Abstract
The article argues that altruistic giving based on anonymity, which is expected to promote social solidarity and block trade in human body parts, is conceptually defective and practically unproductive. It needs to be replaced by a more adequate notion which responds to the human practices of giving and receiving. The argument starts with identification of the main characteristics of the anonymous altruistic donation: social separation of the organ donor (or donor family) from the recipient, their mutual replaceability, non-obligatoriness of donation, and non-obligatoriness of reciprocation on the recipient’s part. Since these characteristics are also central to typical market relations, anonymous altruistic donation not only cannot promote solidarity but may encourage proposals for (regulated) markets of transplantable organs. Thus, transplant ethics needs to be reframed. It needs to be rooted in, rather than promote, the practices of giving and receiving known to human societies. As the basis for such reframing, the idea of sharing in another’s misfortune is proposed. It relies on the human practices of giving and receiving and, with appropriate regulatory safeguards, can provide a better conceptual basis for blocking commercial exchanges of human body parts.
Highlights
The article argues that altruistic giving based on anonymity, which is expected to promote social solidarity and block trade in human body parts, is conceptually defective and practically unproductive
Altruistic organ donation, as it is currently understood in transplant ethics, cannot serve as an effective conceptual barrier to commerce in transplant organs or promote social bonds and solidarity
The argument below aims to show that altruistic giving based on anonymity, which is the core of the dominant transplant ethics, is conceptually defective, even though that ethics may encourage morally noble actions
Summary
Altruistic gift-giving and the prohibition of trade in human organs are well-established in the conceptual framework which informs important transplant regulations (United States 1984; United States 1987; Council of Europe 2002a; European Union 2000, art. 3; International Summit on Transplant Tourism and Organ Trafficking 2008; WHO 2010; Nuffield Council on Bioethics 2011). In order to be motivated to make such a gift, the benefactor must intend to promote someone else’s benefit but does not need to know the identity and circumstances of the gift recipient This idea of pure altruistic gift is the conceptual core of the ethics of organ transplants. Organ donation is not obligatory as such, irrespective of the circumstances or relationship between the potential benefactor and beneficiary, but is one of many possible ways of discharging the general duty to help Performing such a duty on a particular occasion would remain within the agent’s discretion. The imaginary character of the relation is further characterized by the social and ethical discontinuity secured by lack of reciprocity In this way the relationship between donors and recipients is fundamentally different from the practices of giving and receiving known to human societies (Mauss 1990[1925]). The recipient and the donor are more isolated from each other than they would be if they entered a typical market relation, where some, even if mediated (e.g., online commerce), interaction between the parties takes place
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