Organ Transplantation: Ethical, Legal, and Psychosocial Aspects: Towards a Common European Policy

Abstract

W. Weimar, M. A. Bos, J. J. Busschbach. PABST Science Publishers 2008. 584 pages, Paperback. This book presents the proceedings of the European Commission sponsored International Congress, “Organ Transplantation: Ethical, Legal, and Psychosocial Aspects: Towards a Common European Policy.” The meeting was held in Rotterdam in April of 2007 and proved to be successful. Aspects of transplantation that are rarely covered in depth at major international transplantation meetings were discussed and debated in six working groups with presentations from many of the participants within each working group to generate the discussion. The workshops covered the following topics: Commercialization and trafficking Legal systems for organ donation and allocation Altruism, counseling, and psychological aspects of living donation Minorities, religion, and gender aspects Postmortem donation Role of patients, media, and the pharmaceutical industry. At the conclusion of each workshop the chairpersons summarized the highlights of the workshop, including the discussions that took place which in some instances were highly emotive. These summaries were then presented at the final plenary session. The book includes the summaries by the chairpersons as well as articles from all the presenting participants. It would be invidious to pick out individual articles but everybody involved in clinical transplantation will find it fascinating to browse through this book. I am sure that clinicians will find much information that they were previously unaware of. As might be expected the workshop on commercialization and trafficking was charged with emotion, with both sides of the case for and against being presented by people well known in this area. But perhaps I will just mention the two presentations from Iran, which has been held up as a model of a regulated donor payment system. It seems that it is anything but regulated and is indeed a commercial practice with the poor donating kidneys to wealthy recipients. The working group finally agreed to strongly oppose trafficking of organs or a regulated donor payment system. The workshop on legal systems for organ donation and allocation was of great interest as the articles discussed the various systems that exist in different countries within Europe. In particular, there was an interesting article on the ethics of paired kidney exchanges. The workshop on altruism, counseling, and psychological aspects of living donation again was worthwhile with discussions ranging from the psychosocial evaluation of living unrelated kidney donors in the United States to characteristics of persons seeking to become adult to adult living liver donors. A further group discussed the aspects of transplantation related to minority groups, religious groups, and gender and again some fascinating contributions ranged from “Living kidney donors: are women motivated by love and men by logic?” to “Religious convictions and consequences of transplantation waiting lists.” The workshop on postmortem donation was again equally intriguing with presentations on non-heart beating donations and a discussion of why relatives refuse permission for organ and tissue donation. Finally, the workshop on patients, media, and the pharmaceutical industry was a mixed bag in topics, but did contain some interesting presentations, ranging from the emerging ethical issues associated with the continual evolution of science to the problems presented by the use of immunosuppressive drugs in young adults. In summary, this is a book that every transplantation unit should have available for reference. It is not a book you would sit down to read from cover to cover, but flick through picking out articles of interest. As mentioned earlier, much of the information and opinion presented is not readily accessible elsewhere. Peter J. Morris Anthony P. Monaco