The ethics of organ transplantation reconsidered: Paid organ donation and the use of executed prisoners as donors

We examine the arguments for and against the practice of paid organ donatio n and the use of judicially executed prisoners as seen in a world context. Although Western opinion is almost universally against both practices, we s eek to establish that this has arisen largely from justification of an init ial revulsion against both and not from reasoned ethical debate. In examini ng the most commonly cited arguments against these practices, we demonstrat e that this revulsion arises mainly from the abuses to which both processes have been subjected, rather than the acts themselves, together with opposi tion to a death penalty. At the moment and for some future time, in the abs ence or shortage of dialysis in large parts of the developing world, transp lanted organs represent the only means of treating end-stage renal failure. Thus, a clear ethical conflict arises as to whether greater harm or good i s done by allowing individuals to die or adopting strategies for obtaining organs that raise ethical problems. We call for continued reasoned ethical debate on both issues, rather than accepting that the argument is already o ver.