To coincide with the release of the second edition of Sociology for Nurses this month, Elaine Denny and Sarah Earle take a look at a controversial new organ transplant strategy announced in the scientific journal The Lancet.
In most countries of the world where the transplantation of human organs takes place, there is a shortage of organ donors. Therefore people who need a kidney, heart, liver or lungs are placed on a waiting list to wait for a suitable match. While waiting, the condition of some may become so serious they are classed as urgent and moved up the waiting list, or they may even die waiting.
For the majority of organ transplants to take place, someone has to die and be willing for their organs to be removed and transplanted. In most countries the potential donor’s relatives may countermand the decision following their death. The system of donation in the UK and many other countries has been based on what sociologist Richard Titmus called ‘the gift relationship’. Writing about blood donation in 1973 he remarked on the altruism involved in doing something which had no benefit to the donor, but was of major benefit to some unknown recipient. He admired the selflessness of giving, rather than selling, blood for the sake of someone else’s need. Titmus was writing before the days of routine transplant surgery, but would probably have been struck by the willingness of people to donate organs after death to allow an unknown person to be treated for serious disease, and of their relatives to agree to this at a time of tragedy for themselves.
In TheLancet today (17th December 2009), an Israeli strategy which moves away from the idea of an altruistic gift in the donation of organs was announced. Like most countries, Israel faces an acute shortage of organs for donation and plans to address it by linking the willingness to accept an organ if ever it is required to the responsibility to donate organs after death. So people who sign organ donor cards will take precedence over people with equal need who have not if they are on a transplant waiting list. There are also concessions for their families and for live donors, providing they donate to the public pool rather than to a named person. This will remove the ‘gift relationship’ and make organ donation a matter of self interest, although the phrase being used by the Israeli government is ‘reciprocal altruism’.
The intention of this policy is obviously to increase Israel’s particularly low level of organ donation, but whether this will happen is questionable. The reasons why people do not sign organ donation cards are complicated, and may be concerned with moral or cultural views that are not addressed by reciprocity. Most countries with high levels of donation, such as Spain, have systems in place whereby a lot of time and effort is made by transplant co-ordinators in counselling families of potential organ donors around the time of their death.
Will Israel’s policy mark an end to the gift relationship and a move to a situation where people expect to receive in exchange for giving? Or is the concept of altruism for the sick a strong enough motivation for the gift relationship to survive?
The second edition of Denny and Earle’s Sociology for Nurses provides a vibrant and jargon-free introduction to the relevance of sociological ideas to nursing and the health care sector.