Engaging transplantation ethics

Through its Ethical eye series, the Council of Europe has addressed a number of recent developments in science and technology, including cloning and the human genome. The series aims to outline the ethical issues relating to each topic and to make these topics accessible to as wide an audience as possible. The most recent volume, edited by the eminent transplant surgeon, Sir Peter Morris, addresses the ethics of solid organ transplantation.

The organisation of this collection is anachronistic and this provides a clue to its strengths and weaknesses. It begins with a historical review of transplantation and then considers a series of ethical issues raised by transplantation, including threats to identity, xenotransplantation, brain death, rights and duties, the media, conflict between individual benefit and the “common good”, and the appropriate limits of transplantation. The remaining sections cover transplantation practices in Europe, including religious perspectives. While the division of chapters according to national boundaries may seem of little relevance to non-European readers, the format actually provides tangible local exempla of many of the topical issues in transplantation, including presumed consent, cultural determinants of organ donation and organ commerce.

The section dealing with religion and transplantation is excellent in its philosophical depth and practical clarity. The book discusses organ donation and transplantation in terms of issues relevant to Christianity, Buddhism, Islam and Judaism. This is invaluable and often lacking in other texts.

As with all multiauthored works there is some unevenness in the contributions. A practitioner, not a patient, wrote the chapter called “Patients’ perspective” (a problem common to many medical texts), and several chapters lack references for further reading. Perhaps the weakest of the contributions is the chapter entitled “Agnostic ethics”, which is almost completely lacking in logical and philosophical substance.

This book does not provide a comprehensive coverage of the ethics of transplantation, but it does provide a fascinating overview of the ethical, cultural and sociopolitical context of transplantation using examples from contemporary European practice. It is written in an engaging and accessible style that will be of interest both to the professional and the lay reader.

Ian H KerridgeAssociate Professor of Bioethics Centre for Values, Ethics and the Law in Medicine University of Sydney, NSW