a living organ donor that participates in the list-paired exchange (American Medical Association, Vol. 284 The Journal of the American Medical Association 2919, 2923 (2000); Bundestag printed paper 15/5050 (2005), p. 48; Dondorp, in Weimar/Bos/Busschbach (ed.) (2008), p.112 f.; Gutmann (2006), p. 39; Health Council of the Netherlands (2007); Price (2010), p. 224; Ross, Vol. 16 Kennedy Institute of Ethics Journal 151, 161 f. (2006); Ross/Zenios, Vol 4 American Journal of Transplantation 1553, 1553 (2004); cf. Gentry/Segev/Montgomery, Vol. 5 American Journal of Transplantation 1914, 1914 f. (2005).

  370. 370.

    Rawls (1971); cf. Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 84 (2006). It is claimed that it has to be distinguished between ABO-compatible and ABO-incompatible list-paired exchanges, because these different types of exchanges have different ethical consequences. In cases of ABO-compatibility between potential donor and intended recipient, they have the same blood type, but a different crossmatch that prevents a direct LOD. An exchange can then be considered as a simple replace of a deceased donor kidney with the relevant blood type with a kidney from a living donor with the same blood type. Since a kidney donated by a living person has several advantages in comparison to a kidney donated post-mortem, it can be assumed that patients on the waiting-list would prefer a living kidney donation. That is considered as moral justification for ABO-compatible list-paired exchanges. In ABO-incompatible exchanges, in contrast, the potential donor will usually be of blood group A, B or C and therefore donate a corresponding organ to the waiting list, while the recipient will regularly be of blood type 0 and consequently removes a corresponding organ from the waiting list. This will typically cause a disadvantage for patients with blood type 0 who are on the waiting list (Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 83 (2006); Ross/Woodle, Vol. 69 Transplantation 1539, 1540 f. (2000)).

  371. 371.

    Gentry/Segev/Montgomery, Vol. 5 American Journal of Transplantation 1914, 1920 (2005); den Hartogh (2008), p. 83; Price (2010), p. 224.

  372. 372.

    den Hartogh (2008), p. 83; Price (2010), p. 224.

  373. 373.

    Health Council of the Netherlands (2007); Price (2010), p. 224.

  374. 374.

    Cf. Dondorp, in Weimar/Bos/Busschbach (ed.) (2008), p.115; Nickel/Preisigke, Vol. 22 Medizinrecht 307, 309 (2004); Riedel, in Rittner/Paul (ed.) (2005), p. 75.

  375. 375.

    Bundestag printed paper 15/5050 (2005), p. 48.

  376. 376.

    Cf. Gutmann/Schroth (2002), p. 120; Ross/Zenios, Vol 4 American Journal of Transplantation 1553, 1554 (2004).

  377. 377.

    Gutmann/Schroth (2002), p. 120; Gutmann (2006), p. 39; Ross/Zenios, Vol 4 American Journal of Transplantation 1553, 1554 (2004); Veatch (2000), p. 200. The experts who distinguish between ABO-compatible and ABO-incompatible exchanges suggest allowing list-paired exchanges only in cases of ABO-compatibility (Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 84 (2006)).

  378. 378.

    Dondorp, in Weimar/Bos/Busschbach (ed.) (2008), p. 112.

  379. 379.

    Cf. Dondorp, in Weimar/Bos/Busschbach (ed.) (2008), p. 112; cf. Hilhorst in Weimar/Bos/Busschbach (ed.) (2008), p. 136.

  380. 380.

    Cf. Dondorp, in Weimar/Bos/Busschbach (ed.) (2008), p. 113 f.; cf. Hilhorst in Weimar/Bos/Busschbach (ed.) (2008), p. 136.

  381. 381.

    Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 87 (2006).

  382. 382.

    Frade et al., Vol. 40 Transplantation Proceedings 677, 679 (2008); cf. Gutmann (2006), p. 29; cf. Lennerling et al., Vol. 19 Nephrology Dialysis Transplantation 1600, 1603 (2004); Schneewind/Sedlmayer, in Schroth et al. (ed.) (2006), p. 39 & p. 44; cf. Waterman et al., Vol. 16 Progress in Transplantation 17, 17 (2006).

  383. 383.

    Gutmann (2011), p. 4.

  384. 384.

    Gutmann (2006), p. 25 f.; Roff, Vol. 33 Journal of Medical Ethics 437, 440 (2007).

  385. 385.

    Borowsky, in Meyer (ed.) (2011), Art. 3 at 43.

  386. 386.

    Höfling, in Tettinger/Stern (ed.) (2006), Art. 3 at 17.

  387. 387.

    Cf. Gutmann (2006), p. 26 ff.

  388. 388.

    Cf. Evans, Vol. 15 Journal of Medical Ethics 17, 19 (1989); cf. Patel/Chadha/Papalois, Vol. 3 Experimental and Clinical Transplantation 181, 185 (2011).

  389. 389.

    Art. 2 (1) Charter of Fundamental Rights of the European Union.

  390. 390.

    Ibid., Art. 3 (1).

  391. 391.

    Ackerman/Thistlethwaite/Ross, Vol. 6 American Journal of Transplantation 83, 86 (2006).

  392. 392.

    This has been discussed at the 2011 ELPAT-Working Group on Legal Boundaries Conference in Berlin.

  393. 393.

    Art. 14 1 Federal Act on the Transplantation of Organs, Tissues and Cells.

  394. 394.

    Fateh-Moghadam (2008), p. 165.

  395. 395.

    Sec. 13 ff. Human Tissue Act; information from D. Price.

  396. 396.

    Fateh-Moghadam (2008), p. 292.

  397. 397.

    This is criticised by Choudhry et al., Vol. 29 Journal of Medical Ethics 169, 2003.

  398. 398.

    1 (1) Human Tissue Act 2004, Schedule 2 – The Human Tissue Authority.

  399. 399.

    Sec. 8 III 2 Act on the donation, removal and transplantation of organs.

  400. 400.

    Ibid.

  401. 401.

    Cf. Daar et al., Vol. 11 Transplantation Review 95, 99 (1997); cf. Evans, Vol. 15 Journal of Medical Ethics 17, 20 (1989); Gutmann/Schroth (2002), p. 61; Gutmann (2006), p. 47; cf. Hilhorst et al., Vol. 24 Transplant International 1164, 1168 (2011).

  402. 402.

    Cf. Gutmann et al., Terasaki (ed.) (1995), p. 356; Land, Vol. 2 Transplant International 168, 173 (1989) with regard to spouse-to-spouse donation.

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    Leonie Lopp

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Lopp, L. (2013). Analysis of the Normative Arguments That Dominate the Policy Arena About Necessity and Legitimacy of Legal Restrictions in Living Donor Transplantation. In: Regulations Regarding Living Organ Donation in Europe. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-33799-4_4

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