Custodians of the body

by ALAN RUBENSTEIN

Achilles Lamenting the Death of Patroclus ARTIST/Gavin Hamilton

Our organ donation regime strikes the right balance between generosity to the living and respect for the dead.

New medical technologies offer humanity increasing power to use and manipulate the human body. Techniques for precisely editing the human genome and for assembling human life at its earliest stages raise urgent questions about how we understand the human body and the appropriate limits on what medical science may do with it. But to answer these questions, we must first understand the commonplace biotechnologies that have already altered the way we think about the human body. One of the signal achievements of modern medicine is our ability to collect and transplant organs from one human body to another, a practice that raises vexing moral and philosophical problems — about the just distribution of organs to those who need them, about how to respect the wishes of donors and their families, about the integrity of the human body, and even about what death is.

In the United States, as in most other parts of the world, our laws and norms for dealing with the practical challenges of organ transplantation are grounded in an understanding of the transplanted organ as a gift. The very name of the law that has governed the practice for over fifty years — the Uniform Anatomical Gift Act — instructs us about the importance of thinking of transplanted organs as freely given gifts of the body. This system has long faced critics, for whom the shortage of organs for transplantation is a crisis that must be alleviated by a radical reform in how we procure organs. One proposal for such radical reform is to introduce a regulated market in organs. Allowing body parts to be treated as marketable property for sale would increase their supply and thereby save lives. The current system of donation, the argument goes, already implies that body parts are property we own, and as owners we should have a right to sell what we own.

Beyond the contingent risks of an organ market — most importantly the threat that the poor will be exploited for their body parts — we must ask what such a change in our legal regime would imply about what philosopher Hans Jonas, in the context of genetic engineering, described as our “image of man.” In a time of increasing technological control over the human body, Jonas argued, there is nothing more urgent for our understanding than reflecting upon that image. What image of ourselves would be implied by our treating the human body as property that can be sold? What image of ourselves would we lose if we abandoned our understanding of transplanted organs as gifts?

Our gift-based system is derived from the perennial understanding that my body, although it is “mine,” is not merely an object; it is also subject, and even after death it retains some critical part of the dignity due to a human person. Organ giving, rather than selling, can preserve this understanding, incentivizing generosity of spirit rather than financial gain.

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