244 M. Coombs and M. Woods
Traditional moral approaches are increasingly found to be at odds
with particular social and cultural contexts, especially in the wider social
aspects of debates concerning organ transplantation and donation. The
promotion of universal moral principles and individual choice may
not take into account the bearing that socio-cultural circumstances,
and complex relational arrangements have on moral decision-making
(Woods 2014 ). Furthermore, the preoccupation with a justice-based
ethics that assumes universally applicable moral principles is impractical
and fails to appreciate the complexity of social realities in the context
of health care and medicine. Consequently, present-day debates about
the ethics of organ donation need to reflect a wider range of bioethical
approaches, and the inclusion of social (or socio-cultural) ethics in this
chapter is used to draw attention to situations that require an alternative
ethical analysis.
Two of the most significant bioethical issues associated with organ
donation concern the processes by which organs are donated and the
shortage of suitable organs for transplantation. Most transplantable
organs are extracted from deceased persons with prior consent, but it
is this type of consent that lies at the heart of many bioethical issues in
organ donation. It has been argued that, given the scarcity of organs for
transplantation, modern medical responses and their dependence on the
notion of the ‘altruistic society’ is failing. This has led to concerns about
whether fairness, justice and social responsibility are applied when it
comes to the distribution of organs to those most in need.
Organ Donation Cases with Commentary
In the following section, abbreviated excerpts from three family nar-
ratives about organ donation from deceased organ donors within
Aotearoa/New Zealand have been used to explore a variety of different,
yet connected, clinical practice challenges, with their associated ethical
arguments and resolutions. The cases are quoted verbatim from the
New Zealand Organ Donation website.
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