Taking from the Dead: an Examination of Cadaveric Organ Procurement

Abstract

Within the last 40 years, post mortem organ transplantation has emerged as a reliable and effective life-saving medical therapy. Since an integral part of organ transplantation involves organ donors, this dissertation considers a series of interrelated ethical and policy questions on donor autonomy. In Chapter 1, I consider presumed consent policies of organ procurement, which presume that people have consented to organ donation if they fail to “opt-out” of donation. I give and defend a novel argument, which implies that the main argument typically offered in favor of a presumed consent policy is unsound. In Chapter 2, I discuss the often-cited “family veto” problem. This problem emerges when a person makes a decision to be an organ donor but after her death her family blocks her decision. Many have argued that the family veto is a clear violation of patient autonomy, but I develop a novel argument that the family veto does not violate the autonomy of deceased donors. In Chapter 3, I consider one of the most fundamental questions in organ procurement policy: must we obtain a patient’s consent before removing her organs for transplantation? I argue that obtaining patient consent before organ removal is not strictly necessary because there are other ways to properly respect patient autonomy that do not involve obtaining consent. In this chapter, I also argue that the kind of consent obtained from donors by current U.S. policy fails to respect patient autonomy. Finally, in Chapter 4, I consider the ethical merits of a conscription policy, a policy on which organs are automatically removed from a person’s body after her death, regardless of whether she decided to donate or not. There is a seemingly powerful argument which demonstrates that implementing an organ conscription policy is a moral obligation, but I suggest that it can be defeated by showing that organ conscription violates at least some people’s posthumous rights regarding their bodies. To do this, I develop an account of posthumous rights and argue that people’s posthumous rights outweigh the interests of living patients who need organs to continue living.