In Favor of Organ Donation?
June 20, 2019
by D. Joy Riley MD, MA (Ethics)
The Department of Health & Social Care of GOV.UK recently notified its email subscribers of a new law regarding organ donation in England. Beginning in 2020, “Everyone in England over the age of 18 will be considered to be in favour of donating their organs and tissues after death unless:
- They have said they don’t want to donate their organs (they have ‘opted out’).
- They have appointed a representative to decide for them after their death.
- They are in one of the excluded groups – under the age of 18, ordinarily resident in England for less than 12 months before their death, or lack mental capacity for a significant period before their death.”
There are several “do not panic” assurances, however. The family will be consulted first, and if they have pertinent information regarding their loved one’s wishes not to donate their organs, they will not proceed with the organ donation. However, there is no explanation as to what that pertinent information might be. Tissue for “novel” or “rare” transplants, however, will need express consent—unless and until the decision is taken by the government to change the designation of those transplants. For now, though, face, nose, ovary, uterus, penis and testicle, along with brain and spinal cord, are excepted out of the new law. The complete list of excepted body parts is available here.
Other exceptions to the opt-out system are certain human cells or tissues: “Advanced Therapy Medicinal Products, (ATMPs), are another form of novel transplant. ATMPs are classified as medicines for human use and are based on manipulating genes, tissues or cells. They often use human cells and tissues as starting materials.”
How long will these exclusions apply? The document notes that limb transplants are already being done in Leeds, and face and uterine transplants are being developed. Already, even though the law has not yet come into effect, the exclusions are being lined up to fall. Transplants become standard practice after passing through “two assessment stages: research and service evaluation.”
Citing statistics of more than 5,100 persons waiting for transplantation, together with the past year’s removals from the waiting list (643) and deaths (339) while on the waiting list, the government is acting. With certain exceptions, upon one’s death, the government owns that person’s body.
The anguish and grief of needing a transplant, and waiting for a transplant, impact the person in need and his or her family. The donor and his or her family are also affected, often dramatically. There is no denying the distress of all parties involved.
It is intriguing, though, that the government is moving with such alacrity to possess bodies, given the numbers cited in the consultation. The numbers of persons on the waiting list or having died in the previous year pale in comparison to those affected by roadway accidents in England in a similar time frame. In the year ending in June 2018, England reported “26,610 killed or seriously injured casualties (KSIs) in road traffic accidents” that had been reported to police. There were 1,770 road fatalities reported during that year, and this represented a 3 percent increase over the previous year. Yet, the government is not claiming ownership of all motor vehicles that have been smashed, with parts to be meted out to those vehicles in need.
As chair of the U.S. President’s Council on Bioethics several years ago, Leon Kass addressed this kind of thinking. He advised asking the question, “Is the human body really like a car with completely fungible and replaceable parts?” about both medical and moral considerations:
“Medically, of course, we have the immune rejection problem which no automobile has, suggesting that there is some kind of difference between us and simply a heap of spare parts….To talk about the person that somehow survives the replacement of these parts invites the kind of person, machine or person-body dualism and one of the questions I think that we want to keep in mind is what kind of a view of ourselves are we tacitly promoting, not only in organ transplantation to begin with, but how might that view be affected by the varying proposals to increase the supply.”
It seems the government and citizenry of England, as well as those in the United States, would be well-served by carefully considering Kass’ words.