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Should You Be Able to Give Your Heart Away—Literally?

We may want to rethink the conditions we place on those who can donate organs.

Key points

  • Donors need to be declared dead before their organs can be harvested and transplanted.
  • Some bioethicists argue that terminally ill patients should be able to donate organs before their life support is stopped.
  • Didde Andersen argues that this latitude should be extended to others who wish to donate vital organs while they are healthy.
Silas Camargo Silão/Pixabay
Source: Silas Camargo Silão/Pixabay

Most of us appreciate hearing about real or fictional people who sacrifice their lives to save others, whether they're first responders, soldiers, or ordinary people in extraordinary situations. We admire such people for choosing to neglect their well-being and focus on that of others in the heat of the moment, and we wonder if we would do the same—while hoping we will never have to find out.

We also consider it heroic to donate a nonessential organ, such as a kidney, to save another person, whether a family member, close friend, or even a stranger we may never meet. (Any similarity to this recent viral story is purely coincidental.)

But what if someone wanted to donate an essential organ, such as their heart, to save another person, at the cost of their own life? Current medical practice does not allow this: Donors need to be declared dead before their essential organs can be harvested and transplanted into a person who needs them.

Some bioethicists have argued that this condition should be relaxed, allowing terminal patients, who could otherwise ask that their life support be removed, to take their organs instead. Assuming appropriate measures are taken to ensure this choice is voluntary would allow terminally ill patients to end their lives as they choose while keeping their organs in better shape for transplant, increasing the chances that others will be saved.

In a recent paper published in the journal Bioethics titled "May, I Give My Heart Away? On the Permissibility of Living Vital Organ Donation," Didde B. Andersen summarized such proposals for "organ donation euthanasia" but argued they could be taken further to allow healthy people to donate essential organs to save the lives of others.

Andersen identified three essential principles relevant to the question: patient autonomy, organ viability, and harm avoidance. She argued that patient autonomy is promoted by following the potential donor's wishes, provided that safeguards are put in place to ensure a voluntary, clear-minded decision. (This would help deal with the valid and serious concern that such an option would encourage suicides.) Organ viability would be enhanced, assuming that potential donors would be healthier, on average, than recently deceased donors or those currently on life support.

The main issue of contention is the avoidance of harm. In the case of patients on life support who could ask that it be removed, there is no additional harm if they die due to organ donation instead. However, if the potential donors are not at imminent risk of death, the harm they are incurring by volunteering to sacrifice their lives is significant (to say the least).

Andersen provided several examples of potential living donors whose offers may be understandable. One is a person who is slowly dying and is told he has only five years left to live in steadily declining health. Were this person to donate his organs before his death, he would be losing whatever time he had (in whatever state he would be in), but this would be balanced by the increased chances he would pass on a healthy organ to save another life. Another example is the person who, in her later years, feels she has lived a good life and wants to help another person have the same chance. (Recall that prominent doctor Ezekiel Emanuel wrote in The Atlantic that he sees little reason to live beyond 75.)

Living donors incur significant harm from offering to end their lives to save others. Still, Andersen regarded it as unacceptably paternalistic to refuse people this option (again, assuming measures have been taken to ensure a genuinely voluntary decision). There may be other reasons to oppose this option, such as a general objection to ending one's own life. Still, such explanations would have to contend with the life or lives that could be saved, as well as the preservation of individual autonomy (especially when it's being exercised for the good of others).

I'll leave you with this question: If we honor those who sacrifice their lives in the heat of the moment to save others, is there a reason we should question those who do so more calmly and deliberatively?

References

Andersen, Didde B. (2021). "May I give my heart away? On the permissibility of living vital organ donation." Bioethics, 35, pp. 812–819. https://doi.org/10.1111/bioe.12935

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