The Metaphysics and Ethics of Vital Organ Donation
Nolan, Catherine Ann
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Breakthroughs in organ transplantation technology during the last several decades have led both to a greater ability to help dangerously ill patients and to a rash of new and pressing ethical questions. What is death, and how best can we diagnose it in order to retrieve organs in a viable condition? Must we wait until a patient is dead before removing organs, especially if these are unpaired vital organs? Can we kill one patient for the sake of others? Because there is a constant demand for organs which are in very short supply, answers to these and many related questions have taken on a particular urgency: answering these questions will save lives, and quite possibly prevent us from taking lives unjustifiably. This dissertation concludes that the Dead Donor Rule--the ethical claim that we should only remove unpaired vital organs from dead donors--is inappropriate for guiding unpaired vital organ donation. The Dead Donor Rule (DDR) is intended to allow viable organs to be taken as soon as the patient is dead, while protecting patients from being killed for the sake of (or by) retrieving their organs. I argue, however, that it fails on both counts. First, during the time that a patient's vital organs are still viable, we cannot prove satisfactorily that patients are indeed dead. Second, vital organs can--at least in theory--be removed from a living patient without killing the patient, as long as the vital organs are no longer playing a role in maintaining the patient's body. I conclude that the DDR should be rejected as a guideline in organ retrieval, since following the DDR prevents us from retrieving vital organs during the window of time in which they are viable, even when it would neither kill nor further endanger the patient. If we hope to transplant vital organs in an ethical manner, we should stop attempting to diagnose death on the operating table. Instead, we should try to identify the moment when the individual organs we want to retrieve will not recover without intervention. I introduce my argument with the Uniform Determination of Death Act (UDDA), which gives two criteria for death--the circulatory/respiratory criterion, and the brain-death criterion--and in turn leads to two forms of organ procurement: heart-beating and non-heart-beating. Particularly important is the interpretation of "irreversibility" in the UDDA's criteria, which I continue to explore in the second, third, and fourth chapters. Given the way we use "death" in law, medicine, theology, and philosophy, I argue in the second chapter that death is irreversible in a very specific way. Next, I expand on the notion of the irreversibility of death by examining some popular definitions of death (and, in some cases, theories of the person) in order to see if they can accommodate our intuitions and the conclusions I have derived from these intuitions. In the fourth chapter, I conclude the first part of my argument by criticizing the criteria for death given by the UDDA: satisfactory circulatory/respiratory criteria for death cannot be met while vital organs are still viable. The second part of my argument--that we can break the DDR without killing patients--is introduced in my fifth chapter, where I examine the ethical repercussions of removing vital organs from living patients and patients who have not been determined to be dead. I conclude: in order to justify non-heart beating organ donation, ensuring that we are neither killing nor unduly hastening the death of the donor is a more achievable, moral, and productive goal than ensuring that the donor's death has occurred.