might further enhance the system or provide incentives for more individuals or families to consent to organ donation.

In 2004, the Health Resources and Services Administration (HRSA) and The Greenwall Foundation asked the Institute of Medicine (IOM) to study the issues involved in increasing the rates of organ donation. This report is the result of a 16-month study conducted by an IOM committee composed of experts in the fields of bioethics, law, health care, organ donation and transplantation, economics, sociology, emergency care, end-of-life care, and consumer decision making.


The committee carefully examined the ethical and societal implications of a range of proposals to increase the rates of organ donation by deceased donors in the United States and also considered several of the ethical issues regarding organ donation by living donors.

The committee’s deliberations were undertaken from the perspective of the shared interest that all members of society have in access to organs for transplantation should the need arise. The perspectives and principles guiding the committee’s report are as follows:

  • Common stake in a trustworthy system: Everyone in the national community has a common stake in the creation and maintenance of an effective and trustworthy system for providing timely access to transplantable organs and, if organs are scarce, in increasing the number of organs recovered and distributing them fairly.

  • Acceptable appeals for donations: Policies and practices designed to increase organ donation may properly appeal to a variety of motivations for donation, including altruism, community spirit, and reciprocity.

  • Respect for persons: Policies and practices designed to increase the rates of organ donation and the recovery of organs from deceased individuals must be compatible with four limiting conditions deeply rooted in the cultural, religious, and legal traditions of the United States: (1) respect for the moral worth and dignity of each human being; (2) respect for each individual’s right to govern the disposition of his or her body after death, including the voluntary choice of whether or not to donate organs; (3) respect for the remains of human beings, as represented in particular cultural and religious practices; and (4) respect for the wishes and feelings of families of deceased individuals.

  • Fairness: Policies and practices designed to increase the supply of transplantable organs need to be fair in their distribution of both benefits and burdens, with particular attention to their impacts on disadvantaged groups.

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