Organ donation, Past, Present and Future

1
Organ donation, Past, Present and Future

• Bobbie Farsides
• Professor of Clinical and Biomedical Ethics
• Brighton and Sussex Medical School

2
Declaration of Interests

• Member of the Department of Health Taskforce on
  Organ Donation and and Specialist Advisor to
  House of Lords European Affairs Sub-committee
  currently investigating organ donation issues
• Views expressed today are my own unless otherwise
  stated

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The significance of transplantation

• The ancient dream of successful organ
  transplantation was finally realised 50 years
  ago, on December 23, 1954, at the Peter Brent
  Brigham Hospital in Boston. Over the subsequent
  half century, the separate disciplines of
  clinical transplantation and transplant
  immunology have made remarkable progress. The
  story of the convergent evolution of these two
  fields represents one of modern medicines most
  important advances.
• Doyle, Lechler and Turka
• Journal of the American Society of Nephrology 15
• Pp 2965-2971, 2004

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Why buy into organ donation?

• Life saving
• Life enhancing
• Cost effective
• Emotively powerful

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Ethical interest in organ donation

• Early focus on the recipient
• Involvement in research -
• Refusal of treatment ordinary extraordinary
  means distinction
• Allocation of scarce resources

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Shift of emphasis to the donor

• Altruism influence of Richard Titmusss The
  Gift Relationship (1970)
• Criteria of death - brain stem death
• Advance statements
• Consent

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Cultural issues

• Definitions and rituals around death
• Evolving models of communication
• Communitarianism versus individualism
• Body part scandals

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A philosophical battleground?

• Consequentialists versus Deontologists
• The meaning of best interests

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Current issues

• What do we do in the face of scarcity a
  resource allocation issue?
• Opting in
• Mandated choice
• Required request
• Opting out
• Live donation
• Unrelated live donation
• Market
• Survival lottery

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How do we distribute the available benefits?

• Efficiency
• Fairness
• Blame and responsibility
• Reciprocity

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What can we do?

• This is a practical and empirical question which
  formed a large part of the work of the Taskforce

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What ought we to do?

• Requires a wider debate
• What are we entitled to do in order to increase
  and fairly distribute the benefits associated
  with organ donation?
• What can we require of others in order to secure
  these benefits?

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The others

• Potential donors
• Families
• Health Care professionals
• Communities

14
Future

• Round full circle to the age of pioneers and new
  frontiers
• Major challenge for health care professionals and
  citizens
• The age of looking forward and hopefully working
  together