ETHICAL AND POLICY ISSUES IN ALTRUISTIC LIVING AND CADAVERIC ORGAN DONATION

Organs for transplantation are usually obtained from living genetic re latives or from heart-beating cadavers. Unfortunately, these sources h ave so far been unable to keep up with demand. As a result, there is a large and steadily increasing number of potential recipients awaiting transplantation, some of whom will die before an organ can be found. In an attempt to rectify this tragic situation, several solutions have been proposed. This review will consider proposals designed to increa se the availability of human organs without resorting to commercialism . These include expanding the use of living donors by: 1) encouraging donations by genetic relatives; 2) allowing volunteers a greater voice in determining their own suitability; 3) encouraging the use of emoti onally related individuals and accepting altruistic strangers; and 4) considering motivated identical twin miners and older adolescents as d onors, Suggestions for increasing the pool of cadaveric donors include : 1) overcoming the family consent barrier by presuming consent, manda ting completion of binding advanced directives, or by eliminating the need for consent entirely; 2) reconsidering non-heart-beating donors; 3) elective ventilation for organ donation; and 4) accepting organs fr om anencephalic infants before brain death occurs. All of these propos als raise concerns which are discussed. Those approaches considered to be ethically acceptable and to hold promise for success should be vig orously pursued, beginning with carefully designed pilot studies. Hope fully, such an approach will eventually increase the number of organs available for patients sufferung from end-stage organ disease.