Increasing New Zealand’s Organ Donation Rates: Ethical Considerations

Abstract

New Zealand’s deceased organ donation rates are low by international standards and have remained static for many years, while the need for organs increases. The general public express a willingness to donate that is not reflected in the 50% refusal rate by next of kin to donate in New Zealand Intensive Care Units.1 This thesis uses applied ethics to determine how best to increase organ donation in New Zealand. It is informed by empirical data on the current state of donation in New Zealand, a study of New Zealand’s live liver donors, and an ethical analysis of altruism and obligations. Chapter one provides background information on current international ethical debate on organ donation, showing the ineffectiveness of relying on altruism and discussing trends such as increasing living donors. Also included is information on New Zealand’s current methods and rates compared with successful international practices. Chapter two contains a case study devised for this thesis on the experiences and opinions of New Zealand’s live liver donors. This study reveals that live donors were motivated by concern for the recipient, and felt no external pressure to donate. Participants’ views of organ donation systems showed support for opt-out systems (76%) and increasing education (95%); but against the family veto (86%) and financial incentives (71%). Chapter three discusses ethical considerations and argues that New Zealand’s reliance on voluntary altruism as a motive to elicit organ donation is not ethically justifiable. Current methods do not produce results that adequately utilize or reflect New Zealanders’ levels of altruistic intent. To avoid preventable deaths additional methods are required which obligate citizens towards deceased donation. Chapter four provides practical recommendations to improve New Zealand’s donation rates, based on the previous three chapters. These are to: decrease the power of the family veto, provide a method for informed consent prior to death, use donor coordinators to improve the asking of potential donors, and provide education and promotion of organ donation to the New Zealand public. These methods address aspects of New Zealand’s system that are currently deficient. New Zealanders’ altruism and obligations should be utilized effectively and turned into practical results.