Organ and Blood Donations

Organizations and Technical Change

States, commercial and industrial firms, or nonlucrative organizations manage organ and blood collection. In the United States, blood banks were created [Page 1065]during the interwar years. After World War II, industrial firms began to collect blood and plasma to produce blood derivatives products. In 1974, the National Blood Policy Act advocated for the collection of blood from voluntary donors. In 1984, the National Organ and Transplant Act prohibited the selling of organs and established the Organ Procurement and Transplantation Network (OPTN). In France, nonlucrative organizations monopolized, with the agreement of the French State, the collection of blood and organs until the end of the 1980s. Several scandals prompted the organization to change, and now the French State manages and controls the whole collection and distribution of all human body parts and tissues. French law prohibits the selling of blood and organs.

Scientific and technical changes transformed the collection of blood into an industry. The fractionation of plasma during the 1950s and the discovery of many blood derivatives increased the consumption of blood. The use of immunosuppressive drugs contributes to the growth of demand for organs and compels improved management. The public, governments, physicians, and patients ask for the respect of human dignity and condemn the selling of human body parts but want to obtain safe products. On one hand, people assert the ethics of organ and blood donation; on the other hand, they consume human body parts and tissues to recover from illnesses.

Ethics of Organ and Blood Collection

In 1970, Richard Titmuss published The Gift Relationship in which he explains why the unpaid gift is “better” than the selling of blood. The poor and the unhealthy would sell their blood and “good” blood would be scarce. This book provoked an important debate, which contributed to the National Blood Policy being enacted in the United States.

The collection of organs raises other ethical questions, such as how to ensure the deceased person agrees with the gift of his or her organs. In France, “presumed consent” is the rule: people are considered to agree if they did not expressly refuse. In the United States, organ donors register with their state organ registry. Another issue is how to encourage people to donate organs. The debate in France is focused on presumed consent versus expressed consent. In the United States, discussions concern the exhortation to give: despite the prohibition of organ selling, some compensation might be offered as payment for the funeral.

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