Abstract

Transplantation has long been recognized as a value-laden enterprise. Consequently, the rhetoric of transplantation has been dominated by a potent moral vocabulary. The themes of gift, altruism, and stewardship are commonly invoked in transplantation practice and policy. These themes have been appropriated by the transplant community with little critical analysis. In light of the historical evolution of transplantation, an evaluation of these themes is warranted, to determine whether they offer substantive insights into contemporary practice. ;This dissertation undertakes such an appraisal, proceeding by way of a phenomenological explication of the operative values shaping transplantation policy and practice. The central contention of this dissertation is that much of the moral language of transplantation is rooted in an experience of transplantation that differs in significant and relevant ways from contemporary practice. The development of an increasingly sophisticated system of organ procurement and sharing presents a profound challenge to the implementation of a stewardship model for organ allocation. Likewise, the structural dichotomy between organ donation and allocation dramatically alters the gift-exchange aspects of organ donation. Ultimately, the uncritical acceptance of the traditional moral vocabulary of transplantation has largely obscured the moral import of transplantation policy and practice