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All Donations Should Not Be Treated Equally: A Response to Jeffrey Kahn's Commentary

Published online by Cambridge University Press:  01 January 2021

Lainie Friedman Ross
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Extract

Jeffrey Kahn and I agree that organ donation by altruistic strangers is acceptable, and that the organ procured this way ought to be allocated equitably. Our agreement in principle, however, is challenged in the details of its application. Specifically, I want to focus on three issues raised by Kahn that merit further discussion: whether relationships matter; how kidneys should be allocated; and the ethical acceptability of the expanded donor pool.

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Article
Information
Journal of Law, Medicine & Ethics , Volume 30 , Issue 3 , Fall 2002 , pp. 448 - 451
Copyright
Copyright © American Society of Law, Medicine and Ethics 2002

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References

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It may be that we should question this policy for cadaveric organs as well, but I will limit my comments to living donors. I would like to thank Carol Stocking, Ph.D., for pushing me on this issue and Glannon, Walter, Ph.D., for helping me to critically examine the ethics raised by this issue.Google Scholar
Kant, I., Groundwork of the Metaphysic of Morals, trans. Paton, H.J. (New York: Harper & Row, 1964): at 89;Google Scholar
and The Doctrine of Virtue, trans. Gregor, M. (New York: Harper & Row, 1964): at 54.Google Scholar
I thank Goldblatt, Ann Dudley J.D.L.L.M., for suggesting this analogy to me.Google Scholar
See, for example, Ackerman, T., “Donation Dilemmas: Schools Need Cash but Some Cringe at Strings,” The Houston Chronicle, April 2, 1995, at A33;.Google Scholar
Golden, T., “Donations to Universities Sometimes Carry a Price,” The New York Times, Dec. 9, 1996,): at A1; Associated Press.Google Scholar
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I write that the obstacle was or should have been understood to be physiologic and not moral, because this was not the case at all transplant centers. Elsewhere, my colleagues and I explore the basis for this policy, which was twofold. First was the belief that the improved transplant survival that was seen with living donors was due to a degree of genetic similarity between the donor and recipient (i.e., matching for minor as well as major histocompatibility antigens) that was not possible with unrelated donors. This was found to be less important than the fact that the organ was from a living person. Second, many transplant programs were also of the belief that only biological family members were properly motivated. The exclusion of all nongenetic relatives failed to distinguish between the emotionally related nongenetic relative (e.g., spouse or close personal friend) and the non-emotionally related stranger, and “suggests a misguided valuation of genetic relationships instead of on relationships grounded in intimacy.”Google Scholar
See Ross, L.F. et al. , supra note 2, at 419.Google Scholar
Kahn, , supra note 1, at 447.Google Scholar
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