title: Ethical issues in organ transplantation.
abstract: We discuss ethical issues of organ transplantation including the stewardship tension between physicians' duty to do everything possible for their patients and their duty to serve society by encouraging organ donation. We emphasize consideration of the role of the principles of justice, utility and equity in the just distribution of transplantable organ as scarce resources. We then consider ethical issues of determining death of the organ donor including the remaining controversies in brain death determination and the new controversies raised by circulatory death determination. We need uniformity in standards of death determination, agreement on the duration of asystole before death is declared, and consensus on the allowable circulatory interventions on the newly declared organ donor that are intended to improve organ function. We discuss the importance of maintaining the dead donor rule, despite the argument of some scholars to abandon it.
authors.affiliation: Department of Surgery, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. richard.b.freeman@dartmouth.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Freeman
authors.forename: James L
authors.initials: JL
authors.lastname: Bernat
mesh_terms: D004992:Ethics, Medical; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D014019:Tissue Donors / Q000941:ethics*; D009927:Tissue and Organ Procurement / Q000941:ethics*