The complex arrangements needed to stimulate and maintain a growing supply of transplantable organs amount to a delicate social system. Any perturbation in the system (arising, for example, from removing organs over the family’s objection, a premature declaration of death, or an apparently discriminatory allocation practice) can have a marked and immediate impact on the willingness to donate and therefore on the supply of organs. It follows that a successful system of organ recovery, whether from deceased donors or live donors, requires continuous and unstinting efforts to promote and nurture public understanding, which is a necessary condition for trustworthiness and, therefore, for public trust.
Policies and practices designed to increase organ donation may properly appeal to a variety of motivations for donation, including altruism, community spirit, and reciprocity.
People donate organs for a variety of reasons. Individual and familial decisions about organ donation are often grounded in altruism, a spirit of community or solidarity, reciprocity (the recognition that everyone is a potential recipient as well as a potential donor), a desire to gain some meaning out of a tragedy (e.g., a parental decision to donate a deceased child’s organs), or some combination of these and other motivations. Cultural and religious traditions differ in the predominance of one of these values or another. The committee believes that these motivations are all morally acceptable and compatible and that a system of organ recovery and distribution may properly appeal to all of them.1
Confusion has marred much of the discussion of altruism in relation to donation of organs from deceased donors (deceased organ donation), perhaps because of an assumption that a donation or gift system (under state versions of the Uniform Anatomical Gift Act) is necessarily grounded in altruism. However, the ordinary experience of gift-giving among families or friends should be sufficient to dispel that notion—the motives of gift givers are often quite complex and may reflect a combination of generosity, perceived obligation, and a desire to be regarded with favor. Nevertheless, altruism—a motivation for action that is concerned only about others’ welfare—is sometimes viewed as the predominant and only acceptable motivation for donation in the current system.
It is important to dispel this confusion between “donation” and “altruism” because it inhibits successful resolution of ethical disputes regarding
The only motivation that is not currently acceptable is the prospect of financial benefit. Principles bearing on financial motivation are discussed in Chapter 8.