Focus
Spotlight
March 18, 2002
The Anatomy of Organ Donation
At the recent Medical Ethics forum titled "Organs for Sale? The Economics of Altruism," held on March 14, Walter Robinson, HMS assistant professor of medical ethics, outlined the complex medical issues involved in organ donation. In an environment where the demand for organs so outpaces the supply, should financial incentives be offered to increase the number of organ donor recruits? Is the selling of organs a legitimate capitalist activity or is it barbarism? A panel of distinguished physicians and anthropologists, experts in the field of organ donation, debated these issues over the course of two hours in the Walter Amphitheater.
In a March 14 medical ethics forum on the economics of organ donation, panelists agreed that a critical need exists for research on the widespread resistance to becoming an organ donor. Speakers were (l to r) Margaret Lock, Nancy Scheper-Hughes, Clive Callender, Frank Riddick, and moderator Walter Robinson. Photo by Bob Jacques, HMS Media Services
According to Robinson, the twin issues of organ donation and transplantation are ones that occupy society's fantasies, hopes, and fears. Robinson, who is also a lung transplant physician at Children's Hospital, said that a simple Internet search using the terms organ donor and transplant produces links to slasher movie sites that stand in stark contrast to the medical community's desired image of organ donation as the gift of life. Robinson stressed the importance of understanding these contrasting cultural messages in order to increase the number of organ donors. He argued that all efforts to address organ supply and demand must be guided by the cultural understanding of issues including death, body integrity, and choice.
Frank Riddick, chair of the American Medical Association's council on ethics, described the association's opposition to any plan that would pay living donors for organs but its willingness to consider financial incentives to people who list themselves as future donors. Clive Callender, transplant surgeon and chair of the United Network for Organ Sharing, addressed the history of institutional racism in American medicine. He spoke of the differences of opinion among cultures and subcultures in minority communities on the issue of organ donation and stressed the importance of focus groups to inform public education efforts and recruitment activities.
Warning against the slippery slope of financial incentives, Nancy Scheper-Hughes, professor of anthropology at the University of California at Berkley and director of Organs Watch, provided dramatic accounts of the invisible suffering of the poor in developing countries who have been victimized by black market organ brokers. She said that in places like the Philippines, body parts might be a poor person's only asset. Margaret Lock, professor of anthropology at McGill University, described the importance of human contact between donor families and donor recipients, citing her ethnographic research on organ donation. Unfortunately as much as donor families long to know how their loved ones' organs benefited another, the recipients struggle with such contact, knowing that their good fortune was the result of another's misfortune.
The panelist described how biomedical and public health advances have contributed to both the increased demand for and decreased supply of donor organs. As transplant services have broadened their sites in terms of the number of individuals deemed appropriate candidates for organ transplantation surgery, the number of people on waiting lists in the U.S. now stands at 80,000. At the same time a reduction in traffic accidents and improved trauma interventions have realized decreased numbers of people who experience brain death. That number has remained a fairly constant 14,000 over the course of the past three years. But despite educational efforts to increase the number of future organ donors, only 6,000 of those declared brain dead each year actually do become donors. All agreed that there is a critical need for research to determine the reasons behind society's apparent resistance to organ donation.
--Mary Anne Macaulay