13. November 2017

Directed deceased donation: beyond the impartial allocation dogma


"Within a pluralistic account of morality, partial values have a merit of their own and should be assessed in their own terms. These values are extremely relevant in the field of organ transplantation, but are misunderstood at a political level where partiality is put at par with injustice, and where fairness is exclusively taken as impartial justice." Dr. Medard Hilhorst (Erasmus Medical University Rotterdam) argues "that partial values are fundamental for social life and that directed donor preferences should be incorporated and facilitated in a new system of fair organ allocation. The justification for a prohibition of directed wishes is mistaken, whereas arguments to lift the prohibition are ethically convincing."

TThe study appeared in "Ethical, Legal and Psychosocial Aspects of Transplantation", edited by E.K. Massey, F. Ambagtsheer, W. Weimar.

Hilhorst notes various wishes:

  • donation to specified person

  • as well as to a specified group

  • either as a preference (a priority wish) or

  • as a strict condition (if not feasible, there will be no donation at all)

  • put forward, orally or written in advance, by the donor/patient or

  • the relatives on patient´s behalf

Hilhorst emphasizes arguments that favour directed donations:

  • autonomy and self-determination

  • optimizing outcomes

  • coherence in the system

  • restoration of trust

  • relevancy of partial values

"Personal relationships imply special loyalities and moral duties and give rise to personal choices, particular preference and specific wishes. Personal ties are a moral source of their own, they bring along their own motivation and language, and their own justification. For example, the question ´Why do you want to give to your partner, not to the system?´, gets its own answer: ´Because my partner needs it.´ Referring to this special loyality makes sense and is not reducible to the general duties embodied in the current impersonal allocation system ..."



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