Title

The Role of Death in The Moral Permissibility of Solid Organ Procurement After Cardiac Death and Its Implications

Date of Award

2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Philosophy, Applied

First Advisor

Michael Bradie, PhD

Second Advisor

Lee Meserve, PhD (Committee Member)

Third Advisor

George Agich, PhD (Committee Member)

Fourth Advisor

David Shoemaker, PhD (Committee Member)

Abstract

“Donation after cardiac death” is the practice of procuring multiple vital organs from patients who are declared dead through cardiopulmonary criteria. While the procedure is widely deemed morally permissible and desirable, it has not enjoyed a sound moral justification for its practice. Most moral defenses of it rely upon the assumptions that it is permissible to procure organs from dead patients, the “dead donor rule”, and that the donors are dead, but the patients are not dead by any reasonable criteria, and thus violate the rule. I maintain that the dead donor rule ought to be abandoned because it would prevent what are otherwise clearly morally permissible procurements such as these. Some have argued that a prognosis of immediate death captures the apparent moral value of death in these cases, but using the prognosis of death in this analysis is just as problematic as using death. Additionally, I argue that the fact that organ donors are killed by organ procurement is morally irrelevant to whether or not such procurements are morally permissible, which further supports abandoning the dead donor rule. What appears to be the primary concern for proponents of the dead donor rule is a desire that donors not be killed for their organs. However, terminating patients for their organs is not a serious moral problem and is a necessary reality of organ procurement, as donors are terminated at a specific time in order to procure their organs. I maintain that donation after cardiac death is permissible because it upholds the principles of respect for persons and nonmaleficence, the two primary guiding principles in American bioethics, and not merely because the patients are dead or imminently dying. These principles can be readily upheld when patients are dying and have properly consented to be organ donors. Although my analysis is primarily moral, there are policy implications that should follow from my analysis, primarily that donation after cardiac death ought to continue, the dead donor rule ought to be abandoned, organs ought to be taken earlier in the dying process, and the donor pool ought to be expanded.