5. WHO OWNS THE BODY?
In Hungary, pituitary glands were routinely removed from the dead, sold to foreign companies, and turned into commercially valuable hormones. This arrangement was finally exposed in what was called the "hypophysis scandal." (Hypophysis is another name for the pituitary gland.) The public had not previously been aware of this practice, but, as one account put it, "Where living human beings are little respected and life is cheap, then what happens to human beings after death becomes a genuinely trivial question."
For many years, rumors abounded that, when prisoners were executed in China, their organs were sold to those who needed transplants. The availability of such transplants would be advertised in the papers. The recipients were typically rich or important officials in China or foreigners who could pay. The transplants were performed in military or government hospitals, suggesting that the Chinese government condoned the procedures. When confronted, Chinese officials said that, yes, the practice occurs, but only with the consent of the prisoners. Human rights workers have been watching this situation, and, in early 1998, two Chinese men peddling Chinese kidneys and corneas in New York were arrested.
In France in 1993, when a young man (Christophe Tesniere) died in an accident, his "ghost-like stare" suggested to his parents that his corneas had been removed. They did not object, although they were surprised that they had not been asked whether they would agree to the "donation." A few weeks later, however, they hit the roof when the hospital sent them a bill for "postmortem surgery" for the removal of Christophe's corneas as well as several other organs. The prevailing law in France was one of presumed consent: all organs are up for grabs unless the person has indicated that they are not.
In Brazil on January 1, 1998, a new law was passed stating that all people will be organ donors unless they "opt out" and officially register their unwillingness to be donors. The legislation has met with stiff public outrage, fueled both by a strong reverence in the culture for the dead and by fears and rumors: people recalled the story of a man who was drunk one night, woke the next day in a field, and found that his eyes had been removed.
In Japan, transplantation is rare. A single heart transplant was carried out in 1968, but the doctor was then accused of murder. (After a two-year investigation, the surgeon was not officially charged.) The accusation arose because, at the time, death was defined in Japan only as the moment when the person's heart stopped beating. More recently, Japan has accepted "brain dead" as another definition of death; this would allow for transplants from brain-dead individuals. Nonetheless, by late 1998, no hearts, lungs, or livers had yet been transplanted from donors who had died. In contrast, Japanese doctors do transplant bone marrow, corneas, sclera, skin, and livers and kidneys from live donors.
- Natural History, 1998, October, 8(107):48.
- Bulletin of Medical Ethics, 1992, October, 29-32.
- The Lancet, 1997, November 1, 350:1307.
- The Lancet, 1998, March 7, 351:735.
- New York Times, 1998, February 24, A1.
- New Scientist, 1993, July 3, 12-13.
- New York Times, 1998, January 15, A4.
- New York Times, 1997, May 11, A1, A14.
- The Lancet, 1998, December 5, 352:1837.
- The Nation, 1995, June 12, 819.
- Francisco Goldman, The Long Night of White Chickens, 1992, Atlantic Monthly Press, NY (about Guatemalan organ snatching).
- Public Health, 1997, 111: 367-372.
Students should understand the following:
- Presumed consent and its application
- The opt-out system in which people state unwillingness to donate an organ
- The opt-in system and its advantages and disadvantages
- Economic price put on the human body
- Religious and cultural differences in attitudes toward organ transplantation
- Obligations of medical personnel with respect to transplantation
- Policy differences from country to country
- Critical reading of policy proposals concerning federal and state criteria for advertising, donation, and sale of body parts
- Importance of examining personal religious attitudes, moral reasoning, and ethics regarding integrity of the body
Suggested questions for discussion
- Who owns the human body: the person, the relatives, the state, no one?
- What specific teachings of the major religions affect attitudes toward organ transplantation?
- Does the policy of presumed consent undermine the meaning of "donation?"
- Should people who are very poor be allowed to sell their kidneys in order to earn money?
- What role might education play in the willingness or unwillingness of individuals to donate organs?
- How free is the choice to donate an organ for people in poor or totalitarian countries?
Topics for discussion/written assessment
- How do cultural differences in defining death affect transplant policies in different cultures?
- What are the strengths and weaknesses of these organ donation policies:
- Presumed consent, in which it is assumed that all organs are available for transplanting when someone dies, and the person must "opt out" or officially state an unwillingness to donate.
- Opting in, in which people indicate their willingness to donate by signing a donor card or other document.
- How fully do governments and doctors in different types of countries (democracies, totalitarian countries, strongly religious countries, others) respond to the positions and concerns of the citizens of their country with respect to organ donation policies?
- What policies should pertain to "free riders," individuals who are willing to receive an organ but not donate one? Should they be given the same chance at an organ as those people who have opted in to giving or should they have a lower priority?
- The essay published in The Nation (reference 1 above) describes the obligations and ethical responsibilities of doctors. Do you think doctors are stepping over the line if they agree to remove organs from prisoners who are about to be executed? Do you think doctors should benefit financially from organ transplants of these sorts? What can you learn about the role (if any) of American doctors who are in collusion with the Chinese doctors who advertise organs for sale?
- During World War II, doctors in Nazi Germany conducted inhumane medical experiments on people in the concentration camps. After the war crimes trials, international policies for protecting people who are subjects in research studies were formulated. What policies were instituted? What are the ethical obligations of the physicians?
- David Patterson lives in Folsom prison. He gave his daughter Renada a kidney in 1996. It failed when Renada refused to take her medicine faithfully; she didn?t like the way it made her feel. Patterson then offered her his second kidney and expressed his willingness to spend the rest of his life using a dialysis machine. As a prisoner, does he have the right to make this "donation" at tax-payer expense? (Dialysis costs about $40,000 each year for one person; the cost would be paid by Medicare.)
- Could you foresee a time/situation in which it would be appropriate for the government to legislate that a person on public assistance with few or no marketable skills must donate a healthy organ as payback for receiving welfare?
- College newspapers regularly run advertisements by couples who want to conceive a child but need an egg donor. In the 1998-1999 school year, one couple offered $50,000 to a woman who met specific criteria: high SAT scores, tall, etc. If you were a student, what factors would you consider before you decided whether or not to agree to such a contract?
Topics for teacher preparation
- Organ transplant practices in different countries
- Definition of death in various countries
- Presumed consent
- Opting in
- Opting out