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Between Death and Donation: Ethical Considerations in Pediatric Heart Transplantation

  • Eric SmawEmail author
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Abstract

In this chapter, I offer philosophical analyses of the problem of organ scarcity and the solutions that have been offered by some medical ethicists against the backdrop of a discussion of heart transplants in pediatric patients. The solution that I find most promising is that of “nudging.” By definition, “nudging” is the practice of encouraging families to donate the organs of their recently deceased loved ones. I find this solution to be interesting because, on the one hand, it can be used to address the problem of organ scarcity, and, on the other hand, more needs to be done to protect parents who are thinking about donating the organs of their recently deceased child from organ procurement agents who act in aggressive or excessive ways. I offer some refinements to the practice of nudging that are designed to protect parents from harm and allow hospitals to do good for their patients. I conclude that adherence to my suggestions will increase organ donation, remove problems with over-zealous organ procurement policies, and increase good will among all concerned.

Keywords

Pediatric heart transplant Organ shortage Organ procurement Institutional nudging And interpersonal nudging 

References

  1. 1.
    Plato. Gorgias. In: Hamilton E, Cairns H, editors. Plato: the collected dialogues. Princeton: Princeton University Press; 1961.Google Scholar
  2. 2.
    Chandler J, Gruben V. Ethics of persuasion: evaluating the ethical limits on attempting to persuade families to donate the organs of deceased family members. In: Greenberg R, Goldberg A, Rodriguez-Arias D, editors. Ethical issues in pediatric organ transplantation. Cham: Springer; 2016.Google Scholar
  3. 3.
    Tomlinson C, Hellmann J. The newborn as organ donor. In: Greenberg R, Goldberg A, Rodriguez-Arias D, editors. Ethical issues in pediatric organ transplantation. Cham: Springer; 2016.Google Scholar
  4. 4.
    Troug R. Organs for donation: balancing conflicting ethical obligations. N Engl J Med. 2008 Mar;358(12):1209–11.CrossRefGoogle Scholar
  5. 5.
    Paquette E, Frader J. Controlled donation after cardiac death in pediatrics. In: Greenberg R, Goldberg A, Rodriguez-Arias D, editors. Ethical issues in pediatric organ transplantation. Cham: Springer; 2016.Google Scholar
  6. 6.
    Harrison C. Ethical and organizational issues in adopting a pediatric protocol for controlled donation after circulatory determination of death. In: Greenberg R, Goldberg A, Rodriguez-Arias D, editors. Ethical issues in pediatric organ transplantation. Cham: Springer; 2016.Google Scholar
  7. 7.
    Mavroudis CD, Cook JT, Jacobs JP, Mavroudis C. Ethical considerations of transparency, informed consent, and nudging in a patient with paediatric aortic stenosis and symptomatic left ventricular endocardial fibroelastosis. Cardiol Young. 2016;26(8):1573–80.CrossRefGoogle Scholar
  8. 8.
    Thaler R, Sunstein C. Nudge: improving decisions about health, wealth, and happiness. New Haven: Yale University Press; 2008.Google Scholar
  9. 9.
    Whyte K, Selinger E, Caplan A, Sadowski J. Nudge, nudge or shove, shove: the right way for nudges to increase the supply of donated cadaver organs. Am J Bioeth. 2012;12(2):32–9.CrossRefGoogle Scholar
  10. 10.
    Department of Health and Human Services. Organ procurement network. National data reports. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#.
  11. 11.
    Health Resources and Services Administration. U.S. Government Information on Organ Donation and Transplantation. https://www.organdonor.gov/statistics-stories/statistics.html.
  12. 12.
    Jones J. Bad blood: the Tuskegee syphilis experiment. New York: Free Press; 1993.Google Scholar
  13. 13.
    Washington H. Medical apartheid: the dark history of medical experimentation on black Americans. New York: Anchor Press; 2008.Google Scholar
  14. 14.
    Owens D. Medical bondage. Athens: University of Georgia Press; 2018.Google Scholar
  15. 15.
    Zink S, Zeehandelaar R, Wertlieb S. Presumed vs expressed consent in the US and internationally. AMA J Ethics. 2005;7(9):610.Google Scholar
  16. 16.
    Nozick R. State, anarchy, and utopia. New York: Basic Books; 1974.Google Scholar
  17. 17.
    Dworkin G. Paternalilsm. Monist. 1972;56:64–84.CrossRefGoogle Scholar
  18. 18.
    Assemblyman won’t move forward organ donation registry ‘opt-out’ legislation. https://www.nystateofpolitics.com/2019/04/wny-assemblyman-wont-move-forward-organ-donation-registry-opt-out-legislation/.
  19. 19.
    Dalal A. Philosophy of organ donation: review of ethical facets. World J Transplant. 2015;5(2):44–51.CrossRefGoogle Scholar
  20. 20.
  21. 21.
    Samuel L. To solve organ shortage, states consider ‘opt-out’ organ donation laws. https://www.statnews.com/2017/07/06/opt-solution-organ-shortage/.
  22. 22.
    List of countries and their system of organ donation from “An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study.” https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4/tables/1.
  23. 23.
    List of deceased organ donation rate by country from the Global observatory on donation and transplantation. http://www.transplant-observatory.org/data-charts-and-tables/chart/.
  24. 24.
    Locke J. Second treatise of civil government. Cambridge: Cambridge University Press; 1988.Google Scholar
  25. 25.
    Cherry M. Organs for Sale by owner: human organs, transplantation, and the market. Washington: Georgetown University Press; 2005.Google Scholar
  26. 26.
    Radcliffe Richards J. Nephrarious goings on: kidney sales and moral arguments. J Med Philos. 1996;21:375–416.CrossRefGoogle Scholar
  27. 27.
    Hippen B. A defense of a regulated market in kidneys from living donors. J Med Philos. 2005;30(6):593–626.CrossRefGoogle Scholar
  28. 28.
    de Castro LD. Commodification and exploitation: arguments in favor of compensated organ donation. J Med Ethics. 2003;29(3):142–6.CrossRefGoogle Scholar
  29. 29.
    Hart HLA. The concept of law. Oxford: Oxford University Press; 1961.Google Scholar
  30. 30.
    Keehn J, Klitzman R, Sauer MV, Howell E. How agencies market egg donation on the internet: a qualitative study. J Law Med Ethics. 2015;43(3):610–8. https://www.ncbi.nlm.nih.gov/pubmed/26479570.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Economic Diversity and Student Outcomes at the University of California at Los Angeles. New York Times. https://www.nytimes.com/interactive/projects/college-mobility/university-of-california-los-angeles.
  32. 32.
    Stein R. New zeal in organ procurement raises fears. Washington Post; 2007. http://www.washingtonpost.com/wp-dyn/content/article/2007/09/12/AR2007091202681.html?sid=ST2008032103015.
  33. 33.
    Troug R. When does a nudge becomes a shove in seeking consent for organ donation? Am J Bioeth. 2012;12(2):42–4.CrossRefGoogle Scholar
  34. 34.
    Casey v. New England Organ Bank, 446 Mass. 270; 2006.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Philosophy and ReligionRollins CollegeWinter ParkUSA
  2. 2.Florida State University, School of MedicineOrlandoUSA

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