Abstract
Certain proposals designed to increase the supply of cadaveric organs suitable for donation, (e.g. confiscation of organs, an opt-out system, and various methods of compensation), are controversial in large part because many see cadaveric donation as a supererogatory act. The view that people are not obligated to make their organs available after death is based on Kantian respect for autonomy and a notion of rights derived from social contract theory. I look to both Kant and contractarian-informed views of free-riding to argue instead that making one’s own organs available for donation after death is in fact a moral duty. According to a Kantian conception of a duty of mutual aid , we have a duty to respond to the true needs of rational beings when fulfilling such needs places little burden on us. And a refusal to donate organs entails the kind of indifference to interdependency that characterizes morally problematic free-riding . Accepting that cadaveric explantation is morally obligatory lends justificatory support to the proposals mentioned above, though I do not endorse any of them here.
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- 2.
Leichtman et al., p. 138.
- 3.
Caplan (2012, p. 30).
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Rohter (2004).
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The idea of nonmaleficence dates back to the Hippocratic Corpus, and has been fleshed out more thoroughly in recent literature. Beauchamp and Childress (2008, pp. 113–119).
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Korsgaard (1985, p. 24).
- 7.
G: 422–424.
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Herman (1984, pp. 579–582). The distinction between the irrationality of a maxim of universal indifference from a prudential irrationality is important for two reasons. First, Herman defends Kant from the charge that his project (of grounding a system of ethics on our rational nature rather than contingent features of our experience) is undermined by an empirical foundation. Second, in the case of organ donation, it is important to establish the irrationality of non-donation even if the willing agent is certain that he will never need a donated organ himself.
- 9.
Herman (1984, p. 586).
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Herman (1984, p. 595).
- 11.
Herman (1984, p. 596, 597).
- 12.
Procedural requirements to prevent such a scenario might include strict criteria for defining death and strict separation of treatment teams and transplant teams. Furthermore, even if this concern were realistic, it is worth pointing out that such behavior would be motivated by a shortage of suitable donated organs. Measures to address the shortage would reduce pressure on transplant coordinators, and should thus diminish the specter of overzealous procurement.
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A system of organ procurement that accepts the moral irrationality of unwillingness to make one’s organs available could have the effect of transforming social mores and eliminating that very unwillingness. It often happens that when something achieves recognition as a moral or even merely a legal duty, popular sentiment swiftly rallies in support. There is some evidence that Kant would agree with this point, as he argues that if one exercises one’s duty of beneficence “often and succeeds in realizing his beneficent intention, he eventually comes actually to love the person he has helped […] do good to your fellow human beings, and your beneficence will produce love of them in you (as an aptitude) of the inclination to beneficence in general”. Gregor (1996, p. 162). There is also evidence that Kant viewed the state’s role in cultivating rationality and “removing potential barriers to morality” as an essential component in an individual’s moral development. Surprenant (2006, pp. 90–111).
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Mendis, K. (2016). Foundations of a Duty to Donate Organs. In: Jox, R., Assadi, G., Marckmann, G. (eds) Organ Transplantation in Times of Donor Shortage. International Library of Ethics, Law, and the New Medicine, vol 59. Springer, Cham. https://doi.org/10.1007/978-3-319-16441-0_5
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