Public solicitation of directed organ donation.

From here

To what extent should directed organ donation be regulated? Should families or individuals be able to specify which person organs must go to? Can they specify other criteria (only go to white or black people, for example)?.

Should public advertising for donors be regulated? If not…will people who have more income for advertising have an unfair advantage at winning “directed donations”?

Is the Krampitz episode the beginning of a troubling trend?

I don’t really see anything wrong with it. Viable organs are a severely limited resource, and generally it seems that people can direct the use of their physical body after death to a limited degree, so long as it is legal, and so long as there are people willing to stick up for those wishes. I find it rather in poor taste (read: vile and immoral) to collect money for organs, but directing their use seems perfectly fine to me, so long as there is someone to back it up. If it had to be codified, I’d suggest that absent any clear directive to donate organs directly, the general procedure of “top of the list gets the prize” should be used, but otherwise… do what you want with your corpse.

I agree. The unique nature of the “assets” notwithstanding, people get to donate their, um, possessions largely any way they’d like. I can bequest my money to the Little Sisters of the Poor or to the KKK or to my cousin Fred. Same with my liver. In fact, now that I think of it, I plan on leaving my liver to my cousin Fred whether he wants it or not. I expect it to be an enlarged, fossilized, disagreeable-looking article by the time I no longer need it (even more than a liver typically is), so I’m not sure how happy he’ll be about it. Maybe he can use it as a doorstop.

Of course one just doesn’t “leave” your kidney to your cousin Bob in the same fashion that you leave your George Forman grill.

There is an organ procurement process between your kidney and Uncle Bob or the Klan.

Because there is currently a far greater demand for organs than the supply can take care of…someone is making decisions about where those organs go.

It seems that in this particular case, the liver that went to Krampitz would have probably gone to someone else who best fit the medical criteria on the waiting list. IOW, who DIDN’T get a liver (but would have gotten one according to the waiting list criteria) because Krampitz “jumped ahead”?

The Krampitz example is not really a situation where he set up organ donation wishes way in advance…the people who donated their relative’s liver seem to have been swayed by the media campaign.

With a limited number of organs…is choosing who gets those organs best determined by who can put out the best media campaign? And again…it’s not just a one to one swap…there are doctors, hospitals…an entire organ procurement system involved. Are these media campaigns bypassing the carefully constructed criteria for a waiting list?

Why the blazes are people concerned about what happens to their bodily parts after they die? I mean, they can do anything they want with any part of me after I die. Cut off my head and stick on a pike. I don’t care. Pity the poor sod though who gets my liver transplanted, or my lungs. Even worse, my glands that don’t seem to make pherenomes that attract the opposite sex. That would be pure sadism!
Christ almighty, just dig a bit of a hole, and shove me in it. Then plant a tree. Except some evil devil will probably then cut down said tree and burn it, or use it for some useless ornament.
Hellfire, it seems you can’t win even when dead! Sod this life for a lark!

Are you saying that there is some form of governing body that must approve directed donations? Or are you just referring to the harvesting procedures? My impression is that no one gets to decide except the immediate family, post mortem that is.

But how is that different than any other situation where someone makes a bequest for any damn reason he wants to? I can leave my money to my wife and son, but I’m certain there are other people more in need, more destitute–hell, people whose lives hang in the balance for the want of some cash. Someone could put up a billboard asking people to leave him their money, and maybe I like the billboard so much that I do as he asks. Does someone get to intercede and decide my wishes don’t satisfy the most dire need?

I hear what you’re saying, but I think this falls under the category of “That’s just how it has to work,” and I don’t mean that to sound callous. The state can’t compel you to allow your deceased loved one’s organs to be harvested. From a practical perspective, even if John Q. Almostdead is the most needy candidate, he ain’t getting a kidney from your poor, recently deceased Uncle Benny if your Aunt Suzy refuses.

There are no consistent ethical and medical criteria established to determine cash or food distributions. Different organizations (churches…state or federal agencies…the United Way etc) might have a different focus on how they approach that problem.

There certainly IS an agency that expend a lot of energy developing consistent ethical and medical criteria for “who gets a liver”.

Notice the word “fair”?

“Fair” is at the heart of what organizations like UNOS do. They spend a great deal of effort determining what actually IS “fair”…and their argument is that the case in the OP may threaten that notion of “fair”.

It’s the same reason that they oppose buying/selling organs. Would you be OK with the selling of organs (assuming “consent” of involved parties?)


I hit SUBMIT too soon…I was going to include this quote from UNOS

But why does that lack of consistency invalidate my point? I would say that most organ donations are roughly analogous to leaving your money without any stipulations to some charity–let’s say Catholic Charities. In this case, you are trusting them to use your money wisely, and there’s all kinds of things they can use it for. Similar to donating your organs without directing them to a particular person. You assume the organizations that administer this will handle it as best they can, and that’s good enough.

But leaving your money to your family (or anyone in particular) is analogous to a directed donation. You have decided in either instance that your primary objective is not to ensure the most dire need is met, rather it is to satisfy the need of someone who is special to you in some way, for whatever reason. Certainly there are lines people cross that make us roll our eyes, questioning the wisdom and fairness. Someone leaving a million bucks to her cat while kids are starving, for example. But it’s just a question of degree, isn’t it? Leaving my money to my family, again, probably doesn’t help the most destitute people it could.

I do, and believe me, your point isn’t lost on me. I am glad there are organizations dedicated to this for the organs out there that haven’t been directed to a particular person.

As I’m sure you’ve surmised, I would say that UNOS doesn’t get to decide, not to the extent where they should be able to override someone’s personal decision. And that does not for a second mean they wouldn’t have a point regarding who is most in need.

I’d have to think more about this, but I think I would be OK with it.

I honestly do get your point that personal decisions regarding donations (however wise or foolish) are personal, and generally free of intrusion.

I guess I’m not really addressing those folks who decide ahead of time to donate their Grandma’s kidney to their Uncle Bob…but those who get swayed by media campaigns and make the decision to direct an organ based soley on that campaign.

Although I raised the notion of “regulating advertising” in the OP…it’s not a realistic response to the problem…more of a “thinking out loud” response to the problems raised by Dr Fox et al.

Heres another approach, perhaps. Do the medical folks involved in the harvesting process have to respect the directed request outright?

If I am Dr. Beagle and I have request to harvest a liver for transplantation into a patient whom the medical community has established is a poor candidate for transplantation…(and I know that there are plenty of “better” candidates on the waiting list), do I automatically have an obligation (ethically/medically) to do that harvesting?

If the success of this advertising breeds similar advertising campaigns…what will happen to the current carefully constructed criteria for a waiting list? Will the liklihood of a person to receive a donated organ rely soley on his or her means to advertise…all medically established criteria thrown out the window?

Hmm…I would say that the doctor has an obligation to harvest the organ if there’s a reasonable hope that it can provide a significant benefit to the targeted patient, even if the doctor believes that there are better candidates. This would be a real subjective call in some instances, I bet. “Reasonable,” for me, wouldn’t even have to mean “high probability of success.” Not necessarily. But there are probably some patients in a condition where a transplant offers not even the faintest glimmer of real hope.

Probably pretty academic. I would expect that there has to be a doctor willing to transplant the organ before the harvesting takes place, which by definition means somebody (somebody with a medical degree, that is) has decided it’s a feasible option. Without that, of course a doctor would refuse (“Hey, here’s our Uncle Sammy’s liver. Good luck finding somebody to do the operation!”).