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Donation is an act of giving, intended to help others at a time of need, which is globally regarded as virtue, and a sign of love and compassion. However, there are opposing views towards the donation of a person’s body tissue or corpse for the sake of others because different cultures hold diverse views concerning the safeguarding of an individual’s body. With the reality of the progress in medical technology, the promise of better health for each person has gradually opened people’s minds to the donation of body tissues or even an entire corpse for medical purposes. The foundation of global bioethics is this universal willingness to do good and help others.
This chapter ﬁrst discusses the multidimensional implications of donation and then explores the reasons for donation of the body for either transplant or scientiﬁc purposes. What to do with leftover tissues is continuously debated in research ethics; thus, in this chapter, the concept of consent is examined. In addition, the arguments for and against body donation are discussed as well as the phenomena of body trade that is occurring in some parts of the world.
A donation is a charitable act of giving something to someone or for some cause as a gift to beneﬁt others without anticipating anything in return. Such gifts can be money or any material things that others can use. Some people may also render their talents by giving voluntary service to someone in need, e.g., a carpenter helps build a house for a poor family or someone volunteers to visit a shut-in to offer comfort and encouragement. Therefore, donation can be material or non-material. Such giving of tangible goods or one’s talents or time to someone for a common good has always been regarded as a noble cause in all cultures, thus bearing global value. To the Chinese, donation is an act of Jen (benevolence); to Hindus, it is known as Dāna, such as almsgiving, gifting, and sharing; to Muslims, almsgiving is known as Zaqat; to Christians, charity such as extending love to one in the lowest position in life is regarded as an act of love towards God. Our world has indeed become a better place because many people are willing to donate something to someone in need.
Donation From A Biomedical Perspective
From a biomedical perspective, donation can be the giving of body tissues or organs to another for transplantation to replace or repair the damaged body part. One may also donate one’s own body after death for the purpose of deepening physiological understanding of the human body or for studying the disease that caused death.
Research is a necessary step to solve biological mysteries and ﬁnd new ways of treating diseases. In the last few decades, some countries have launched biobank projects with the purpose of discovering the genetic causes of human illness. Participants are recruited to donate their blood and body tissues for medical research and to share information regarding their living habits so that greater understanding and prevention or cure of certain genetic diseases can be found. Therefore, donation is multi-dimensional; it can involve tangible material, physical parts, or spiritual support for a common purpose, namely to help others, and is altruistic in nature.
The various types of donations from a biomedical perspective can be summarized as follows:
- A substance of the human body, such as blood for transfusions to assist those with hemophilia or someone in need of blood supply during an operation.
- An organ for transplantation, such as a heart, liver, kidney, lung, pancreas, skin, etc. Some parts of the body can be regenerated, such as the liver and skin, and therefore giving part of that organ will not endanger the donor’s life, which is called living donation. Other donations, such as the heart or pancreas, have to wait until the donor’s death for the transplant to take place, which is called corpse donation.
- Body tissues, such as blood, or to consent to the use of leftover tissues extracted from surgery, such as cancer tissues, for research purposes.
- The body after death, i.e., the corpse, for teaching or for autopsy to solve the mystery of the cause of death, etc.
A donation is motivated by one’s good will to extend love toward others. In medical ethics, it is known as an act of beneﬁcence that beneﬁts others. Donation has to be totally voluntary. No one can force anyone to donate anything unless the donor himself is willing to do so; it is entirely autonomous. Body tissue donation must not cause any harm to the donor. In medical ethics, primum non nocere (“do no harm”) is the ﬁrst principle and the health condition and suitability of the donor must be ensured prior to any living donation. In distributing the donated tissues, we must also keep in mind its fairness and justice to all.
Donation For Transplant
Among the different donations, the donation of body organs is most in demand and also the most controversial.
The ﬁrst successful transplant (of a kidney) took place in Boston (MA, USA) in 1954 between identical twins. The operation was a success largely because their genetic make-ups were identical. Christian Bernard performed the ﬁrst heart transplantation in December 1967 but the recipient died 18 days later of double pneumonia. The rejection of the transplanted part by the recipient was the main reason for this failure, but the discovery of cyclosporin A, which suppresses rejection, in 1980s gave transplantation medicine new promise. Today, it is possible to transplant most organs, including the kidneys, heart, liver, pancreas, lungs, skin, and a variety of tissues such as bone marrow and corneas. The transplantation of organs from one human to another has become commonplace. However, without someone willing to donate their organs, those in need of transplantation cannot have a chance to improve their quality of life. To transplant a heart or pancreas, we have to wait until a potential donor is dead to extract the needed organ from a cadaver or corpse. Other transplants can be from living donors, donating a kidney or part of a liver.
Consent In Donation
Removing an organ from a living or dead person cannot be arbitrary and has to be voluntary. Free choice and volunteerism have been the philosophical foundation for ethical and legal arguments on organ donation. To promote donation, in some countries a consent card has been prepared for people to sign, but the number of people doing this has been limited. There are at least three kinds of consenting, namely: (i) express consent, which is lucid and without question, such as a person signing a consent form indicating their willingness to donate organs; (ii) presumed consent refers to the situation when there is no explicit objection to donation of an organ, and consent should be presumed; (iii) tacit consent is similar to presume consent, i.e., although no expression is indicated, either opting out or in, consent is implied by one’s silence. From a utilitarian perspective, all of these forms of consenting are acceptable, but from deontological perspective and legal view, written consent cannot be ignored.
Pros And Cons Of Body Donation
Helping others is regarded as good and ethical in all world cultures, but different opinions exist regarding the question of donating one’s body organs for transplant. Some cultures deem keeping the whole body intact in life as obligatory and believe that no one should hurt one’s own body and nor can we desecrate a corpse by removing organs. Other cultures regard giving oneself for others as the highest expression of love. Let us look at the different interpretations and stands on organ donation.
In Confucian ethics, the human body is regarded as a gift given by the parents and therefore children should safeguard its completeness. This thinking has resulted in a reluctance to donate organs as it is un-ﬁlial to mutilate your given body.
Taoism believes in naturalness and spontaneity of life. Any attempt to interfere with the natural ﬂow of things is not encouraged.
In Shinto tradition, the body becomes impure after death and any interference with a corpse, including removing an organ, brings bad luck in life. People must be careful not to injure the relationship between the dead person and the bereaved by interfering with the corpse. Hence, organ transplantation is comparatively rare in Japan (Namihira 1990).
Hindus believe that the atman, the soul of a person, lives on forever and is immortal. This soul will be reborn into a new physical form. The giving of organs for donations could damage this soul. Besides, the real death takes place only at the rituals of cremation and burial. Though a person may die biologically, religiously the person is not completely dead until after the cremation and burial. Thus, organ extraction for transplantation is to be avoided.
Pure Land Buddhism, a branch of Mahayana Buddhism, believes that a dying person must not be disturbed physically so that the soul, which takes 8 h to depart from a body, can have a peaceful migration towards its new destiny (Shu 2001). This belief makes procurement of organs impossible. Fundamental Buddhists believe life is nothing but suffering: living a virtuous life is required to escape the wheel of rebirth. A reasonable person will not desire to receive an organ transplant to prolong this suffering as clinging to life is a craving that contributes to the accumulation of karma, trapping a person to continue suffering life. Furthermore, Buddhism sees everything on earth as transitory; nothing, including self, is permanent. With the belief that everything is only a part of impermanent psychological processes, transplanting an organ to keep a life going appears to be foolish as there is nothing to have and nothing to be had. An individual can simply let go because letting go is the end of suffering.
Transplantation is prohibited in the Jehovah’s Witness faith, which opposes any movement of blood from one person to another as the Old Testament of the Bible prohibits against the “eating” of blood. Any blood transfusion is a violation of this teaching. Organ transplantations involving blood exchange should not be performed.
Modern Confucian scholars argue that donation of an organ for others is an act of compassion that reﬂects the Confucian core teaching of Jen (charity). Confucius is reported in The Analects as saying: “the man of Jen is one who, desiring to sustain himself, sustains others. A man of humanity wishing to establish his own character, also establish the characters of others and wishing to be prominent himself, also helps others to be prominent. To be able to judge others by what is near to ourselves may be called the method of realizing humanity” (Chan 1963, p. 31). These scholars argue further that Jen and righteousness are valued more in Confucian tradition than simply preserving the physical body received from a person’s parents. They quote Confucius as saying “a man of benevolence will not do anything to hurt the realization of humanness and righteousness. A man of humanity will never seek to live at the expense of injuring humanity. He would rather sacriﬁce his life in order to realize humanity” (Chan 1963, p. 43). This saying can indeed be interpreted as favoring the donation of organs for transplant, but, by the same token, it can also be used to justify one’s argument against organ donation because the donation can be interpreted as un-ﬁlial as the person is mutilating the very body given by his parents, and thus he is not acting as a man of humanity.
Modern Taoist scholars facing the challenge of medical technology also argue that Taoism sees the human body only as a shelter that bears no substantial meaning. The important parts of life are the Tao (the Way) and the Te (the Virtue) that ﬂow in life. If the physical body is simply a shelter, any attempt to change it or remove any part from it will not affect the essence of life; life cannot be limited by organs. Life points to all possibilities, and thus donating organs cannot affect anything at all. Besides, Taoism also believes love is a natural expression of life; for instance, a mother wolf taking care of her cubs, even to the point of sacriﬁcing herself, is natural and spontaneous. Therefore, donating one’s organs for the sake of sustaining another life should not be opposed. Lao-tze said that the way of Tao is to let what is superﬂuous ﬁll what is insufﬁcient (Tai 2008). From this point of view, anything that can be said to be more than sufﬁcient, for instance the dying person’s organs, can be used to help the insufﬁcient, namely ill patients in need of transplants.
Mahayana Buddhism emphasizes that a merciful Buddha cannot suffer seeing people live in foolishness and thus decides to postpone his own entrance to Nirvana in order to remain on earth to teach and save more people from the condemnation of evil karma. This Bodhisattva nature is compassionate. Based on this teaching, a new interpretation has emerged that Buddhism will encourage donation of organs for transplantation as it is an act of compassion. Therefore, Buddhism is not negative toward this new medical technology.
Modern Hindu scholars interpret the physical integrity of the dead body as not being crucial to reincarnation of the soul. When a body is formed, the soul will put on new clothes, disregarding the old, and therefore any organs that have been extracted in the previous life will not affect the new one from forming, nor does any ritual have the power to change the new body. Besides, in Hindu mythology the story of Ganesha describes how the transplanted body will form a new one when the old parts are destroyed. The story is the best example of a new life after transplantation, although Ganesha received an elephant head as it was the ﬁrst organ available to be transplanted (Oliver et al. 2011). The Hindu sacred text, the Bhagavad Gita, has this to say: “As a person puts on new garments giving up the old ones, the soul similarly accepts new material bodies giving up the old and useless ones” (Prubhupada 1972, Chap. 2, p. 22).
Hasmukh Velji Shah of the World Council of Hindus stated that the important issue for a Hindu is that which sustains life should be accepted and promoted as Dharma (righteous living), for organ donation is an integral part of our living.
Christians hold love, hope, and faith as the most important virtues in life and the greatest love of all is to sacriﬁce oneself for the sake of others. Christianity teaches that one must love your neighbor as oneself. The progress of medical technology to enable transplantation of organs from one person to another challenges Christians to love their neighbors in a new ways. The Vatican charter for healthcare workers in 1994 quoted Pope John Paul II as saying: “With the advent of organ transplants, begun with blood transfusions, human persons have found a way to give part of themselves, of their blood and of their bodies, so that others may continue to live” (John Paul II 1991). According to the principle of totality, one person may sacriﬁce a part of the body for the welfare of the whole body. This justiﬁcation of donation of one’s organs to beneﬁt others is regarded as the fulﬁllment of love.
Judaism believes the dead must be buried as quickly as possible. However, for the sake of removing an organ to save someone, a delay is justiﬁed. Some even assert that Jews are required by their faith to donate organs as it is a duty to save those in need. Though there is concern about mutilating a corpse during the removal of organs, the majority of opinion feels saving a life is a fundamental value in Judaism and that the urge to save a life should take precedence over any concerns.
Islam supports organ donations, seeing it either as charitable or required to preserve life. Saving a life is placed very highly in the Qur’an. Though disﬁguring the human body, whether living or dead, is forbidden, altruism is also an important principle of Islam. The Islamic Jurisprudence Assembly Council in Saudi Arabia approved deceased and live donation in a landmark decision in 1988 (Golmakani et al. 2005). However, even though most international Islamic scholars have endorsed organ donation, many individuals within the faith are still reluctant, particularly regarding deceased donation.
Organ Trade For Transplant
The World Health Organization and most civilized countries have forbidden the sale of organs and made the organ trade illegal, but in some poor countries a black market organ trade (Annas 1984) is evident which beneﬁts the rich and harms the poor. As long as the demand is there, the trade vehicle is always present. The trader argues that it is an unfortunate means of survival in dire poverty. People have no other choice but to exchange their own body parts for money for food. They say that at least they can still control their individual bodies and, if willing to sell, it’s no one else’s business.
But who owns one’s body? At death, does the person’s body become common property? If so, has society the right to decide its disposition? Most people still think the body is private property and therefore autonomy is one of the main principles in medical ethics.
Challenging Ethical Issues Regarding Body Donation
There are opposing views towards organ transplantation. But, as medical technology progresses and with the propitious perspective it offers, the negative views have gradually been diminishing. Will this mean that the removal of tissues for medical purposes, including research and transplantation, will no longer have any ethical dispute? No; new, precarious challenges are always present. For instance, what should be done with leftover tissues that have been autonomously donated for medical research, especially in a situation where the researcher ﬁnds something worthy of pursuing other than that which the informed consent form has indicated; should the new research goal require a new consent from the donors? What to do when the donor is no longer reachable? Later, when the donated tissues have contributed to the ﬁnding of new treatments for disease, should the donor receive any recognition? In order to encourage participation in research, should there be any gratuity given to the tissue donor?
Another debatable question is with regards to living donation in the case where a family member is reluctant to give their organs but mounting family pressure may force them to give in. The possibility of conﬂicts of interest, discrimination, exploitation of familial relations, and even outright pressure and force cannot be excluded from any moral assessment of intra-familial donation and donation by friends. Presume consent in organ donation is also debatable; can we take those indicating nothing as giving consent? Facing the scarce availability of organs for transplant, presume consent seems a good way to solve the shortage; however, is it ethical to assume that those who never express their will give consent?
Enough cadaver organs indeed exist and if they can be available for transplant, many people can be beneﬁtted. But does the society have a right to claim the ownership of the organs of the diseased?
New arguments are also present regarding the commercialization of organs and the presence of the black market for organ trade (Annas 1984). The poor are sometimes forced to sell their organs in exchange for a little money to survive. When corpse donation cannot meet the demand, people seek living donors through trade. Justice is at stake here.
Scholars such as Sass suggest that perhaps some system can be regulated to facilitate the process of ﬁnding available organs. He said that the “selling of organs is unfair and unjust and should be punished harshly. However as [the] black market thrives … would it not be better to think about a highly regulated market as an alternative to the black market?” (Sass 1998). Some will argue that if organ trade is allowed, the sacredness of human life will be lessened to a daily commodity, losing human dignity.
Donating something to someone or for some cause is an act of love that cannot be forced. Provoking altruism to appeal to human compassion for others should be a good way to promote donation of organs, but as the world is becoming more and more materialized, alternative methods need to be considered.
Life is sacred, noble, and should be cherished. If donating part of oneself can beneﬁt the world, everyone should be encouraged to do so. It is not only good and right but also morally encouraged. However, we must respect each person’s free autonomy to decide either to donate or not.
World values can be best described as diverse. When trying to ﬁnd a common good among all, “do to others as one likes to be done to oneself” could be it. In Christian tradition, it is “love your neighbor as yourself”; in Confucian teaching, it is “do not treat others as you don’t want to be treated”.
In medical ethics, these are the reﬂection of the principle of beneﬁcence and non-maliﬁcence. But what is do no harm? Is removing one’s body organ a harm to those who insist on the value of integrity of the body? Is transplanting an organ to a person in need so that the recipient can gain new health and live on doing good? If giving help to others has been agreed upon by all world cultures and is regarded as virtue, love, and compassion, being willing to give oneself for the sake of others should be the foundation of global bioethics.
- Annas, G. J. (1984). Life, liberty and the pursuit of organ sales. The Hastings Center Report, 14, 22–23.
- Chan, W. T. (1963). A source book in Chinese philosophy. Princeton: Princeton University Press.
- Golmakani, M. M., Niknam, M. H., & Hedayat, K. M. (2005). Transplantation ethics from the Islamic point of view. Medical Science Monitor, 11, 105–109.
- John Paul II. (1991). To the participants at the ﬁrst international congress on the transplant of organs, 20 June 1991. Insegnamenti, XIV/1: 1711.
- Namihira, E. (1990). Shinto concept concerning the dead human body. Transplantation Proceedings, 22, 940–941.
- Oliver, M., Woywodt, A., Ahmed, A., & Saif, I. (2011). Organ donation, transplantation and religion. Nephrology, Dialysis, Transplantation, 26(2), 437–444.
- Prubhupada, S. (1972). Chapter 2: The eternal reality of the soul’s immortality. In Bhagavad Gita as it is (p. 22). New York: Macmillan.
- Sass, H. M. (1998). Ethics of technology allocation. Artiﬁcial Organs, 22(3), 266–267.
- Shu, C. H. (2001). A Buddhist view on organ transplant (p. 56). Taipei: Pure Heart Foundation.
- Tai, M. C. (2008). The way of Asian bioethics (pp. 95–105). Taipei: Princeton International Publishing.
- Annas, G. J. (1984). Life, liberty and the pursuit of organ sales. The Hastings Center Report, 14, 22–23.
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