the permissibility of various approaches for increasing the donation rate. For example, one commentator has stated that “[t]he voluntary decision to donate must be based on altruistic motives; otherwise, it is not permitted” (Prottas, 1994, p. 50). This line of thinking is based on the assumption that altruism and financial gain are the only possible motivations for authorizing recovery of an organ and that, because our system has ruled out financial motivation, a gift of an organ must be based on altruism. This proposition, if it were true, would preclude the use of any sort of incentive, or appeal to self-interest, such as giving people who have recorded their intention to donate preferred status as recipients. It also implies that organ procurement organizations should be ascertaining families’ motivations for donation, a task that they do not currently undertake as long as financial compensation does not appear to be involved.
Another analyst insists that “[o]rgan procurement activities in the United States are based on altruism. Out of their compassion for others, people agree to donate the organs of a deceased relative” (Evans, 1993, p. 3113). In fact, however, it is not really known, and it may not be possible to determine, what actually motivates people to donate organs. It seems likely, though, that people may have all sorts of reasons for donating organs. Altruism, including feelings of compassion for people in need, is clearly an important motivation for many donors. Other motives, however, as noted, may include a strong sense of communal solidarity; a sense of obligation, perhaps based on reciprocity (e.g., the Golden Rule); a desire to find redemptive meaning in a tragic set of circumstances; or a desire for praise, honor, and the like. Policies and practices aimed at increasing the rates of donation may properly appeal to all of these motivations. By overemphasizing altruism, however, the system of organ recovery has often neglected other powerful motivating reasons that could connect and align the individual’s and family’s interests more closely with the interests of potential recipients of donated organs. Instead, it has tended to view these interests as totally separate. As a result, organ donation has been praised as a highly disinterested, sacrificial, and heroic act that may appear to be out of the ordinary person’s reach because it is so demanding. The act of donation is voluntary, in the sense that others cannot claim it as a right. This does not mean, however, that altruism is the only possible or acceptable motivation or that donation policies should appeal only to altruism.
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