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Bioethics

Three Guys with Failing Organs vs One Guy with Good Organs

Michael Voytinsky finds another take on a classic utilitarian dilemma.

A hypothetical example comes up in many discussions of utilitarianism and its implications: three people with three different failing organs lie dying in a hospital when a healthy person arrives with a minor injury. If utilitarians are serious about wanting the greatest happiness for the greatest number of people, it is argued, then surely they should favour killing the healthy person to provide organs to save the other three? The following document offers a new perspective on the issue.

This document came into my possession as a result of an integrated DVD player/coffee maker malfunction that briefly sent me into a dystopian (or perhaps utopian) near future. I have shown it to friends and family, and while none of them would want to join the Voluntary Organ Exchange Society, they cannot give a rational reason for not wanting to do so.

• • • • •

Voluntary Organ Exchange Society F.A.Q.

Q. What is the Voluntary Organ Exchange Society?

A. The Voluntary Organ Exchange Society (VOES) is an international non-profit mutual assistance organization dedicated to prolonging the lives of its members. Its members agree to donate any of their organs to other members needing them, if doing so will result in an overall increase of years of human life by the members of the society.

Q. How does that work?

A. For example, one member of the society may suffer a failure of both kidneys. If a search of the membership database turns up a suitable kidney donor, that person will typically be required to donate one out of two kidneys.

All organ donations are subject to life expectancy calculations. In this example, if the kidney donation is likely to add five years to the life of the recipient, but the state of health of the donor is such that it is likely to take six years from the life of the donor, no donation will be required.

Q. How are the life expectancies calculated?

A. The life expectancies are calculated based on actuarial information. The Society has retained the Life Mutual Actuarial Services of Zurich for the life expectancy calculations.

Q. What happens if there are three people, who need a kidney, a heart, and a liver – and I am the only suitable donor?

A. The needed organs from one person will be donated to the three people, provided that the donation is likely to increase the overall number of human years lived, based on actuarial information.

For example, if the three individuals are all in their 80s, donating vital organs from a suitable healthy 20 year old will, on average, result in overall loss of years lived. In this case, the terminal organ donation is not justified and is not required. The 20 year old might still be required to donate a kidney, and possibly part of a liver.

On the other hand, if the recipients have a reasonable life expectancy after the transplant – which is likely providing they have no other health problems beyond the failing organ in question – and actuarial calculations show an overall increase of years of life lived, then a terminal donation will be required.

Q. Wouldn’t it be better to concentrate on productive or healthy years of life, rather than simple raw life expectancy?

A. Possibly, and this is a matter of some debate within the society. There are some difficulties involved in defining ‘productive’ and ‘healthy’ in this context, and at the last General Meeting the membership voted to continue using raw life expectancy figures. There is a sub-committee currently studying this issue and it will present its findings at the next Annual General Meeting.

Q. You mean if I sign up, I could end up being forced to make a ‘terminal donation’?

A. This is possible but not very likely. In the ten years the Society has been in existence, only seven terminal donations have taken place. In the same period of time, 98 members have died as a result of violent crime and traffic accidents.

Q. How is this donation enforced?

A. This varies by jurisdiction. In Meximerida, for example, organ donations, including terminal donations, will be enforced by the courts if necessary. Some jurisdictions do not allow enforcement of terminal donations, and some prohibit terminal donations altogether. The society always complies with local laws, and some services are not available in some jurisdictions.

If you are resident in a jurisdiction that does not permit enforcement of terminal donations, refusal to comply will lead to termination of membership of the society.

Residents in a jurisdiction that does not permit terminal donations at all do not have this service available, either as a donor or a recipient.

Members who successfully avoid donation enforcement will have their credit rating destroyed.

Q. Once I join the Society, can I leave?

A. You can leave at any point before being called to be a donor, or before becoming a recipient. As a recipient, you cannot resign your membership until such a time as you become a donor of an organ or organs of similar or greater value.

Q. Is it true that the Society wants to make the organ exchange program part of mandatory national health plans?

A. This is not true. The Society believes that people are sovereign owners of their bodies, and cannot be required to part with them, or any parts of them, without their consent. The voluntary nature of the Society’s membership is an aspect of its fundamental philosophy.

There is a fringe element of the Society that does not share this view, but at the last Annual General Meeting this element did not have sufficient presence to even force a motion to put the voluntary principle to the vote. Unfortunately, this fringe element gets disproportionate attention from the Press.

Q. Who can join the Society?

A. Anyone who has reached the age of majority in the jurisdiction in which they reside may be a member of the society. A member who moves to a jurisdiction where they have not reached the age of majority will have their membership temporarily suspended until they reach the age of majority, or move to a jurisdiction where they are legal adults.

In order to join, the new member must not have major medical conditions. We use the same standards as life insurance companies – an individual who would not be eligible for life insurance without a medical condition surcharge is not eligible to become a member. We urge potential members to join as soon as they reach the age of majority, since serious medical conditions are more likely to develop with age.

Michael Voytinsky is working on his M.A. in philosophy from the University of Wales, Lampeter, while living in Ottawa, Canada. He spends a lot of time thinking, reading, and writing philosophical things, and does technical support for computer security products in his spare time.