COMMENTARY
ETHICS OF ORGAN TRANSPLANTATION KARL HOLUBAR, M,D,
Two recent articles in the Sounding Board of the New England Journal of Medicine raise additional questions of ethical importance.'-^ Spital and Veatch elaborately discuss the problems of incentives and deterrents for (post mortem) organ donation and the associated legal problems. Both authors agree on one point, namely, the suggestion to put the question of consent or dissent before the potential donor, that is, before all of us (e.g., when applying for a driver's licence or on the income-tax return). Both ways look practical and promising, possibly providing the public (and the medical community) with an identifiable means of securing a person's own will in this special regard. In Austria, in contrast to the United States, "presumed consent" is already practiced today when the possibility of organ donation arises (e.g., in victims of accidents of which no relatives can be contacted in time). Suggestions (or motions, eventually) like the above by a leading nation may well change the situation and would have to be considered. Let us assume that, a decade hence, the majority of the populace in the United States, Japan, or Europe
will carry their positive or negative statements on their drivers' licences, have it stored in a central computer, or have it included in any routine medical history, as suggested above.^ As an inevitable consequence, doctors may then be facing (also) a reverse situation as compared to now, i.e., a given patient with a documented negative will (to donate his organs), who has become the potential recipient and not the possible donor of an organ. Once the necessity has arisen to perform a transplantation, will a patient with a declared unwillingness to donate his own organs have the same moral right to receive organ(s) from others? Will he be placed far down the waiting list with such a negative decision on record? Or will he perhaps be able to improve bis position by changing his earlier decision and adopting a positive stance? Or will the price tag just be higher? An irritating and disquieting array of questions, indeed, even if sensu strictiori such considerations are out of question and only medical parameters must count. REFERENCES
1,
From the Institute for the History of Medicine, University of Vienna, Vienna, Austria.
2,
Address for correspondence: Karl Holubar, M,D., Wahringer Strasse 25, A1090 Vienna, Austria.
Spital A, The shortage of organs for transplantation. Where do we go from here? New Engl J Med 1991325:1243-1246. Veatch RM, Routine inquiry about organ donation—an alternative to presumed consent. New Engl J Med 1991; 325:1246-1249.
DRUG DELAY AND THE EDA VINCENT P. BARRANCO, M.D,
In the area of infectious disease, it is well known that microorganisms may become resistant to certain commonly used antimicrobial agents. Some antimicrobial agents have more favorable pharmacologic properties in certain individuals and certain organ systems. Some antimicrobial agents have a broad spectrum of activity.
and of course, some patients are allergic to certain agents. It seems evident that the pharmaceutical industry must actively pursue new and better agents. Then, why am I sometimes frustrated by the lack of adequate antimicrobial therapy for my patients with infection? Colleagues in other areas of medicine have expressed similar concerns and frustrations regarding not only new and better antimicrobial agents, but also new and better cardiovascular, renal, oncologic, and neuropharmaceutical agents. Certainly, the pharmaceutical industry might share some of the blame, but there are some facts regarding the Food and Drug Administration (FDA) that I would
From the Department of Dermatology, University of Oklahoma Gollege of Medicine, Tulsa, Oklahoma, Address for correspondence: Vincent P, Barranco, M,D., 2121 East 21st Street, Tulsa, OK 74152, 691
ETHICS OF ORGAN TRANSPLANTATION KARL HOLUBAR, M,D,
Two recent articles in the Sounding Board of the New England Journal of Medicine raise additional questions of ethical importance.'-^ Spital and Veatch elaborately discuss the problems of incentives and deterrents for (post mortem) organ donation and the associated legal problems. Both authors agree on one point, namely, the suggestion to put the question of consent or dissent before the potential donor, that is, before all of us (e.g., when applying for a driver's licence or on the income-tax return). Both ways look practical and promising, possibly providing the public (and the medical community) with an identifiable means of securing a person's own will in this special regard. In Austria, in contrast to the United States, "presumed consent" is already practiced today when the possibility of organ donation arises (e.g., in victims of accidents of which no relatives can be contacted in time). Suggestions (or motions, eventually) like the above by a leading nation may well change the situation and would have to be considered. Let us assume that, a decade hence, the majority of the populace in the United States, Japan, or Europe
will carry their positive or negative statements on their drivers' licences, have it stored in a central computer, or have it included in any routine medical history, as suggested above.^ As an inevitable consequence, doctors may then be facing (also) a reverse situation as compared to now, i.e., a given patient with a documented negative will (to donate his organs), who has become the potential recipient and not the possible donor of an organ. Once the necessity has arisen to perform a transplantation, will a patient with a declared unwillingness to donate his own organs have the same moral right to receive organ(s) from others? Will he be placed far down the waiting list with such a negative decision on record? Or will he perhaps be able to improve bis position by changing his earlier decision and adopting a positive stance? Or will the price tag just be higher? An irritating and disquieting array of questions, indeed, even if sensu strictiori such considerations are out of question and only medical parameters must count. REFERENCES
1,
From the Institute for the History of Medicine, University of Vienna, Vienna, Austria.
2,
Address for correspondence: Karl Holubar, M,D., Wahringer Strasse 25, A1090 Vienna, Austria.
Spital A, The shortage of organs for transplantation. Where do we go from here? New Engl J Med 1991325:1243-1246. Veatch RM, Routine inquiry about organ donation—an alternative to presumed consent. New Engl J Med 1991; 325:1246-1249.
DRUG DELAY AND THE EDA VINCENT P. BARRANCO, M.D,
In the area of infectious disease, it is well known that microorganisms may become resistant to certain commonly used antimicrobial agents. Some antimicrobial agents have more favorable pharmacologic properties in certain individuals and certain organ systems. Some antimicrobial agents have a broad spectrum of activity.
and of course, some patients are allergic to certain agents. It seems evident that the pharmaceutical industry must actively pursue new and better agents. Then, why am I sometimes frustrated by the lack of adequate antimicrobial therapy for my patients with infection? Colleagues in other areas of medicine have expressed similar concerns and frustrations regarding not only new and better antimicrobial agents, but also new and better cardiovascular, renal, oncologic, and neuropharmaceutical agents. Certainly, the pharmaceutical industry might share some of the blame, but there are some facts regarding the Food and Drug Administration (FDA) that I would
From the Department of Dermatology, University of Oklahoma Gollege of Medicine, Tulsa, Oklahoma, Address for correspondence: Vincent P, Barranco, M,D., 2121 East 21st Street, Tulsa, OK 74152, 691
![[Organ transplantation. Questions in the interface of ethics and anthropology].](/assets/img/hold.png)
