There is an ever increasing shortage of human organ transplants in Germany. This paper aims at understanding the reasons for that shortage better and then discusses various ways to overcome it. After estimating the potential supply of donor organs it is discussed why actual supply remains far below potential supply. Insufficient reimbursement for hospitals, a lack of incentives to donate, and mistaken donation rules are diagnosed to cause the shortage. Thus, organ shortage is due not to natural constraints but to (...) inappropriate social institutions. Introducing a presumed consent rule, reciprocity in organ allocation, better payments for hospitals and for donors seem potential remedies. (shrink)

Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the (...) inability to make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)

Ethics is a philosophical branch of inquiry that reasons between what is right and wrong. The moral philosophy of Socrates, Aristotle, and Plato from ancient Greek became the basis of most of the western ethics. These days, ethics can be divided based on its inquiries for example, normative, descriptive, metaethics, and applied ethics or based on its theories like utilitarianism, emotivism, and universal ethics. In context with applied ethics that examines issues involving emerging technologies, this study will look into the (...) ethics of Malaysian stem cell technology based on written literature. It was mainly to identify Malaysian literature on stem cell ethics through conventional search since the mainstream international database indicated an obvious shortage. The critical review of this literature will facilitate in the understanding of unique position of Malaysia towards stem cell and its ethics in reference to the limited number. Despite the limitation, this can be a preliminary study urging for more inquiries and exploration to fulfil the multiple perspectives in ethics such as the diversity of Malaysian ethics, the impact of ethics in stem cell regulation in Malaysia, and if western contemporary ethics influences Malaysian ethics particularly involving stem cell technology. (shrink)

Any program seeking to provide antiretroviral treatment to the many patients in need is bound to confront ethical dilemmas. Dilemmas, as we know, are situations in which decisionmakers are faced with a choice between equally unsatisfactory alternatives. Yet those in charge must make a decision or establish a policy that takes one pathway to the exclusion of another. Reasonable people may disagree over the choice, arguing that an alternative selection would have been ethically superior.

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This article discusses the serious problem of the shortage of about 50 000 nurses in Japan today. If efficient measures to solve it are not adopted by administrators, it is clear that the shortage will become still more alarming in the future, in a society with more people in advanced years and in which the numbers in the younger generation will decrease from now on. The main factors behind the Japanese nursing labour shortage are, among others: a rapid increase in (...) the number of hospital beds between 1986 and 1989; poor working conditions; and nurses’ low social position in their places of work. Behind these factors, there has always been a contempt for the art of nursing in our society. Why has Japanese society made light of nursing? Three points can be identified: traditional discrimination against women; our disregard for a religious mentality; and our short history of hospital nursing. To overcome these problems, we must first of all change fundamentally our sense of values, such as love for one another and compassion. We must now reconstruct a caring culture in our society. (shrink)

Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from (...) countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals. (shrink)

The organ shortage is commonly presented as having a clear solution, increase the number of organs donated and the problem will be solved. In the light of the Northern Ireland Assembly’s consultation on moving to an opt-out organ donor register this article focusses on the social factors and complexities which impact strongly on both the supply of, and demand for, transplantable organs. Judging by the experience of other countries presumed consent systems may or may not increase donations but have not (...) met demand. Donation rates have risen considerably in all parts of the UK recently but there is also an increasing demand for organs. Looking at international donation rates and attitudes, future demand for organs and education on donation, the question is whether the organ shortage could ever be met. The increase in longevity, in rates of diabetes and obesity and in alcohol related liver disease all contribute both to increased demand for transplants, and re-transplants, and a reduction in the number of usable organs. It is unlikely that demand could ever be met, since, if supply was unlimited, the focus would move to financial resources and competing demands on the health care budget in a publicly funded health system. These factors point to the need to focus on ways of reducing, or at least stabilizing, demand where lifestyle factors contribute to the underlying disease. (shrink)

Organ shortage is a major survival issue for millions of people worldwide. Globally 1.2 million people die each year from kidney failure. In this paper, we critically examine and find lacking extant proposals for increasing organ supply, such as opting in and opt out for deceased donor organs, and parochial altruism and paired kidney exchange for live organs. We defend two ethical solutions to the problem of organ shortage. One is to make deceased donor organs automatically available for transplant without (...) requiring consent from the donor or their relatives. The other is for society to buy nonvital organs in a strictly regulated market and provide them to people in need for free. (shrink)

The North American wood frog, Rana sylvatica, endures seasonal whole‐body freezing during the winter and thawing during the spring without sustaining any apparent damage from ice or oxidative stress. Strategies from these frogs may solve the shortage of human donor organs, which is a multidisciplinary problem that can be alleviated by eliminating geographical boundaries. Rana sylvatica deploys an array of molecular and physiological responses, such as glucose production and microRNA regulation, to help it survive the cold. These strategies have been (...) adapted in the lab to impart cryotolerance in liver cells, and the non‐freezing supercooled storage of transplantable rat livers − milestones that have advanced the field toward cryopreserving human donor organs in the clinic. In this review, a case is presented for the use of non‐coding RNAs to decrease oxidative damage of donor organs by activating endogenous antioxidant systems prior to procurement. (shrink)

Replacements for corporate farm managers are increasingly hard to find. At the same time, there is a large pool of potential managers that has been hardly tapped into: young female professionals. Focusing on the supply side of the labor market for farm managers, we investigate how gender-specific life aspirations impact occupational intention. To explain gender-specific occupational intention, we operationalize two conceptual frameworks: a behavioral economic conceptualization that focuses on the material and non-material cost and benefits associated with occupational choice, and (...) a psychological conceptualization based on the theory of planned behavior. Our analysis of survey data among agricultural students shows that participating women are less inclined to pursue a farm manager position than participating men for two main reasons: first, they expect less internal benefits from such a position. Second, they believe to be less suited to meet the professional requirements. (shrink)

The American Journal of Bioethics, Volume 12, Issue 1, Page 18-20, January 2012.

Despite a recent economic downturn, there is considerable political and industry pressure to retain or even increase the number of scientists in the UK and other developed countries. Claims are made that the supply of scientists (including engineers and mathematicians) is crucial to the economy and the health of the nation, and a large number of initiatives have been funded to address the problem. We consider these claims in light of a re-analysis of existing figures from 1986 to 2009, for (...) young scientists passing through education and into employment. Science graduates are heavily stratified by social origin, and this sorting takes place during initial schooling just as it does with other 'prestige' subjects. The majority of science graduates then move into initial occupations that are not directly related to their degree, suggesting that at this stage of life at least, the demand for scientists trained in specific areas is more than met by existing numbers. We have no reason to believe that the situation is different to other vocational and non-vocational subjects, so perhaps science is not as special as politicians and business leaders imagine. Perhaps young people are put off careers in science by their education. Or perhaps the incentives are not right, leading to the 'wrong' kinds of students in science, and so wastage and inefficiency in the supply process. More pertinently, perhaps this vocational outcome is not how a developed country should assess the value and importance of scientific knowledge among its population. (shrink)

Due to the shortage of organs, it has been proposed that the ban on organ sales is lifted and a market-based procurement system introduced. This paper assesses four prominent proposals for how such a market could be arranged: unregulated current market, regulated current market, payment-for-consent futures market, and the family-reward futures market. These are assessed in terms of how applicable prominent concerns with organ sales are for each model. The concerns evaluated are that organ markets will crowd out altruistic donation, (...) that consent to sell organs is invalid, that sellers will be harmed, and that commodification of organs will affect human relationships in a negative way. The paper concludes that the family-reward futures market fares best in this comparison but also that it provides the weakest incentive to potential buyers. There is an inverse relationship between how applicable prominent critiques are to organ market models and the increase in available organs they can be expected to provide. (shrink)

This book analyzes the reasons for organ shortage and ventures innovative ideas for approaching this problem. It presents 29 contributions from a highly interdisciplinary group of world experts and upcoming professionals in the field. Every year thousands of patients die while waiting for organ transplantation. Health authorities, medical professionals and bioethicists worldwide point to the urgent and yet unsolved problem of organ shortage, which will be even intensified due to the increasing life expectancy. Even though the practical problem seems to (...) be well known, the search for suitable solutions continues and often restricts itself by being limited through disciplinary and national borders. Combining philosophical reflection with empirical results, this volume enables a unique insight in the ethics of organ transplantation and offers fresh ideas for policymakers, health care professionals, academics, and the general public. (shrink)

In a short rejoinder, I thank Macklin and Benatar for their very helpful and thought-provoking comments and at the same time, I want to provide some additional information, which might be of interest to Macklin and our readers.

The debate over financial incentives and market models for organ procurement represents a key trend in recent bioethics. In this paper, we wish to reassess one of its central premises—the idea of organ shortage. While the problem is often presented as an objective statistical fact that can be taken for granted, we will take a closer look at the underlying framework expressed in the common rhetoric of “scarcity”, “shortage” or “unfulfilled demand”. On the basis of theoretical considerations as well as (...) a socioempirical examination of public attitudes, we will argue that this rhetoric has an economic subtext that imbues the debate with normative premises that have far-reaching social and ethical consequences and need to be made explicit and discussed. (shrink)

Effective altruism is a growing philosophical and social movement, whose members design their lives in ways aligned with doing the most good that they can do. The main focus of this paper is to explore what effective altruism has to say about the moral obligations people have to do good with their organs, in the face of an organ-shortage problem. It is argued that an effective altruism framework offers a number of valuable theoretical and practical insights relevant to ongoing debate (...) about how to resolve the organ-shortage problem. Its recommendations constitute a plausible and promising strategy for increasing the supply of, and decreasing the demand for, human organs, in a way that protects the global poor. And, many of its recommendations can be implemented into policy without requiring that citizens actually become effective altruists themselves. (shrink)

This article describes the shortage of generic injectable medications in Canada that affected hospitals in 2012. It traces the events leading up to the drug shortage, the causes of the shortage, and the responses by health administrators, pharmacists, and ethicists. The article argues that generic drug shortages are an ethical problem because health care organizations and governments have an obligation to avoid exposing patients to resource scarcity. The article also discusses some options governments could pursue in order to secure (...) the drug supply and thereby fulfill their ethical obligations. (shrink)

Diversity scholars have emphasized the critical role of corporate leaders for ensuring the success of diversity strategic initiatives in organizations. This study reports on business school leaders’ attributions regarding the causes for and solutions to the low representation of U.S. faculty of color in business schools. Results indicatethat leaders with greater awareness of racial issues rated an inhospitable organizational culture as a more important cause and cultural change and recruitment as more important solutions to faculty of color under-representation than did (...) less racially aware respondents. Aware leaders also rated individual minority-group member responsibility for performance a less important solution than did less racially aware respondents. Implications are discussed. (shrink)

Globally there is a shortage of organs available for transplant resulting in thousands of lives lost as a result. Recently in the United Kingdom 457 people died as a result of organ shortage in just 1 year. 1 NHS Blood and Transplant suggest national debates to test public attitudes to radical actions to increase organ donation should be considered in addressing organ shortage. The selling of organs for transplant in the United Kingdom is prohibited under the Human Tissue Act 2004. (...) This discussion paper considers five ethical objections raised in the United Kingdom to paid donation and discusses how these objections are addressed within the only legal and regulated paid living unrelated renal donation programme in the world in Iran, where its kidney transplant list was eliminated within 2 years of its commencement. This article discusses whether paid living unrelated donation in Iran increases riskier donations and reduced altruistic donation as opponents of paid donation claim. The paper debates whether objections to paid donation based upon commodification arguments only oppose enabling financial ends, even if these ends enable beneficent acts. Discussions in relation to whether valid consent can be given by the donor will take place and will also debate the objection that donors will be coerced and exploited by a paid model. This article suggests that exploitation of the paid donor within the Iranian model exists within the legally permitted framework. However, paid living kidney donation should be discussed further and other models of paid donation considered in the United Kingdom as a radical means of increasing donation. (shrink)

Thousands of lives are lost each year because of a lack of organs available for transplant, but currently, in the UK and many other countries, organs cannot be taken from a deceased donor without explicit consent from the donor or his or her relatives. Switching to an ‘opt‐out’ system for organ donation could substantially increase the supply of organs, and save many lives. However, it has been argued in some quarters that there are serious ethical objections to an opt‐out policy, (...) and that it would be better to adopt a different policy known as the ‘presumptive approach’, that requires explicit consent while also attempting to sway the choices of potential donors and family in the direction of donating, using various persuasive techniques. This article shows how reflection on the impact of a well‐known cognitive bias known as ‘status quo bias’ can explain why moving from the status quo to an opt‐out policy might be effective in increasing organ availability, even without impinging on anyone's autonomous choices, why we might have overestimated the strength of the objections to an opt‐out policy, and why the presumptive approach is morally objectionable, while an opt‐out policy is not. (shrink)

We verified moral distress related to organ shortage for transplantation in nursing students. This quantitative pilot study analyzed data from 104 nursing undergraduate students. Data were collected through a survey composed of four questions and two sociodemographic items. The chi-squared test was used to examine categorical variables, whereas continuous variable data were analyzed using ANOVA and the Pearson Product Moment correlational test for determining the existence of moral distress regarding the availability of one heart for four individuals susceptible to heart (...) transplantation. A high level of moral distress was identified with regard to the hypothetical decision-making process, which justifies the need for further studies on the subject. Given the hypothetical scenario, moral distress was observed among the students, reaching severe distress in some cases. Approval CEP-University of Alberta Pro00068610. (shrink)

This article sets out the key findings from the seminar series ‘Transplantation and organ deficit in the UK: Pragmatic solutions to ethical controversy’ which ran from November 2006 to March 2008, and was sponsored by the Economic and Social Research Council. A broad range of issues were examined in the seminars, including religious and cultural attitudes affecting organ donation, the role of health-care professionals and what could be learned from the experiences of other countries, particularly in the European context. Core (...) participants in the series came from a range of academic and practitioner backgrounds and had different ethical perspectives on issues affecting organ donation and transplantation. Notwithstanding such diversity, the findings set out in the article reflect the fact that core participants were focused on developing a principled, yet pragmatic approach to dealing with the urgent problem of organ shortage in the UK. (shrink)

T. L. Zutlevics has written a thoughtful response to my piece on the anxiety borne of cutting bodies. I am grateful for this opportunity to turn back to the pressing problem of organ shortages.

The American Journal of Bioethics, Volume 12, Issue 1, Page 20-22, January 2012.

The American Journal of Bioethics, Volume 12, Issue 1, Page 16-18, January 2012.

A private, for-profit company has recently opened a pair of plasma donation centres in Canada, at which donors can be compensated up to $50 for their plasma. This has sparked a nation-wide debate around the ethics of paying plasma donors. Our aim in this paper is to shift the terms of the current debate away from the question of whether plasma donors should be paid and toward the question of who should be paying them. We consider arguments against paying plasma (...) donors grounded in concerns about exploitation, commodification, and the introduction of a profit motive. We find them all to be normatively inconclusive, but also overbroad in light of Canada’s persistent reliance on plasma from paid donors in the United States. While we believe that there are good reasons to oppose allowing a private company to profit from Canada’s blood supply, these concerns can be addressed if payment is dispensed instead by a public, not-for-profit agency. In short, we reject profiting from plasma while we endorse paying for plasma; we therefore conclude in favour of a new Canadian regime of public sector plasma collection and compensation. (shrink)

Whether enough highly qualified STEM workers are being educated and trained in the UK is an important question. The answer has implications not only for educators, employers and policymakers but also for individuals who are currently engaged in, or are considering entering, education or training in this area. Set against a policy backdrop that prioritises students studying more science for longer, this paper considers long-term patterns of participation in STEM education – from school science through to graduate entry into the (...) highly skilled STEM labour market. Using a unique dataset that extends across seven decades and comprises many hundreds of thousands of students, the paper finds that patterns of participation in most STEM subjects have varied little over the period considered; suggesting that efforts to increase the numbers of students studying science in school has had limited impact on the throughput of students who study STEM, including the pure sciences, at university level and, subsequently, on the number of graduates who would be available to undertake highly skilled work in areas for which degree-level skills are a pre-requisite. (shrink)

Drawing on fieldwork and in-depth interviews with homeschooling mothers in the Pacific Northwest, the author reveals several ways the temporal experience of motherhood was emotionally problematic. The intensive demands of homeschooling left them stressed and dissatisfied with the amount of time they had to pursue their own interests. Mothers tried to allocate their time differently to manage these feelings, yet their efforts were unsuccessful, which led them to become frustrated and resentful. To resolve these troublesome feelings, mothers resorted to manipulating (...) their subjective experiences of time through a process the author calls “temporal emotion work.” In the conclusion, the author examines the theoretical confluence of emotions and temporality, suggesting that the dominant form of motherhood is culturally defined as a “time-sensitive identity” and that “temporal emotions” are unique tools in managing the emotional difficulties inherent in the trajectories of some identities. (shrink)