Warum wäre das Opt-out-System zur Organbeschaffung fairer?

The possibility of organ transplantation has created new problems for medical ethics as well as clinical medicine. One of them, organ procurement, is tried to be solved mainly by two systems. Many countries have adopted the ‘optin system’, which aims to raise awareness and make the individuals donate their organs by their own will. The other system, ‘optout’ or ‘presumed consent’, which considers all members of society as potential donors, was adopted by some countries. In this system, individuals should state that they do not wish to donate their organs; otherwise they are considered as donors. By trying to ground our argument with various justifications, we claim that optout system for organ procurement is a fairer option regarding the right to access to healthcare needed, and therefore it should be implemented instead of optin.Mogućnost transplantacije organa je otvorila nove probleme kako u medicinskoj etici tako i u kliničkoj medicini. Jedan od njih, pribavljanje organa, pokušava se riješiti uglavnom pomoću dva sustava. Mnoge države su prihvatile ‘optin’ sustav, koji teži širenju svijesti o problemu i vlastitom izboru pojedinca da donira svoje organe. Drugi sustav, ‘optout’ ili ‘pretpostavljeni pristanak’, u kojem se svi članovi društva smatraju potencijalnim donorima, uveden je u nekolicini zemalja. U tom sustavu, pojedinci trebaju izričito navesti da ne žele donirati svoje organe; u suprotnom se smatraju donorima. U pokušaju utemeljenja našeg argumenta na različitim opravdanjima, tvrdimo da je ‘optout’ sustav pribavljanja organa pravednija opcija, uzimajući u obzir pravo na pristup potrebnoj zdravstvenoj skrbi, te bi stoga treba biti uveden umjesto ‘optin’ sustava.La possibilité de transplantation d’organes a posé de nouveaux problèmes à l’éthique médicale aussi bien qu’à la médecine clinique. Deux systèmes tentent de résoudre l’un de ces problèmes, celui qui concerne l’approvisionnement en organes. Nombre d’États ont adopté le système « optin » qui cherche à répandre la conscience du problème et du choix personnel de l’individu de faire le don de ses organes. Un autre système, appelé « optout » ou « accord tacite », où tous les membres de la société sont considérés comme donateurs potentiels, a été introduit dans certains pays. Dans ce système, les individus doivent indiquer explicitement qu’ils ne souhaitent pas donner leurs organes, faute de quoi ils sont considérés comme donateurs. En essayant de baser notre argumentaire sur les diverses justifications, nous soutenons que le système « optout » est plus juste, compte tenu du droit à l’accès aux soins médicaux nécessaires. Il devrait par conséquent être introduit à la place de « optin ».Die Möglichkeit zur Organtransplantation kreierte neue Probleme für die Medizinethik wie auch für die klinische Medizin. Eines davon, die Organbeschaffung, versucht man hauptsächlich mithilfe zweier Systeme anzugehen. Zahlreiche Staaten haben das ‚OptinSystem’ angenommen, das die Bewusstseinserhöhung sowie Selbstentscheidung der Einzelnen zur Organspende anzielt. Das andere System, das ‚Optout’ bzw. die ‚angenommene Zustimmung’, das sämtliche Gesellschaftsmitglieder als potenzielle Organspender ansieht, wurde von einigen Staaten übernommen. In diesem System sollen Einzelne ausdrücklich erklären, sie wollen keine Organe spenden, anderenfalls werden sie für Organspender gehalten. Indem wir unser Argument auf unterschiedliche Rechtfertigungen zu gründen suchen, behaupten wir, das OptoutSystem zur Organbeschaffung sei eine gerechtere Option in puncto Recht auf Zugang zur notwendigen Gesundheitsfürsorge, und demzufolge solle es anstelle des Optin implementiert werden

Organ trafficking and transplant tourism

Organ trafficking is usually considered to involve the recruitment of living persons for the purpose of removing their organs for transplantation by means of coercion, deception, payment, or other abusive practices. Transplant tourism can constitute a form of organ trafficking. Whereas there is widespread agreement that exploitation in the context of organ procurement is morally wrong, there has been some controversy as to whether payment for organs is ethically acceptable or even required given the unmet need for organs and the hesitancy of many to donate without financial reward. The chapter will start with an overview of the ethical debate on organ trafficking. The major arguments revolve around central principles of biomedical ethics, the respect for autonomy, human dignity, justice, nonmaleficence, and beneficence. In a next step, a review of empirical data illuminating the reality of organ trafficking in different contexts will be presented. The subsequent part will describe policy developments in recent years and summarize the current international norms on organ trafficking. In conclusion, the scrutiny of arguments in favor of organ selling in the light of empirical data shows that there is little plausibility for the claim that payment for organs could increase the number of available organs in a sustainable way, while respecting vendors’ autonomy, minimizing their health risks, and offering fair deals. The prohibitive stance of current international norms is therefore appropriate and should be maintained

Does organ selling violate human dignity?

Shortages in the number of donated organs after death and the growing number of end-stage organ failure patients on waiting lists call for looking at alternatives to increase the number of organs that could be used for transplantation purposes. One option that has led to a legal and ethical debate is to have regulated markets in human organs. Opponents of a market in human organs offer different arguments that are mostly founded on contingent factors that can be adjusted. However, some authors have asked the question whether we still have a reason to believe that there is something wrong with offering human organs for sale for transplantation purposes, even if the circumstances under which the practice takes place are improved. One prominent argument regarding this appeals to the notion of human dignity. It is argued that organ selling violates human dignity. This paper presents a systematic discussion of dignity-based arguments in the organ selling debate, and then develops a social account of dignity. It is argued that allowing the practice of organ selling inherently runs the risk of promoting the notion that some persons have less worth than others and that persons have a price, which is incompatible with dignity. The approach is defended against possible objections and it is shown that it can capture the notion that autonomy is linked to human dignity in important ways, while dignity at the same time can constrain the autonomous choices of persons with regards to certain practices

Planning later life with dementia: comparing family caregivers’ perspectives on biomarkers with laypersons’ attitudes towards genetic testing of dementia prediction

Predictive medicine presents opportunities to consider later life under conditions of illness, such as dementia. This paper examines how family caregivers (N = 27) assess the opportunity of prediction and early diagnosis of dementia for oneself based on their particular experience. Furthermore, it compares their attitudes with laypersons’ attitudes (N = 43) towards genetic testing of APOE. By this, we elaborate how much personal experience impacts anticipation and affects, but also moral attitudes towards predictive medicine. Differences in our settings do not allow for direct comparison, so our analysis focuses on multiple similarities in the assessments of predictive (non-genetic vs. genetic) testing. Groups’ reasoning showed also differences influenced mainly by personal experience. Family caregivers addressed more responsibility towards family and had more hopes into medical treatments. To cope with the disease, they expressed expectations to start with medicine and care decisions as early as possible. Laypersons, however, stressed self-determination more and expressed worries about the influence of the pharmaceutical industry by referring to unnecessary medication and, implicitly, the medicalization of aging