The moral status of preferences for directed donation: who should decide who gets transplantable organs?

Abstract

Bioethics has entered a new era: as many commentators have noted, the familiar mantra of autonomy, beneficence, nonmaleficence, and justice has proven to be an overly simplistic framework for understanding problems that arise in modern medicine, particularly at the intersection of public policy and individual preferences. Directed donation occurs when a person requests that transplantable organs be given to a particular candidate or class of candidates after his or her death. Concerns are immediately raised by other sorts of requests regarding directed donation, especially where it seems that the media is involved in promoting the cause of a particular waiting transplant candidate or where a family aggressively seeks a donor by publicly stressing that their family member is particularly needy. Given that media access is not uniform, it is not appropriate to allow unequal access to publicity to result in unequal access to transplantable organs.