• Society of Bioethics and Medicine

Organ Donation: We Need an Attitude Transplant

Written By - Elizabeth Katanov, Edited By - Pooja Suganthan

A dramatic scene on television – a young patient suffers in critical need of a new, functioning heart, while a beloved character passes away and is urgently rushed to an operating room. Cut to the next frame, where a medical assistant is rushing across the unit with a container in her hands labeled ‘Human Organ for Transplant.’ Although one life was lost, another was saved.

This is no isolated incident, and certainly not a situation separate from the realities of healthcare. In 2020 alone, 39,000 organ transplants were performed (HRSA 2021). These organs include hearts, lungs, livers, kidneys, pancreases, and intestines and translate to 39,000 saved lives. And yet, the possibilities of organ transplantation would cease to exist without the foresight of individuals.

To become an organ donor, one must submit documentation indicating their consent to have their organs taken once declared dead and harvested for use in a recipient. In terms of organ transplantation, death is defined as when “either the heart stops beating, or the brain function ceases” (Ethics of Organ Transplantation 2004). The process seems simple, yet it deters millions from performing this life-giving role. Indeed, there is a shortage of organ donors and organs available for transplant. Currently, there are over 107,000 people on the national transplant waiting list (HRSA 2021).

The best way to increase the number of available organs is to increase donor sign ups. However, many are hesitant to sign up due to fear of being a pawn in a larger game. The aversion stems from the misconception that healthcare workers would work less valiantly to save a life if that person were signed up as an organ donor (Caplan 2014).

Currently, there are five main strategies under consideration to increase organ donations. Education involves teaching people at every age level about the positive impact from their decision to donate organs. Another technique may be to mandate choice, which involves having every American indicate whether they want to be a donor or not. In Europe, the recently popular approach is one of presumed consent. With this model, a citizen’s organs are harvested after death unless specifically requested otherwise. This reduces the friction of having to fill out paperwork and makes the default decision one that is desirable for the larger society (Ethics of Organ Transplantation 2004).

The last two techniques pose a more debatable circumstance: incentivizing donations and using organs of prisoners. Incentivizing organ donation may take the shape of assistance with funeral costs, donation to charity, recognition and gratitude, or direct financial incentives. By essentially exchanging organs for a service or money, a donor’s decision is turned into a highly politicized one. Instead of choosing to donate for the good of society, many see an incentivized choice as one where someone is turning the body into a “money-making tool” (Ethics of Organ Transplantation 2004). Additionally, putting a paywall on organs will deepen the divide between quality of healthcare among different socioeconomic communities. It would create a system where the wealthier population could access organs more readily while lower-income candidates are put at a severe disadvantage; this would ultimately convert the idea of organ donation into a business (Caplan 2014). Other than the economic disadvantages of an incentive-based organ donation system, donors would be at an increased risk of illicit harm. This may come in the form of threats, ultimatums, holding hostages, and overall thwarting the main point of becoming a voluntary donor.

The last strategy to increase the number of organs available for transplant is to obtain them from prisoners sentenced to death. Some argue that since the death sentence is not a widely agreed-upon form of punishment, it would be unethical to harvest organs from those who passed due to justice. On the other hand, it can be seen as wasteful to not utilize the organs of someone who is otherwise passing away in good health (Ethics of Organ Transplantation 2004).

Organ donation, although driven by positive intentions, brings about a fine line between maximizing effectiveness and converting the system to a completely different one. By adopting an approach that promotes benevolence and deters greed, we can save more lives without converting the initiative into a business. It is only through careful consideration of different options and perhaps trial and error that we as a society can revolutionize this aspect of healthcare and save thousands of lives, without upsetting the fragile ethical equilibrium of American society.


Caplan, Arthur. “Bioethics of Organ Transplantation.” Cold Spring Harbor Perspectives in Medicine, vol. 4, no. 3, Mar. 2014. PubMed Central, doi:10.1101/cshperspect.a015685.

Ethics of Organ Transplantation. Feb. 2004, pp. 1–48.

Health Resources and Services Administration (HRSA). Organ Donation Statistics | Organ Donor. 10 Apr. 2018, Updated February 2021.

Matching Donors and Recipients | Organ Donor. 7 May 2018,