Deny Organ Transplants from People Not Registered as Donors

The policy requires condemning non-donors to death when there are more palatable alternatives. Nearly as many lives could be saved by closing the organ shortfall with incentive schemes or an opt-out system. The fact that so many people do not become organ donors simply because they do not bother to sign up indicates why an opt-out system would be so successful – those who have strong objections to being organ donors can elect not to, while the majority who do not object become eligible donors. If the gap between supply and demand could be closed without this policy, even more lives would be saved (since everyone requiring a transplant, including non-donors, would survive). In addition, in some countries even if the deceased had signed the donor register, the permission of their nearest relatives is required before organs can be removed. This is a further restriction (relatives may have religious views the deceased did not share) that could be removed to ensure a greater supply of organs.

Moral reciprocity does not necessitate performing identical acts. I can consistently believe that I have a moral duty to treat people as I would want to be treated without doing the same things for others as they do for me. The reciprocity is in terms of more basic ideals, such as equal concern for others and respect for the moral obligations I have towards others. In this example, a person with strong religious objections to being an organ donor could ‘do his bit’ for society by contributing in other ways – by donating large sums of money to charity for example. This should not mean that he becomes ‘morally ineligible’ to receive an organ in a transplant because, all things considered, he has carried out his duty towards other people (just in a different way to the organ donor). To draw on another analogy: we do not all expect to have moral obligations to save fire-fighters when they are trapped, since we are not able to do so (other fire-fighters will help them). Rather, we fulfil our duty towards fire-fighters by helping them in other ways that we are able to.

There is a relevant moral difference between killing someone and being a bystander to their death. If there wasn’t, then all kinds of bizarre moral burdens would arise: for example, it would become obligatory to donate all disposable income to charity, in order to save those starving in the developing world (with the consequence that nobody could pursue any personal projects or engage in personal spending beyond that required for survival). The drowning child analogy is misleading, since in that case you are the only person able to save the child – it would be quite different if the pond was surrounded by lots of people, all able to save the child (especially if some of the other people were better placed than you to intervene, a lifeguard for example). However, even if we accept that people who do not donate their organs are immoral, is death an appropriate punishment for this transgression? Because, of course, death is the potential punishment this policy recommends.

Some religious cultures could prohibit donation while not prohibiting transplants for their members. Non-universalistic religions, such as the Shinto, and some Gypsy cultures disfavour organ donation, but do not necessarily believe it inappropriate for non-members to donate organs, and for their members to receive such organs in a transplant. It is also not the case that, just because the religious objection is overstated, that the objection does not exist. As mentioned above, there are religions and cultures that prohibit organ donation; there are others where donation falls into a grey area. The main controversy for Jews and certain Christians is their definition of dead, which is restrictive and rules out many cases where people’s organs are taken (e.g. when organs are taken from the brain-dead whose hearts are still beating). In these cases, the state should permit people to practise religion according to their interpretation, and not hand out de facto death penalties for holding a particular religious view.

The relevant consideration for bodily autonomy applies to the living, and their right to know what will happen to their bodies once they die. It is a part of your ownership of your body that you have control over what will happen to it – hence our respect for people’s wishes to be disposed of in certain ritualistic ways, or, indeed, our respect for wills. The proposition also denies people other kinds of autonomy, namely their freedom to practise religion in a certain way, or choose for themselves a lifestyle that, for some reason, involves not becoming an organ donor. There is also an autonomy issue for the non-donors the state is willing to kill (noting that the proposition wish to claim that allowing to die is morally equivalent to killing in their point 3). Surely these people should not be denied their right to life because of a moral decision they made?

It is unfair to prioritise people in such a way. The only way people should be prioritised is where there is a desperate need for an organ that is more desperate than someone else’s. Most people on the list are there because the transplant will be life saving.

The consideration for an ‘opt-out’ system of organ donation received heavy criticism from the public, especially when it came to human rights aspects of that decision. Organ donation is a sensitive subject and if the public thought that there was favouritism present, it may have a detrimental effect on the NHS and the public perception of organ donation.