On the face of it, there seems to be little reason to question the ethics behind transplanting organs. Apparently one of the greatest achievements of modern surgery, tens of thousands of people are given a new lease on life through the selfless altruism of others who choose to find hope in the midst of tragedy, literally giving of their own bodies in the effort to save others.
But this really is more appearance than fact, because right under the surface lurks a morass of ethical dilemmas and controversies which have threatened to undermine the entire practice of transplanting organs. These problems have only grown in scope as new medical advances have been made in recent years, with little prospect of an easy resolution any time soon.
What are the sources of organs used in transplantation? How can we make the procurement system more efficient? Should we pay for organs? Should someone who has already received one transplant be allowed a second? Should alcoholics be given liver transplants? Are transplants really worth the tremendous costs?
Lying at the heart of most of these ethical debates are the twin questions of procurement and distribution. How do we get organs, and how do we decide who will receive the implants? There are always fewer donors than there are potential recipients, and that's why some 5,000 people die every year while waiting for new organs.
As far as distribution goes, everyone has to be able to pay in order to receive a transplant - and that is why many poor people never undergo the process. Overall, transplants are a procedure for people with lots of money or lots of insurance. But should the choice of who gets new organs also depend upon social worth? That is to say, should a doctor get a new organ but a prisoner be refused? What about alcoholics - should they be denied new livers because they "deserve" what has happened to them?
Procurement is also a problem, especially because not everyone agrees when "death" occurs. Does it happen when the heart and lungs stop, when the entire brain ceases to have activity, or just when the "higher functions" stop? This is an important issue, because no one wants to take organs from someone still "alive," but waiting for "whole brain death" can leave many organs unusable.
And what about the question of consent? Right now, someone has to directly agree for transplantation in order for organs to be removed - but should the policy be changed so that consent is automatically assumed unless someone says "no"? Because most people can live just fine with only one kidney, it is something which can be donated while you are still alive - but should you be allowed to sell it, or is it not possible for there to be genuine consent in such a grave matter?
Even the idea that organ transplants represent a great achievement in medicine is somewhat faulty. As Ronald Munson explains in this book "Raising the Dead," real medical miracles involve causing a person's illness to disappear - the example of antibiotics is the clearest and most common. Organ transplants do not do this however: because a recipient has to take anti-rejection drugs for the rest of their lives, always fearing an infection which will get past their now-suppressed immune system, transplants simply trade one acute illness for another chronic condition.
Transplants aren't a miracle, but they do work - ideally, they are a stopgap measure until something more permanent and effective can be developed. Fortunately, there does exist such a possibility on the horizon, but it causes even more controversy than anything discussed so far. Eventually, people may be able to simply have replacement organs grown from their own DNA, eliminating matters of procurement, distribution, and even organ rejection. But this will apparently require the use of embryonic stem cells developed with cloning technology, opening up a host of different ethical debates.
These two recent books are very complimentary, each with their own strengths and weaknesses. Munson's book does not cover nearly as much ground as Caplan's, but it does cover all of the most basic and most important issues. Munson also makes extensive use of examples of how people - mostly real, but sometimes hypothetical - have to deal with organ transplants, both as donors and as recipients.
This concretizes the ethical arguments and helps to make sure that we don't forget that this isn't an simply an abstract discussion about ethics. What we are dealing with, and what we should not forget, is that this is a discussion about life and death - who lives, who dies, and why. There are real people out there who are suffering, and decisions about the ethics of organ transplants will have a tremendous impact upon them.
Because Munson's book is newer, it covers a few recent topics like the aforementioned issues regarding stem cell research and the growth of new organs. Munson's book is also aimed at people who don't have much experience either with medicine or with ethical philosophy, making it a good introduction for the average reader.
However, Caplan's book, based upon the contributions from such a wide variety of professionals in medicine and bioethics, ends up providing a great deal more information - both over a wider range of topics and with more depth. The 34 articles are usually reprints form medical journals, and as such they are generally written for an audience of medical professionals. Lay readers can still get a lot out of it, but they will need to read a bit more carefully. Thus, Caplan's is superior for anyone seeking to study the topic more thoroughly - it would, for example, be perfect for a class on bioethics.
More About These Books:
Raising the Dead: Organ Transplants, Ethics and Society, by Ronald Munson. Published by Oxford University Press.
The Ethics of Organ Transplants: The Current Debate, ed. Arthur L. Caplan and Daniel H. Coehlo. Published by Prometheus Books.