10 Organ Donation Practices and End-of-life Care ... 243The Ethics of Organ Donation
Although the history of organ donation now spans several decades, it
is still regarded as a developing science. Even though it is now more
than 60 years since the first kidney transplant and 50 years since the
first heart transplant, it is only a mere 25 years ago that the first lung
transplantation operation was performed (Watson and Dark 2012 ). The
topic of bioethics itself shares this relatively short history, with many of
its substantial developments occurring over the past half century. Given
the continuing developments in organ transplantation and bioethics,
the moral aspects of organ donation and the respective ethical responses
continue to be actively debated (Wilkinson and Wilkinson 2015 ).
Given this continued evolution, what sort of ethical approach is suit-
able for all ongoing debates? Traditional bioethical approaches have
largely depended on the application of a moral framework of major
bioethical principles, such as autonomy, beneficence, non-maleficence,
and justice (Beauchamp and Childress 2013 ). These principles encap-
sulate what is frequently regarded as a justice view of morality, various
aspects of which are prevalent in deontological ethics (e.g. concerned
with moral choices of the sentient, reasoning individual), in utilitarian
ethics (the pursuit of social happiness through egalitarian means) and
within libertarian ethics (where universal moral rules are translated into
individually focused social rights and responsibilities). In the case of
organ transplantation, these formulaic approaches often draw from this
‘justice view’ of morality, in particular the concept of distributive justice
(Persad et al. 2009 ) where the moral ideal is that of a fair and just soci-
ety in which inequalities in outcome are overcome. That this is patently
not the case (e.g. organs are frequently bought and sold, the issue of
‘transplant tourism’, poor people do not readily benefit) is therefore a
moot point. Indeed, there are numerous examples in Western democra-
cies where people in lower social strata, and within social systems such
as health care, are far less likely to receive an organ transplantation than
those who enjoy a greater degree of social capital (Simmerling 2007 ).