On average 21 people die each day waiting for an organ transplant that could save their lives, according to the U.S. Organ Procurement and Transplantation Network (OPTN), with more than 123,000 people currently wait on a transplant list.
Georgetown University Press is releasing the second edition of Transplantation Ethics this month to address the ethical and policy issues that have emerged from the advancements in science and technology that were made in the 14 years since the book was first published.
The second edition combines the expertise of ethics leaders and co-authors Lainie F. Ross, MD, PhD, of the University of Chicago, and Robert M. Veatch, PhD, of Georgetown University, who analyze everything from face transplants to what qualifies a person as dead in order to begin the organ procurement process.
“Not everyone who needs an organ gets one, so it’s the only real case of rationing and scarcity in the United States medical system,” said Ross, UChicago Professor of Medicine and Clinical Medical Ethics and Co-Director of the Institute for Translational Medicine. “When you have such a vital, life-saving technology, it’s important that you examine it for the unintended consequences that may occur from different types of policies. We need to always be willing to look in the mirror and question whether we’re doing the right thing.”
Transplantation Ethics deals with the following issues and more through the framework of distributive justice:
- The importance of ensuring that donors are dead to promote trust in the transplant system.
- A controversial conception of higher brain death.
- How media coverage impacts who receives organs.
- The creation of legal organ markets in foreign countries.
- Whether voluntary lifestyle choices, such as excessive drinking, smoking, weight, etc., should impact a person’s priority on a transplant list.
Ross said co-authoring the book was especially meaningful because Veatch served as her mentor decades ago. Their relationship began in 1990 when Ross enrolled in Georgetown University’s Intensive Bioethics Course while working on her PhD in philosophy at Yale University. She asked to be assigned to Veatch’s small group and they went on to kept in touch over the years, both serving on committees for the United Network for Organ Sharing (UNOS) and authoring their own books on topics in the ethics field.
Veatch wrote the first edition of Transplantation Ethics and invited Ross to co-author its second edition.
“Relationships in your career have to be dynamic and evolving,” said Ross. “Bob is an absolute gem, and I feel really privileged and fortunate to have worked with him.”
Veatch said that having Ross as a co-author not only made the second edition a much better book, but that it also led to a great deal of fun in the writing process.
While the two share fundamental philosophical frameworks, there was one topic in the book where they had to agree to disagree: whether recovered alcoholics should be given a lower priority on the organ transplant list.
Veatch argued that voluntary lifestyle choices should be taken into account, while Ross questioned how to disentangle voluntariness from genetics and early environmental exposures over which individuals have no control.
“Suddenly we’re judging people, and that’s not our job as health care providers,” Ross said. “So my justice argument is that we’re all of equal worth, and sick people need organs, and we need to do it in a fair way. We should not discriminate against individuals on the basis of whether they previously drank, used drugs, or overate and became fat.”
The chapter whips back and forth between the two authors as they flesh out their hours of debate.
“It’s fun because we have our boxing gloves on,” Ross said.
Since 1988, more than 300,000 organs have been recovered for transplants, according to the U.S. Organ Procurement and Transplantation Network, and every 10 minutes another person is added to the national transplant list.
Whether readers are tasked with creating new policies, have been asked to be an organ donor, or will be placed on a transplant waiting list one day, Ross said that Transplantation Ethics will give them the science and ethical framework with which to make educated decisions.