The Gift of Life and the Common Good: The Need for a Communal Approach to Organ Procurement

Abstract

The Need for a Communal Approach to Organ Procurement Its critics to contrary, of metaphor is not to be blamed for indebtedness and guilt that organ recipients often experience. It is certainly misused, however, both by post-transplant caregivers, who exploit it to manipulate recipients' behavior, and by organ procurement system, which has failed to understand that decision to give gift of life must be approached communally. The metaphor of of has shaped most public discussions of organ in United States. Indeed, until very recently, overwhelming majority of appeals to recruit organ donors been framed in terms of this metaphor, and there is evidence that metaphor is persuasive. According to some surveys, a majority of Americans say they would be willing to donate their organs after death.[1] Nevertheless, number of organs actually donated is considerably smaller than would be expected given number of people theoretically committed to donating. Various explanations been offered for this discrepancy. A recent study in these pages has concluded that one problem is that metaphor of gift of life has simply not proven entirely effective in overcoming resistance to donate.[2] According to Laura Siminoff and Kata Chillag, recent studies have shown that major limitation to procuring organs is families' unwillingness to do so when asked in actual donor situations--in fact, less than half donate when asked. Thus while metaphor may aided public awareness of need for organ donation, it has not proven effective in procuring organs for transplantation (p. 35). Further, Siminoff and Chillag argue, not only is gift of life metaphor ineffective in organ recruitment, but it has unexpected and detrimental effects on donor families, as well as on recipients and their caregivers (p. 40). The gift of life metaphor is itself one of major problems with organ system: it has not overcome donor families' reluctance to give, and it generates problems for those who receive. The clear implication is that metaphor ought to be abandoned. In our view, we need not abandon metaphor, indeed we ought not, but certainly if we are to continue to work creatively and constructively with metaphor of gift of life, we must take seriously important criticisms that Siminoff and Chillag directed at it. Problems with the Gift of Life According to Siminoff and Chillag, in order to understand how metaphor functions, we must set out some of basic structure of any social institution premised on voluntary and altruistic gifts. The classic work on gift exchange theory is Marcel Mauss's The Girl: Forms and Functions of Exchange in Archaic Societies, and Siminoff and Chillag draw upon that work to help identify some of problems of organizing organ procurement system around image of gift of life. One serious problem is connected with nature of debt. Mauss, for example, noted that gift giving typically creates relationships in which there is both debt and expectation that debt will be repaid. Indeed, gift giving is a socially useful institution precisely because it creates a network of obligations within a communal context in which group's welfare is partly dependent upon mutual cooperation. Of course, if within a system of gift relationships debt created by a gift is not acknowledged or if debt is not repaid, then system inevitably breaks down, with significant consequences for both individual and group. And this points to two related problems with organ donor system. Given way organ procurement system conceptualizes transaction, donor gives organ to recipient. At least for cadaveric donation, it is obviously impossible for recipient to discharge his or her debt, because nature of gift is such that gift giver is inevitably dead. …