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Whole Body Gestational Donation

photograph of pregnant belly

In her recent paper, “Whole Body Gestational Donation,” Oslo University-based ethicist Anna Smajdor proposed a thought experiment in which the bodies of brain-dead women were used as biological incubators to gestate humans from conception to birth. Her argument follows along the lines of traditional posthumous organ donation, arguing that if we’re comfortable with the regulatory and ethical systems underlying the gifting of individual body parts (hearts, kidneys, livers, eyes, etc.), then we should allow consenting women to donate their entire body to act as a deceased surrogate. And that, if we have some discomfort with the latter prospect, and we are committed to the idea of treating like for like, then perhaps there is something wrong with the more traditional form of donation. But, conversely, if we’re happy with the former, we should be satisfied with the latter.

Unsurprisingly, given the controversial subject matter, her paper blew up. Both curious and indignant responses have come from broadcasters and outlets across the spectrum, including Fox News, Cosmopolitan, BioEdge, and Women’s Health, to name just a few. Smajdor received such vitriol because of this coverage that she wrote a follow-up piece for The Progress Educational Trust, providing some context to her thoughts and defending the work, emphasizing that it was not a policy suggestion but, rather, a way of highlighting a potential inconsistency in how we understand postmortem donation.

Now, much could be written about how media outlets have covered (and, as Smajdor suggests in her response, deliberately misconstrued) her argument. Instead, however, what I want to do here is engage with the work itself. Specifically, I want to discuss the best use of donated organs.

But, before doing so, I feel it’s important to acknowledge that the prospect of women being used as tools for gestation after brain death is bleak. Rather than being taken off ventilation and allowed to die promptly (and maybe with some dignity), the idea that doctors could keep these women artificially alive simply so their reproductive organs can work to grow a fetus for a third party needing a surrogate is, on the face of it, horrifying. It, not unjustly, conjures up intense emotional discomfort for many. But, as Smajdor notes in her paper and response, simply finding something unpleasant isn’t a sufficient justification to consider it immoral or impermissible.

Many things that we now think acceptable, maybe even good, were at one point lambasted because of their seemingly clear immorality (heart transplants, for example). Ultimately, the “wisdom of repugnance,” as Leon Kass terms it, may give us reason to pause for thought but is not a good enough reason to outright disregard a proposal.

What, then, is the problem (or at least one of the problems) with Smajdor’s proposal? The answer for this article’s focus comes down to a numbers game. Specifically, how many people can the organs from a single cadaver help?

In the right conditions – that is, if the cause of death isn’t something that makes the organs unusable – a single deceased organ donor can save up to eight lives. Each kidney can be donated to a different individual, freeing them from dialysis (on average, for someone on dialysis, life expectancy is five to ten years). A single liver can be split into two and donated to two more people. Each lung can go to a different individual, helping another two people. Finally, the pancreas and the heart can help the final two persons. It is not just life-saving body parts like these that clinicians can harvest after death: corneas, skin, tendon, ligaments, blood, bone, bone marrow, and even the hands and face can be donated to those who need them. In fact, according to the U.S.’s Health Resources & Services Administration, a single deceased donor can save eight lives and help another seventy-five.

Not everyone who signs up to be a deceased donor can donate the full range of body parts. There are multiple reasons why this may be the case, from medical to social to religious. Even with this acknowledgement, however, each person who agrees to donate their organs and other biological materials does something which can fundamentally change many people’s lives for the better.

Each part of the body that is donated is a gift of immeasurable worth, one that we must think carefully about how best to use. To waste such organs or consolidate them so that they help only a tiny few is to do a great disservice to the person who, by donating their body after death, undertakes an act of immense selflessness and beneficence.

It is here that whole body gestational donation runs into a problem.

Using someone’s body for gestation means that those organs and tissues cannot be relocated and used for another purpose or help another person. Instead, the life-saving or enhancing organs and tissues will be occupied for the nine months that the donor uses their reproductive organs to grow a human. For example, you can’t harvest the heart from a brain-dead person if the cadaver already uses that heart to pump blood around the body during gestation. The same is true of other organs, which will need to remain in the body to ensure that pregnancy can occur and delivery is successful.

A potential counterargument is that not all organs are required for persons to gestate or even live. Living organ donation happens regularly and doesn’t result in that person’s untimely demise. You can donate part of your liver or pancreas, an entire kidney or lung and keep on living, albeit with some health implications. It seems theoretically possible that the same could be true for whole body gestational donation. Some organs and tissues would need to remain for the pregnancy to occur, while others could be harvested and donated to those in need. In effect, splitting the donation allocation into those required for gestation and those not.

Beyond the unpleasantness of such a proposition (which, again, isn’t sufficient to rule out the proposal), there may likely be practical reasons why this isn’t possible.

As Smajdor herself notes, pregnancy isn’t a benign process. On the contrary, it carries severe dangers and puts a not-inconsiderable toll on the human body. This is as likely to be the case for the dead body as it is for the alive one.

As such, harvesting multiple organs and tissues while simultaneously expecting the brain-dead body to gestate successfully might simply be asking too much. Ultimately, the body may be unable to handle the biological load of pregnancy without relying upon the full range of life-sustaining organs.

In traditional, post-donation pregnancies, this usually doesn’t appear to be the case. For example, the U.K.’s NHS notes that “many women have had babies after donating a kidney without any impact on the pregnancy from the kidney donation.” However, we’re not talking about normal pregnancies here. The brain-dead body could be vulnerable to various complications and negative impacts because it’s dead. And while this wouldn’t be a risk to the pregnant body (after all, they’re already dead), it could jeopardize the efficacy of whole body gestational donation if it means that successful gestation is unfeasible when combined with traditional organ donation.

So then, if faced with a choice between whole body gestational donation, which could help bring one person into the world, or traditional forms of organ and tissue donation, which could save eight lives and help a further seventy-five, the latter seems like the obvious choice. This, in turn, may help us explain (or perhaps justify) our differing intuitions when it comes to the apparent equivalence of organ donation and gestational donation.

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Can Human-Grown Organs De-Liver?

photograph of surgeons conducting procedure on operating table

Despite the majority U.K. shifting from an opt-in to an opt-out donation system, there is still a vast shortage of viable organs. According to NHS figures, there are currently over 7,000 people on the organ transplant waiting list, and just last year 420 died because a suitable organ was not available. And this is not just a U.K. problem. Similar shortages occur across the EU, the U.S., and Canada. In fact, the organ shortage problem is global, with most countries reporting a deficit between the number of donors and the number of hopeful recipients.

Writers at The Prindle Post have already explored and critiqued some solutions to this problem, including harvesting organs from the imprisoned, 3D printing the necessary body parts, xenotransplantation, and paying people to donate non-vital organs. Last month, I wrote a piece about OrganEx, a novel technology that might reverse posthumous cellular damage, thereby making more organs viable for transplant.

But hot on the heels of that innovation came news of an upcoming trial by biotech company LyGenesis, a trial which might have truly radical implications for the organ transplant landscape. In short, the company will try to grow new livers inside the bodies of people with end-stage liver disease.

This is wild in and of itself. But it gets better: twelve volunteers will be given increasingly potent doses of the treatment over the trial period until the final study participants will potentially grow not just one but five mini livers throughout their bodies.

While still highly speculative, the potential to grow livers, or even other organs, within the body of the hopeful transplantee could dramatically reduce global demand. People would no longer have to wait for a whole organ to be available. Instead, they could grow a new one. This would improve health outcomes, ease pressure on healthcare systems, and ultimately save lives.

The procedure involves taking healthy liver cells from an organ donor and injecting them into the lymph nodes of the sick recipient. As the nodes provide an excellent environment for cellular division and growth, the team at LyGenesis believe that the transplanted liver cells would start to divide and grow within the node, eventually replacing it.

Over time, the transplanted cells would develop into one or several miniature livers and start compensating for that person’s damaged original.

The team have already conducted animal trials over the last ten years, growing mini livers in mice, pigs, and dogs, and now believes it is time for human trials. Each trial participant will receive regular check-ups over the following year to ensure doctors pick up on any adverse side effects as soon as possible. In total, the study should take just over two years to complete. If the trial goes well and the results prove promising, LyGenesis plans to implant other cells and grow other types of organs.

But, the donor cells have to come from somewhere – the team do not magic them into existence. The source of these cells will be, unsurprisingly, donated livers. So, organ donation will still be needed even if the trial proves to be 100% effective. However, the proposed technique could vastly increase the number of sick people a single donated liver could help. Currently, when a perfectly healthy liver is donated posthumously, it is split into two, and surgeons implant each half into a different sick person. As such, one liver can help up to two people.

However, the LyGenesis researchers believe that, because only a (relatively) limited number of cells is needed to start the organ growing process, they could get up to seventy-five treatments out of a single donated liver.

Arguably, the LyGenesis cell transplant technique should be the first port of call regarding ethical organ donation processing, as helping more people than less is ethically required.

Now, the prospect of growing organs rather than harvesting them from altruistic donors has been around for several centuries in the dream of xenotransplantation – taking tissues and organs from animals and putting them in people. In fact, the first recorded attempt to use animal material in a human’s body was in the 17th century, when Jean Baptiste Denis transfused lamb’s blood into a patient to surprisingly little harm (i.e., the person did not die). Since then, harvesting animal tissues and organs for human transplantation has become more sophisticated, with scientists employing genetic modification techniques to improve the compatibility of organs and recipients.

However, xenotransplantation comes with a whole host of potentially intractable ethical issues. These include the potential dangers of zoonotic disease transmission (which caused David Bennett Sr.’s death), animal welfare concerns, and reflections upon our ever-increasing capacity to alter the natural world around us for our needs.

When compared to these ethical objections, LyGenesis’ human-growth liver technique seems justifiable on human-interest grounds and on a broader range of bioethical considerations.

Not only does it seemingly have the potential to maximize the net benefit each donated liver can provide, but it also helps avoid many of the issues that come part-and-parcel with growing human organs within non-human animals.

For example, there is no worry about cross-species disease transmission as all the genetic material involved is human. Similarly, beyond the animal’s use in the research, there is no worry about organ farming producing suffering on a comparative scale to the industrial farming complex. Questions regarding our ability to alter the world around us and, in essence, play God remain. However, such criticisms can be levied by critics against practically every medical procedure used today and, as such, fail to be specific to the topic of organ farming. Indeed, complete devotion to such a stance would seemingly paralyze an individual to complete non-action, as everything we do can be interpreted as playing God in one form or another.

Ultimately, while still very experimental, LyGenesis might be on the right track to tackling the organ donation shortage, at least in liver disease cases. Time will tell whether growing organs within one’s body is the way forward. However, compared to the potential issues xenotransplantation raises, human grown livers certainly seem to have a distinct ethical advantage.

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Organ Donors and Imprisoned People

photograph of jail cell with man's hands hanging past bars

Should people who are in prison – even on death row – be allowed to donate their organs? Sally Satel has recently made the case. After all, there is a “crying need” for organs, with people dying daily because they do not receive a transplant. But, as Satel points out, the federal prison system does not allow for posthumous donations and limits living donations to immediate family members.

Imprisoned people, whether they want to donate a kidney whilst alive or all their organs after an execution, are rarely able to do so.

There seem to be a couple of practical justifications for this. For one, it might interfere with the date of execution; secondly, the prison system might have to bear some of this cost. I want to address these two issues before moving on to some of the other ethical issues involved.

It’s important to see that the actual date of execution has no ethical significance – it is not a justice-driven consideration. If it turns out that an execution is delayed two weeks to enable a kidney transplant, so what? Executions are delayed by stays all the time, and if there is some good to come out of changing the date then keeping it fixed doesn’t seem particularly important.

Secondly, there may well be costs to the prison system in, say, medical care for a patient who has donated a kidney (or for the removal of organs post-execution). But the prison system is part of the state. Given there is a nationwide shortage of organs, we might expect the state to play a role in addressing this, and if it has to bear some cost, why should it matter that the prison system – not the health system – must pay? After all, the criminal justice system is meant to help broader society. (That is not to mention that there might be other ways of funding these transplants that don’t increase costs for the prison system.)

There are further explanations for why states do not permit donations. Christian Longo – who sits on death row in Oregon for murdering his wife and children – asked to posthumously donate his organs and was told that the drugs used in executions destroy the organs. But Longo points out that other states use drugs that do not cause such destruction. Still, the specific drugs used in executions brings up an ethical concern: how painful these drugs are is not clear, and there seem to be some incredibly distressing executions.

Fiddling around with these drug cocktails in order to ensure the viability of organs may introduce major risks to the condemned.

Longo asked to donate his organs, so too did Shannon Ross, who is serving a long prison sentence. The fact that people are requesting to donate means that there seems to be more than mere consent here, there is an eagerness to donate. But this might hide some deeper worries, and to see this we need to investigate why inmates wish to donate.

We might also worry that Longo wants to get some “extra privileges” or to somehow improve his own situation. Perhaps an appeals or parole board would look more favorably upon somebody who has given up a kidney. But that doesn’t seem to be the case for Longo, who is resigned to death (though he has not yet been killed, Oregon has a moratorium in place). Yet others might volunteer to donate in the mistaken belief that this will help their case. This might make the expressed consent less voluntary than it seems, since they don’t fully understand the risks and benefits of what they are consenting to.

And this leads to what I think the most difficult moral issue here is: whether prisoners can autonomously consent. Longo points out that consent can sometimes be exploited: prisoners in the 60s and 70s were paid to volunteer for “research into the effects of radiation on testicular cells.”

That, even if it is seemingly voluntary, is unacceptable – prisoners are in a vulnerable position and we shouldn’t exploit them for medical research.

Both for prisoners who will be released and those on death row, I think we can find a useful parallel with cases of voluntary euthanasia. The key similarity is that both are in a desperate situation and are offered a chance that seems to help them improve their position.

David Velleman, for example, poses this challenge to defenders of voluntary euthanasia: perhaps even offering somebody the choice to die is coercive. To simplify a very complex argument, if someone thinks they might be a drain on their family, then offering them the chance to be euthanized might not actually help them do what they would autonomously choose. They want to carry on living, and they regret that this burdens their family. But once confronted with the option to die, they are called upon to provide a justification for continued existence and might, then, feel compelled to take an option they might otherwise not. And we can see how a prisoner on death row might similarly feel compelled to donate – lacking a suitable justification to refuse – once confronted by the choice.

In addition to these concerns about mistaken beliefs and the coerciveness of choice, there might be another deep temptation to donate. Longo notes that he has little opportunity to give back to society in any way – a society that he recognizes he has wronged and harmed. Giving away his organs seems to be a way of giving back. Donation, then, provides a way of atoning, if only to a limited extent.

The worry here is that the prospect of atonement is a bit like the worry of being a burden on your family.

When you’re given the option – donate your organs in the one case, end your life in another – this prospect burns too brightly.

It might be that the prospect of atonement blots out an individual’s proper concern with, say, their own future health (or, if they are on death row, with objections they might have to organ donation).

Yet I think that – powerful and troubling as this concern might be – this is only a worry. In offering his argument, Velleman notes that he isn’t opposed to a right to die, just that this is a (perhaps defeasible) argument against an institutional right to die. Likewise, the argument in our domain only goes so far. Many people have no objection to organ donation, so there is no such concern that they, if on death row, are making the wrong choice for themselves. Plenty of people who are under no pressure at all choose to donate a kidney – why can’t we allow prisoners to make that choice, too?

If we worry too much about the possibility of letting prisoners make a bad choice, we might be paternalistic and also take away from them the free choice to selflessly help others.

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The Heartless Matter of Organ Transplantation and COVID Vaccination

photograph of surgery

Boston’s Brigham and Women’s Hospital has removed one of its patients from its transplant list because he refuses to get the COVID-19 vaccination. 31-year-old DJ Ferguson, who suffers from a hereditary heart issue that causes his lungs to fill with blood and fluid, had previously been prioritized for a life-saving heart transplant. However, according to his family, he has been removed from the transplant list due to his vaccine hesitancy. DJ’s father, David Ferguson, said, “[i]t’s kind of against his basic principles; he doesn’t believe in it. It’s a policy they are enforcing and so because he won’t get the shot, they took him off the list [for] a heart transplant.” DJ’s family are currently considering moving him to another facility but are unsure whether he would survive the trip.

The fair distribution of scarce resources has been an issue throughout the pandemic. For example, in its early days, there was considerable discussion about distributing life-saving ventilators when the number of people needing them outstripped hospital reserves. States such as Alabama, Kansas, and Tennessee all produced guidance recommending, suggesting, or explicitly stating that a patient’s disability status could be considered a reason to withhold — or even withdraw — ventilation. In other words, they deprioritized the disabled in favor of the non-disabled. This problem has, to a degree, eased with the development of effective vaccines and the production of more ventilators.

However, unlike ventilators, we cannot simply manufacture more bodily organs, such as hearts (at least, not yet). The supply of hearts is dictated by how many people donate them. Unlike other donatable organs, like kidneys or livers, donating a heart isn’t something one can do as a kind act during their lifetime. If you’re donating your heart, you’re already dead. As such, hearts are incredibly precious resources. They possess value born from the life that the donor no longer lives and the organ’s potential for its recipient – heart transplantation both takes and awards life.

Because someone must die for a transplantable heart to be made available, there is rightfully an ethical imperative to ensure that the ‘right’ person receives the organ. Giving such a vital and scarce resource to someone who would treat it improperly squanders its potential and disrespects the person who donated the organ. Turk, from the sitcom “Scrubs,” summarizes this well when he refuses to perform surgery on another character’s longtime patient when he finds out that the person has continued to drink, saying:

Dr. Cox, I know it’s really hard on you medical guys, because you spend most of your time with your patients and you get emotionally attached. But as a surgeon, the person I’m closest to is the guy who’s giving us the liver, because it’s a gift, and I think it’s important that it goes to the person that’s proven they’re up to the responsibility.

While the phrase ‘responsibility’ clouds the water here somewhat, the general message remains the same: some people are more deserving of organs than others. While we may wish to save everyone, this isn’t possible given the global shortage of organs. Roughly 17 people die each day because of a lack of organs in the U.S. alone. So for each person who receives an organ, there are numerous others deemed less worthy who must miss out.

In “Scrubs,” it comes down to a matter of responsibility and the ability of potential recipients to demonstrate they will treat the organ with the regard it demands. In a sense, they have to earn that organ. In DJ Ferguson’s case, the point of contention is slightly different. As Arthur Caplan, Head of Medical Ethics at NYU Grossman School of Medicine, states, “Organs are scarce, we are not going to distribute them to someone who has a poor chance of living when others who are vaccinated have a better chance post-surgery of surviving.” So, the concern here isn’t whether Ferguson’s shown he is responsible enough (although you could make a case that his actions demonstrate he isn’t). Instead, it is simply a matter of maximizing outcomes and minimizing risks. Being vaccinated against COVID-19 means you’re less likely to die from the disease, and a reduction in this risk improves the chances of getting the best ‘value-for-money’.

Pinning so much on the vaccination status of a potential organ receipt might strike some as odd. After all, there are countless ways to act that might jeopardize an organ’s recipient but which would seem unreasonable to use as exclusion criteria (denying a transplant to someone who enjoys extreme sports, for example). However, it is essential to remember that individuals are at substantial risk from infections post-transplantation as their immune systems are compromised. This is because the body’s immune system sees donated organs as a foreign entity that must be destroyed, causing organ rejection. To help prevent this, organ recipients take drugs to suppress their immune systems. While allowing successful organ implantation, it means that the recipient is at greater risk from infections. Even something as innocuous as a cold can be fatal, and the same goes for COVID-19. With this increased risk comes an accompanying increase in the threat posed to the positive outcome of transplantation. Therefore, a vaccinated person is a much less risky investment than a non-vaccinated person. Given our interest in maximizing the benefits someone will receive from a donated organ, it seems reasonable (even prudent) to make vaccination a requirement for anyone to receive an organ.

David Ferguson has said his son “is fighting pretty damn courageously, and he has integrity and principles he really believes in, and that makes me respect him all the more… It’s his body. It’s his choice.” David may be right. His son may indeed be acting bravely by exercising his right to bodily autonomy in a dire situation, which might make him deserving of respect. But this does little to change the fact that, when deciding who should receive a heart transplant, DJ is a risky investment. If we’re concerned with making sure that the consequences of a transplant are as positive as possible — “positive” meaning conferring the most amount of life — a person’s choice to be unvaccinated must be taken into consideration.

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Re-Thinking the Nature of Bodies

close-up photograph of Body Worlds Exhibition

Human beings are constantly growing and shedding cells. This means that very few of the cells that any person has as an adult were the cells that they had as an infant. Over the years, as we’ve learned more about cell growth and death, we’ve learned that our bodies aren’t fixed objects that simply change shape over time. Bodies are ever-shifting collections of physical stuff. To co-opt a phrase from Heraclitus, no one occupies the same body twice.

We can also contribute to the set of cells in our bodies by growing them in laboratories outside of the confines of the body. Scientists have already transplanted cell-cultured bladders into people who were born with bladders that do not empty properly. Our improved understanding of cells motivates new questions about bodies. What does it mean to say that I occupy my body? What is a body? What is the relation between my body and my identity? How does emerging technology change and inform our concept of bodies? Why does any of this matter?

In the early 20th century, when scientists first began to experiment with cell culturing, some were quick to point out the implications the technology could eventually have for organ transplants. We’ve long had fewer available organs than are required to save the lives of people experiencing organ failure. For some reason, people are hesitant to donate organs, even after they are dead and are no longer using them. When it became clear that we could cultivate cells in a lab, an incredible life-saving solution appeared to be on the horizon. One initial challenge is that cell-culturing is fairly easy to do when the expected outcome is merely flat plates of cells. But organ cells require a more complex kind of architecture, and this has proven to be a difficult nut to crack. 3-D printing technologies have provided some pathways forward, leading some scientists to conclude that the technology to grow new organs for transplant might well be available within the next decade.

One virtue of producing organs in this way is that a person’s own cells can be used to grow them. When an organ donation recipient has an organ grown in someone else’s body transplanted into their own, the recipient’s body will often reject it. To keep this from happening, doctors put patients on regiments of immunosuppressants to prevent the body from treating the organ as something it should fight. If the organs are grown by culturing a patient’s own cellular material, their body will not interpret it as foreign and the transplant is more likely to be a success. One consequence of all of this is that, once this technology is developed and assuming it becomes widely available, a person’s cellular material is capable of generating many livers, hearts, kidneys, and so on. The organs with which a person was born are just the initial set that the material provided by the body can produce under the right conditions.

These considerations present the raw material for a special form of the Ship of Theseus puzzle. The Ship of Theseus leaves a port on a long voyage. As it travels from one place to the next, it loses its pieces which fall to the bottom of the ocean. We can imagine that by the time the ship reaches its final destination, every part of it has been replaced. Is this still the Ship of Theseus? If not, at what stage did it cease to be the ship that left the port? When it sheds its first nail? When it sheds more than half of its parts? What if we were able to construct a ship using the parts found at the bottom of the sea? Would that be the ship that left the port?

If it becomes possible to grow any part of a human body by culturing cells, we could, in principle, replace a human body plank by plank, so to speak, with material that is cellularly identical to the material that was there before. When these parts have been implanted, what, if anything, has changed about the person’s body? Is there anything either morally or metaphysically important about the fact that cells were grown outside of the body rather than inside of it?

With all of this in mind, you might ask yourself: what does it mean to say that one of your organs is part of your body? After all, at any given time, an organ produced by your cellular material could either be inside of you or in a lab somewhere awaiting implantation or both. One initial way to answer the question may be that your body occupies an identifiable, though somewhat arbitrary, location near the seat of your consciousness. One unique, identifiable feature of occupying your body is that wherever you go, your body goes too. One shortcoming of this kind of position is that it might capture too much; the definition might be too broad. Imagine that a person has shrapnel inside of them from an explosion or has a piercing. These objects occupy the body or adorn the body, but we aren’t typically inclined to say that they are part of the body.

Another proposal is that the organ shares an origin story with the other parts of you, and that’s what makes it part of your body. According to this kind of view, the various parts of a person’s body came into existence as a result of a shared set of causal mechanisms. One shortcoming of this view is that we can, and do, make changes to a body, resulting in sets of physical features that do not share an origin. For example, intuitively, a transplanted organ becomes part of a person’s body after it is implanted, even though it was not grown in that space.

A third, perhaps more plausible, way of thinking about bodies is functional. Your body is your body because of the way the parts work together to play essential roles in keeping you alive and flourishing. So, imagine that you have contributed cellular material dedicated to the creation of a new liver to replace the one that you currently have. The new liver has not yet been implanted and it is currently on ice on the doctor’s office, ready for surgery. The liver that is currently in your body performing the function of a liver (even if it is doing so poorly) is part of your body. Even if the new liver is made of your cellular material, it is not part of your body until it is implanted and serving the function that a liver serves. One consequence of this kind of a position is that functional accounts of the body are not constrained to any particular kind of physical stuff. On this view, a pacemaker or an artificial hip counts as part of a person’s body. This functional account opens up all sorts of possibilities when it comes to how we think about the intersections of body and technology.

The ways that we think about bodies have moral implications at least in part because living beings stand in unique moral relations to their own bodies. Harm done to a person’s body affects that person in a first-personal way that no one else can experience. The things that happen to a person’s body can dictate the course of that person’s life. A person makes choices for their own body that would be either impossible or inappropriate for them to make for anyone else’s. All of this may give rise to unique rights and/or obligations.

For instance, if a person’s organs can be re-grown, are we obligated to provide space and resources for re-growth? Should it be possible for a person to die as a consequence of organ failure simply because they didn’t have the resources to re-grow their organs? Should the number of re-grown organs a person can produce be dependent on their financial resources? Does this technology pave the way for the rich to live forever while the poor die when their original organs fail? Does the potential for the re-growth of organs extend the human lifespan indefinitely and, if so, would this be a desirable state of affairs?

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Decisions for the Dead: The Moral Dimensions of Body Disposal

Photograph of a graveyard overlooking hills and plains

When Monique Martinot died of ovarian cancer in 1984, her husband, hoping to achieve immortality for his wife through cryonics, placed her body in an industrial size freezer in his chateau in the town of Neuil–sur–Layon, France.  When the husband, Raymond Martinot, realized, years later at the age of eighty, that his own death was imminent, he conveyed to his son that he would like to be frozen alongside his wife until such time that their bodies could be revived.  French courts objected to this method of body disposal and demanded that both bodies be removed from the freezer and disposed of in a method consistent with national law—the bodies must be buried, cremated, or donated to science.

Dead bodies are objects, but they are objects of a fascinating and unique kind—they were once possessed by autonomous beings.  Autonomous beings, according to every known moral theory, are deserving of moral consideration. Once the being has left its erstwhile vessel, does some lingering moral status remain?  Once a person is dead, what, if any, relationship exists between that person’s autonomous choices and the body-object they have left behind? Is there a moral obligation to honor the wishes of the deceased with respect to what should be done with their body after death?  Should Monique and Raymond have been allowed to rest unmolested in their modest freezer without intrusion by the government?

Under certain conditions, dead bodies can be a threat to public health.  If the deceased died of an infectious disease, the infectious agents may still be active and can be transmitted after death.  Because of the threat posed to the public in these kinds of cases, some control by the government over the disposal of dead bodies may be morally justified.  In at least some kinds of cases, then, if an individual has a right to determine what happens to their own body after death, the right of the government to protect the public against threats to general health trumps this right.  It’s worth noting, however, that the commonly held belief that all dead bodies pose public health threats is a myth.  Belief in the myth has carried with it some fairly tragic consequences.  In the aftermath of natural disasters and other mass tragedies, unidentified bodies are often buried in mass graves to get rid of the “threat to public health.”  As a result, many individuals never learn what happened to their deceased loved ones. It seems, then, that the government’s right to intervene may rest on the contingent fact that some bodies spread disease.  In a possible world in which infectious disease is eradicated, we’d need to revisit the question of whether the government can tell its citizens that they can’t keep their dead loved ones in freezers in the basement or under the rose garden in the backyard.

If the government’s right to decide what can be done with a body after death can supersede the wishes of the deceased individual in some cases, might there be others in which governmental intervention is justified?  Consider the case of organ donation. There are currently 114,555 individuals on the waiting list for donated organs in the United States. Twenty people die every day waiting for a donated organ.  Fifty-four percent of people in The United States are registered organ donors.  This might sound like a pretty impressive number, but it is dwarfed by the percentage of the population that donates organs in countries that have an “opt out” process for organ donation.  In these countries, everyone is automatically put on the organ donor list, with the option of “opting out” if they decide they’d rather not donate. In those countries, 90% of the population is on the list of registered donors.  Only 3 in 1,000 people die in a way that allows for organs to be successfully transplanted, so the more donors the better the odds that lives will be saved.  If the government is justified in determining what happens to dead bodies when their goal is to promote public health, would they be justified in enacting “opt out” policies?  After all, the need for donated organs is also a public health issue. It’s far from clear that the “rights” of the being that once occupied the dead body are a more pressing concern than the lives lost when the organs are wasted.

There are other reasons for the government to step in when it comes to disposal of the dead. The practice of burying the dead in caskets is terrible for the environment.  Many unnecessary resources are wasted in the process, including precious trees for caskets and water to maintain pristine lawns in graveyards. During the embalming process, formaldehyde—a known human carcinogen—is pumped into human bodies.  When those bodies are buried, that carcinogen eventually seeps out, polluting soil and groundwater. Burying bodies also takes up lots of space. The practice is unsustainable. Cremation is arguably better for the environment, but not much. The practice releases harmful greenhouse gasses into the atmosphere, contributing to climate change.  We aren’t without options; there are some eco-friendly ways of disposing of human remains.  Bodies can be destroyed using a process of alkaline hydrolysis, used to liquefy human flesh.  The remaining bones can then be ground into ash in a way that uses fewer resources than cremation.  Bodies can also be encased in pods that eventually grow into trees or sealed into a ball that is then sunk to the bottom of the ocean where it will feed coral reefs. These are far more environmentally friendly ways of disposing of human remains.  Given that climate change poses serious threats to public health, would governments be justified in mandating that bodies are disposed of in more environmentally friendly ways?

It seems unlikely that changes to our organ donation or funerary practices would be met with swells of public support.  This reticence should give us pause. Many variables inform cultural practices involving dead bodies. Humans have the capacity to reflect on their own mortality, and, unsurprisingly, many of us find it terrifying.  Fear, grief, and love are powerful and crucial emotions, but they have the potential to motivate the formation of superstitious rituals and guidelines for cultural practice that are ultimately indefensible when challenged.

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The Ethics of Human Head Transplants Explored: Part One

Doctor inspecting a patient on an operating table

They are not just plot points in bad horror films anymore. Real surgeons and medical doctors are currently exploring the feasibility of human head transplants. In fact, surgeons Sergio Canavero and Xiaoping Ren claimed in November 2017 that such a transplant was “imminent.” The surgery did not happen, but these two surgeons still claim they intend to perform a human head transplant.

Theoretically, in a human head transplant procedure, a special blade made from diamonds would be used to sever the spinal cord of the donor and recipient as cleanly as possible. The detached human head would be kept alive for a period of time at a very cold temperature and hooked up to pumps for oxygen and blood flow. The spinal cords from the donor and recipient would then be fused together using polyethylene glycol. Vertebrae, blood vessels, muscles, and organs would then be stitched together as well. The person would then be placed into a month-long coma, while blood and nerve networks are re-built, in hopes that the body does not reject the new head (or vice versa).

This whole proposal may sound absurd to you; multiple surgeons and doctors have also questioned on scientific grounds Canavero’s and Ren’s proposals for the procedure. Dean Burnett, neurosurgeon and columnist for The Guardian, writes, “The human body is not modular. You can’t swap bits around like you would Lego blocks, take a brick from castle and put it onto a pirate ship and have it work fine.” Burnett argues that one’s brain develops along with one’s body; as such, a relatively unique interface develops between the two. Simply put, no one knows what would happen between a brain and a body that do not share this interface that was built up through years of growth. The results may be traumatic and tragic.

What’s more, the experimental testing and preparation for a human head/body transplant by Canavero and Ren is quite weak. Canavero and Ren have conducted experiments transplanting rat heads onto rat bodies. Disappointingly, one of these studies involved 60 rats, but only 14 survived for any period longer than 36 hours. They have also claimed to have successfully re-fused the severed spinal cords of a dog and a monkey, but scant evidence has been published to back up these claims. Burnett notes that, in the monkey head transplant, the monkey never regained consciousness after the procedure and only survived for twenty hours after the procedure.

Numerous ethical questions, obviously, emerge from the prospects of human head transplants. As Paul Root Wolpe on Vox suggests, would attempting the surgery on humans at this stage be tantamount to murder? The attempted surgery would likely result in death for the human patient (or at best life in a persistent vegetative state), should it fail. Given the paucity of experimental evidence backing up the safety and efficacy of the surgery, one has little rational justification for believing the surgery, at this stage of development, would even succeed. Defenders of the doctors might reply that the proposed head transplant is offered as a last chance procedure for someone suffering from a degenerative terminal neurological disorder. The intent of the surgery is not to end the life of the person, but rather to save it. As long as the doctors do not manipulate the patient to consent to this radical procedure when other safer options still exist, a human head transplant would be as ethical as any other Hail Mary last chance medical procedure.

Terminal patients may have other life-affirming and important choices to make that would be forsaken should they choose to gamble with such a radical procedure, such as saying goodbye to loved ones, making psychological peace with death and oneself, and having control over ending one’s life in a personally dignifying manner. The doctors advocating for trying this surgery on a degenerative terminal patient might not have the patient’s best interests at heart. In addition, it is not clear if the decision to volunteer for this procedure (at its current stage of development) could be considered rational. While respect for a patient’s decisions is generally important, some obviously harmful and irrational decisions do not accord such respect. A patient who believed that an obviously harmful action would cure him a disease, say ingesting large amounts of a strong poison, should probably be stopped from carrying out this action. Having your head cut off in hopes of a successful head transplant may be considered analogous.

Another important moral question concerns fairness and the allocation of organs. There is a severe shortage in viable transplantable organs in the United States. According to the United Network for Organ Sharing (UNOS), twenty people on average die each day while waiting for an organ transplant. What’s more, one organ donor can save up to eight lives. If a person were to donate their whole body for transplant, rather than their individual organs, that would theoretically deprive seven needy people of viable organs. Another allocation issue concerns cost: the head transplant procedure’s cost was estimated at $100 million USD. It may seem unfair to spend that much money on the vanishingly small likelihood of saving one person, considering what this amount could do for many more people.

Presume, now, that the above moral and scientific questions are overcome, and head transplants become a real (if not regular) part of the medical community’s transplant procedures. We are still left with an intriguing metaphysical question, one that would have serious ramifications for morally and legally fraught issues. What person would emerge from the procedure? The assumption is that the person to whom the head originally belonged is the “recipient” of the transplant, and the person from whom the body came “the donor.” But, is this correct? Is there any basis for conceiving of it the other way around? More intriguingly, it may be that the resulting person after the procedure is a third person metaphysically distinct from either the donor or the recipient. These issues will be discussed in a follow-up post.

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Evaluating the Ethics of Paid Organ Donation

A photo of surgery within the operating room

Actress and singer Selena Gomez recently posted to her Instagram account that she received a kidney transplant because of her lupus; the transplanted kidney was donated to her by a close friend. For people facing kidney failure, transplantation of a healthy kidney from a living donor often presents a much better option than the alternative of dialysis. According to the Beth Israel Deaconess Medical Center, dialysis can only replace 10 percent of the work performed by a functioning kidney. On average, patients who received kidney transplants lived longer than those who remained on dialysis. The kidney donor also does not face significantly increased health risks from donating a kidney. There are the expected risks of going through a major surgery, as well as some increased risk of kidney failure, but there is no evidence that donating a kidney decreases life expectancy.

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A Cross-Species Solution to Organ Donation?

A photo of surgeons operating on a patient.

When thinking of genetically modified organisms, vast fields of corn and large confined animal feeding operations might come to mind. However, a recent development in medical technology has moved us one step closer to modifying animals for purposes other than agriculture. Xenotransplantation is the practice of transplanting cells, organs, or tissues across species. Previously, the largest obstacle to xenotransplantation was the potential infection of viruses between species. However, a new experiment successfully eradicated the threat of such viruses, opening the door a little wider in terms of pig-human transplantation.

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