Organ Shortage : Ethics, Law and Pragmatism

327 Pages·2011·2.075 MB·English

Organ Shortage: Ethics, Law and Pragmatism
Organshortageisanongoingprobleminmanycountries.Theneedless
deathandsufferingwhichhaveresultednecessitateaninvestigationinto
potential solutions. This examination of contemporary ethical means,
both practical and policy-oriented, of reducing the shortfall in organs
drawsontheexperiencesofarangeofcountries.Theauthorsfocuson
the resolution and negotiation of ethical conflict, examine systems
approaches such as the ‘Spanish Model’ and the US Breakthrough
Collaboratives, evaluate policy proposals relating to incentives, pre-
sumed consent and modifications regarding end-of-life care, and
examinethegreatlyincreaseduseof(non-heart-beating)donorssuffer-
ingcirculatorydeath,aswellaslivingdonors.Theproposedstrategies
and solutions are capable not only of resolving the UK’s own organ-
shortage crisis, but of being implemented in other countries grappling
with how to address the growing gap between supply and demand for
organs.
DrAnne-MareeFarrellisSeniorLecturerinLawattheCentreforSocial
Ethics andPolicy and the Institutefor Science Ethics and Innovation,
SchoolofLaw,UniversityofManchester.
Professor David Price is Professor of Medical Law at Leicester De
MontfortLawSchool,DeMontfortUniversity.
DrMuireann QuigleyisLecturerinBioethicsattheCentreforSocial
Ethics andPolicy and the Institutefor Science Ethics and Innovation,
SchoolofLaw,UniversityofManchester.
CambridgeLaw,MedicineandEthics
ThisseriesofbookswasfoundedbyCambridgeUniversityPresswithAlexander
McCall Smith as its first editor in 2003. It focuses on the law’s complex and
troubledrelationshipwithmedicineacrossboththedevelopedandthedeveloping
world.Inthepasttwentyyears,wehaveseeninmanycountriesincreasingresortto
thecourts bydissatisfiedpatients and agrowing useofthecourts toattemptto
resolve intractable ethical dilemmas. At the same time, legislatures across the
world have struggled to address the questions posed by both the successes and
the failures of modern medicine, while international organisations such as the
WHOandUNESCOnowregularlyaddressissuesofmedicallaw.
It follows that we would expect ethical and policy questions to be integral to
theanalysisofthelegalissuesdiscussedinthisseries.Theseriesrespondstothe
highprofileofmedicallawinuniversities, inlegalandmedicalpractice,aswell
asinpublicandpoliticalaffairs.Weseektoreflecttheevidencethatmanymajor
health-relatedpolicydebatesintheUK,Europeandtheinternationalcommun-
ity over the past two decades have involved a strong medical law dimension.
Organ retention, embryonic stem cell research, physician assisted suicide and
the allocation of resources to fund healthcare are but a few examples among
many. The emphasis of this series is thus on matters of public concern and/or
practical significance. We look for books that could make a difference to the
development of medical law and enhance the role of medico-legal debate in
policycircles.Thatisnottosaythatwelackinterestintheimportanttheoretical
dimensions of the subject, but we aim to ensure that theoretical debate is
groundedintherealitiesofhowthelawdoesandshouldinteractwithmedicine
and healthcare.
GeneralEditors
ProfessorMargaretBrazier, UniversityofManchester,
ProfessorGraemeLaurie, UniversityofEdinburgh
EditorialAdvisoryBoard
ProfessorRichardAshcroft, QueenMary,UniversityofLondon,
ProfessorMartinBobrow, UniversityofCambridge,
DrAlexanderMorganCapron, Director,EthicsandHealth,World
HealthOrganization,Geneva,
ProfessorJimChildress, UniversityofVirginia,
ProfessorRuthChadwick, CardiffLawSchool,
DameRuthDeech, UniversityofOxford,
ProfessorJohnKeown, GeorgetownUniversity,Washington,DC,
DrKathyLiddell, UniversityofCambridge,
ProfessorAlexanderMcCallSmith, UniversityofEdinburgh,
ProfessorDrMónicaNavarro-Michel, UniversityofBarcelona
MarcusRadetzki,MarianRadetzkiandNiklasJuth GenesandInsurance:
Ethical,LegalandEconomicIssues
RuthMacklin DoubleStandardsinMedicalResearchinDeveloping
Countries
DonnaDickenson PropertyintheBody:FeministPerspectives
MattiHäyry,RuthChadwick,VilhjálmurÁrnason,GardarÁrnason The
EthicsandGovernanceofHumanGeneticDatabases:EuropeanPerspectives
KenMason TheTroubledPregnancy:LegalWrongsandRightsin
Reproduction
DanielSperling PosthumousInterests:LegalandEthicalPerspectives
KeithSyrett Law,LegitimacyandtheRationingofHealthCare
AlastairMaclean Autonomy,InformedConsentandtheLaw:ARelational
Change
HeatherWiddowsandCarolineMullen TheGovernanceofGenetic
Information:WhoDecides?
DavidPrice HumanTissueinTransplantationandResearch
MattiHäyry RationalityandtheGeneticChallenge:MakingPeopleBetter?
MaryDonnelly HealthcareDecision-MakingandtheLaw:Autonomy,
CapacityandtheLimitsofLiberalism
Anne-MareeFarrell,DavidPriceandMuireannQuigley OrganShortage:
Ethics,LawandPragmatism

Organ Shortage
Ethics, Law and Pragmatism
Anne-Maree Farrell,
David Price
and
Muireann Quigley
cambridge university press
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Singapore,SãoPaulo,Delhi,Tokyo,MexicoCity
CambridgeUniversityPress
TheEdinburghBuilding,CambridgeCB28RU,UK
PublishedintheUnitedStatesofAmericabyCambridgeUniversityPress,
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www.cambridge.org
Informationonthistitle:www.cambridge.org/9780521198998
©CambridgeUniversityPress2011
Thispublicationisincopyright.Subjecttostatutoryexception
andtotheprovisionsofrelevantcollectivelicensingagreements,
noreproductionofanypartmaytakeplacewithoutthewritten
permissionofCambridgeUniversityPress.
Firstpublished2011
PrintedintheUnitedKingdomattheUniversityPress,Cambridge
AcataloguerecordforthispublicationisavailablefromtheBritishLibrary
LibraryofCongressCataloguinginPublicationdata
Organshortage:ethics,law,andpragmatism/[editedby]Anne-MareeFarrell,
DavidPrice,andMuireannQuigley.
p. cm.–(Cambridgelaw,medicine,andethics)Includesbibliographical
referencesandindex.
ISBN978-0-521-19899-8
1. Organdonors–Supplyanddemand. I. Farrell,Anne-Maree,1964–
II. Price,DavidP.T. III. Quigley,Muireann. IV. Title. V. Series.
RD129.5.O748 2011
362.190795–dc22
2010030513
ISBN978-0-521-19899-8Hardback
CambridgeUniversityPresshasnoresponsibilityforthepersistenceor
accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto
inthispublication,anddoesnotguaranteethatanycontentonsuch
websitesis,orwillremain,accurateorappropriate.
Contents
Listoffigures pageix
Listoftables x
Contributors xi
Acknowledgements xviii
Listofabbreviations xix
Tableofcases xxi
Tableoflegislation xxii
PartI Settingthescene 1
1 Aprincipledandpragmaticapproachtoorganshortage 3
anne-maree farrell, david price and muireann
quigley
2 Doesethicalcontroversycostlives? 15
margaret brazier and john harris
PartII Currentissuesaffectingorganshortage 35
3 Organdonationandtransplantation:meetingtheneedsofa
multi-ethnicandmulti-faithUKpopulation 37
gurch randhawa
4 Educatingthepublictoencourageorgandonation? 52
mairi levitt
5 Bereavement,decision-makingandthefamilyinorgan
donation 67
magi sque and tracy long-sutehall
PartIII Strategiesforaddressingorganshortage 87
6 Incentivisingorgandonation 89
muireann quigley
vii
viii Contents
7 Makingthemarginsmainstream:strategiestomaximisethe
donorpool 104
antonia cronin
8 Theallocationoforgans:theneedforfairnessand
transparency 122
phil dyer and sheelagh mcguinness
9 Ante-mortemissuesaffectingdeceaseddonation:an
ethico-legalperspective 136
john coggon and paul murphy
PartIV Comparativeperspectives 149
10 Institutionalorganisationandtransplantingthe‘Spanish
Model’ 151
m nica navarro-michel
Ó
11 Kidneydonation:lessonsfromtheNordiccountries 171
salla l tj nen and nils h. persson
Ö Ö
12 Organdonationandtransplantation:theCanadian
experience 185
linda wright and diego s. silva
13 Systematicincreasesinorgandonation:theUnitedStates
experience 195
alexandra k. glazier
PartV Currentreformandfuturechallenges 213
14 Negotiatingchange:organdonationintheUnited
Kingdom 215
bobbie farsides
15 AddressingorganshortageintheEuropeanUnion:getting
thebalanceright 227
anne-maree farrell
16 Promotingorgandonation:challengesforthefuture 245
david price
Bibliography 269
Index 296
Figures
5.1 InterlockingModelofBereavementServices page74
11.1 Deceaseddonors(permillioninhabitants):
1993–2008 173
11.2 Deceaseddonorkidneytransplants(absolute
numbers):1994–2008 174
11.3 Livingdonorkidneytransplants(absolutenumbers):
1994–2008 174
11.4 Patientsadmittedtothekidneywaitinglist,waiting
fordonationanddeceasedwhilewaitingin2008
(permillioninhabitants) 175
13.1 Exampleofkidneypaireddonationexchange 210
ix
Tables
3.1 Patientslisted(activeorsuspended)foranorgan
transplantintheUKasat31December2008,by
ethnicoriginandorgan page40
3.2 Percentageofindividualsregistered(including
suspended)onthelistforakidney(includingkidney/
pancreas)transplantintheUKasat31December
2008,byagedecadeandethnicorigin 41
3.3 Numberregisteredonthelistforalivertransplant
intheUKasat31December2008,byagedecade
andethnicorigin 41
3.4 KidneydonorsintheUK,2006–2008,bydonor
typeandethnicorigin 42
3.5 Timeactivelyregisteredonthelistforakidney
transplantintheUK 42
3.6 Patientsdyingin2006whilstlistedforatransplant 42
12.1 WaitingtimesfortransplantsbyCanadian
province2008 186
x