168 procurement, the author defends the judgement of the federal Task Force on Organ Transplantation that the community should have dispositional authority over donated organs, that professionals should be viewed as trustees and stewards of donated organs, and that the public should be heavily involved in the formation of policies of allocation and distribution. Concentrating on policies being developed in the United Network for Organ Sharing, the author examines the point system for cadaveric kidneys, the access of foreign nationals to organs donated in the U.S., and the multiple listings of patients seeking transplants. He concludes by identifying two major problems of equitable access to donated organs that will have to be addressed by social institutions other than UNOS: access to the waiting list for donated organs and the role of ability to pay in extrarenal transplants.
The economics and ethics of markets for human organs Hansmann, H. Yale University, New Haven, CT 06520, U.S.A. J. Health Polit. Policy Law 14/l (1989) 57-85 In 1984, federal legislation outlawing payment for human organs for transplantation was adopted after only cursory discussion of the underlying policy issues. More considered analysis suggests that this prohibition may be overly broad. It appears possible to design suitably regulated markettype approaches to the acquisition and allocation of cadaveric organs (and perhaps of organs from living donors as well) that will be neither unduly offensive to ethical sensibilities nor easily abused and that may yield significant improvements over the existing system of organ procuremen& which presents important ethical and practical problems of its own. Moreover, whatever ultimate judgement we reach concerning the merits of markets for transplantable organs, analysis of the sources of the initial moral resistance to the commercialization that lies behind measures such as the 1984 legislation offers insights into the perspective roles of market and nonmarket institutions in general.
Ethical dilemmas of neonatal-perinatal surgery Rostain, A.L. and Bhutani, V.K. Division of Child Psychiatry, Children’s Hospital, Philadelphia, PA, U.S.A. Clin. Perinatol. 16/l (1989) 275-302 This article reviews historical developments and ethical problems, including quality of life determinations, surrogate decision making, informed consent, and medical uncertainty. Procedural aspects of ethical decision making and a framework for resolving ethical dilemmas are described, and case examples are provided.
Marketing of human organs and tissues is justified and necessary Kevorkian, J. P.O. Box 666. Troy. MI 48099, U.S.A. Med. Law 716 (1989) 557-565 The bioethical guidelines now banning commerce in human body parts to be used for transplantation manifest unrealistic and arbitrary inflexibility which perpetuates and worsens the deficit in organ supply. Instead of relying on traditionally revered but now outmoded and even irrelevant bioethical maxims, formulators of the guidelines should have concentrated on a more meaningful situational adaptation to contemporary real-life circumstances. Many unexpectedly relevant and important nuances of concepts such as property, ownership, and altruism must now be taken into account. Hypothetical examples explore the morality of a universal ban by fiat and the associated problems of organ supply and demand, of cost and affordability, and of fair equity. It is difficult to justify purely altruistic organ donation today, when the health care professions and industries are frantically pursuing commercial profits. It is concluded that the ban should be scrapped in favor of a wellorganized, open, and legally regulated commercial market for human organs and tissues.