Is Organ Donation a Moral Obligation?
Welcome! Today we’ll be exploring both sides on whether organ donation is a moral obligation or not and the underlying principles of these arguments. Although first, the term moral obligation itself naturally invites discussion. For the purpose of this blog, the definition that I think captures the essence well is from the book Moral Philosophy, which states that “moral obligatoriness then is a distinctive justificatory force—a force which is distinct from that of ordinary recommendation, and which it is wrong for us to disregard; but which, at least for all we know, it may not be foolish or less than sensible for us to disregard.”
Some numerical information/background before we get started:
In Canada, a yearly average of 250 people on the waiting list die while waiting for an organ
From a UK report, “eligible potential donors and consent rates remain below their pre-pandemic levels.”
From the U.S. Health Resources & Services Administration, “17 people die each day waiting for an organ transplant” and “Every donor can save 8 lives and enhance over 75 more”
Arguments for:
The argument that organ donation is not an act of kindness or charity but rather a moral duty mainly stems from utilitarian rationalism and altruism. In short, utilitarians generally “believe that the purpose of morality is to make life better by increasing the amount of good things (such as pleasure and happiness) in the world and decreasing the amount of bad things (such as pain and unhappiness).” In the context of organ donation, the utilitarian framework would evaluate the morality of organ donation based on maximizing the amount of “good things” (i.e. the greatest number of people helped). One organ donor can save up to eight lives, and would also minimize the suffering of patients on waiting lists. It is also supposedly the economical choice, as in the case of kidney transplants, “increasing deceased kidney donation by 5% would save $4.7 billion, and gain 30,870 quality-adjusted life years over the lifetime of an open cohort of patients on dialysis on the waitlist for kidney transplantation.”
Picture the following adaptation of Peter Singer's "Drowning Child" analogy from this 2014 article: If a child was drowning, and a skilled swimmer could save their life by swimming 20 feet into a calm body of water, would it not be morally reprehensible for them not to save the child? Would you even consider this a heroic act since it is basically inconsequential for the swimmer? Would not donating an organ after death then, be as morally reprehensible and consequently a moral obligation?
“To all the families on the donor side...it’s a very precious gift. So precious that, because of it, I’ll be able to see my niece graduate, and my nephew get married. I will get to do all those things because someone gave me a heart. I was so close to death. I definitely want to pay it forward. I am incredibly grateful.”
Arguments against:
What utilitarian rationalism does not consider however, are the role of feelings, circumstances, culture, and religion. Characterizing organ donation in this way can treat bodies more like public resources. The perspective that we should not be morally obligated to donate organs then, is rooted in the principle of autonomy, where the patient decides about the treatment of their organs. As philosopher Immanuel Kant posits, “rational human beings should be treated as an end in themselves and not as a means to something else. The fact that we are human has value in itself” and should be respected as such.
Picture the Judith Jarvis Thomson’s “Violinist” analogy, originally written to defend abortion autonomy: You were kidnapped and woke up to find yourself surgically attached and filtering the blood of a famous violinist, who is unconscious and has a fatal kidney ailment. If you stay connected to them for nine months, they will recover, however, if you unplug yourself, they will die. Would you feel mad if this were you? Wouldn’t it be wrong to force someone to sustain another person’s life against their will, would then morally obligatory organ donation-even after death- be a violation of autonomy? “Everyone has the right to life, liberty and security of the person,” does this automatically mean the right to use another person’s body?
The “Violinist” analogy was actually originally written to defend bodily autonomy in abortion ethics– Thomson argues that while it would be kind to remain connected, it is not a moral obligation- just how a pregnant person is not obligated to remain pregnant. She also highlights the distinction between the right to life and the right to use another person’s body to sustain life. I highly suggest this read for abortion ethics if you haven’t already; Thomson uses multiple thought-provoking scenarios and importantly discusses the case of pregnancy due to rape.
“When I die I want all of me to die, not a bit of me living on here, I think erm it’s not like erm… it sort of feels like as if you wouldn’t be properly dead do y’know what I mean and then you think well…I want all of me, I want to leave the world the way I came with all the bits that I came with.”
“If you’re going in to opt‐out of something that traditionally people don’t really opt‐out of you’re opening yourself up to a lot of judgement and a lot of uhm just remarks from possibly the people who are part of the kind of system[…]people don’t necessarily want all of their dirty laundry aired out in public and it’s seen as quite a taboo thing at least in my generation to not want to donate your organs”
Conclusion:
I hope this was as thought-provoking for you to read as it was for me to write. There are a lot of considerations (such as inconsistency in treating organ donation differently before and after death) that this blog did not address, and I aim for this to be a stepping point to further discussion and research about the moral implications surrounding organ donation.
Some questions and further reading, in addition to the articles cited:
Taking a morally neutral position: https://doi.org/10.1186/cc2876
What role do physicians and public health authorities play? https://journalofethics.ama-assn.org/article/physicians-role-discussing-organ-donation-end-life/2000-12; https://journalofethics.ama-assn.org/article/organ-donation-collective-action-problem-ethical-considerations-and-implications-practice/2016-02
Economics of organ donation and equality of allocation of resources: https://optn.transplant.hrsa.gov/professionals/by-topic/ethical-considerations/ethical-principles-in-the-allocation-of-human-organs/
Knowledge and attitudes in other countries: https://doi.org/10.7759/cureus.27002 ; https://doi.org/10.3390/ijerph19127404
https://www.organdonor.gov/professionals/grants-research/research-reports - a survey report on Organ Donation Attitudes and Practices in the United States of America, issued in 2020
Death, Interrupted by Blair Bigham has a few excellent, succinct chapters about how organ donation is complicated when life support, comas, brain death, and other states between life and death are involved
By Chloe Wang (she/her/hers) | Blog Committee Member
Works Cited
Am I eligible?. (2025). Canadian Blood Services. https://www.blood.ca/en/organs-tissues/deceased-donation/am-i-eligible
Canadian Charter of Rights and Freedoms, s 7, Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c11
Caplan A. (2014). Bioethics of organ transplantation. Cold Spring Harbor perspectives in medicine, 4(3), a015685. https://doi.org/10.1101/cshperspect.a015685
Cardiac nurse and organ retrieval assistant turned heart transplant recipient. (2025, February 27). BC Transplant. http://www.transplant.bc.ca/about/news-stories/organ-donation-transplant-stories/cardiac-nurse-and-organ-retrieval-assistant-turned-heart-transplant-recipient
Chen, H.-F., Ali, H., Marrero, W. J., Parikh, N. D., Lavieri, M. S., & Hutton, D. W. (2021). The Magnitude of the Health and Economic Impact of Increased Organ Donation on Patients With End-Stage Renal Disease. MDM Policy & Practice, 6(2), 23814683211063418. doi:10.1177/23814683211063418
Ladin, K. (2016, February). Organ Donation as a Collective Action Problem: Ethical Considerations and Implications for Practice. AMA Journal of Ethics, 18(2), 156-162. https://doi.org/10.1001/journalofethics.2017.18.2.msoc1-1602
Miller, J., Currie, S., McGregor, L. M., & O'Carroll, R. E. (2020). 'It's like being conscripted, one volunteer is better than 10 pressed men': A qualitative study into the views of people who plan to opt-out of organ donation. British journal of health psychology, 25(2), 257–274. https://doi.org/10.1111/bjhp.12406
Nathanson, S. (n.d.). Act and Rule Utilitarianism. In Internet Encyclopedia of Philosophy. https://iep.utm.edu/util-a-r/
O’Neill, S., Thomas, K., McLaughlin, L., Boadu, P., Williams, L., Al-Haboubi, M., … Mays, N. (2024). Trends in organ donation in England, Scotland and Wales in the context of the COVID-19 pandemic and ‘opt-out’ legislation. PLOS ONE, 19(7), e0306541. doi:10.1371/journal.pone.0306541
Organ and tissue donation. (2024, October 31). Government of Canada. https://www.canada.ca/en/health-canada/services/healthy-living/blood-organ-tissue-donation/organ-tissue.html
Organ Donation Statistics. (2024, October). Health Resources & Services Administration. https://www.organdonor.gov/learn/organ-donation-statistics
Pink, T. (2022). Moral Obligation. In A. O’Hear (Ed.), Moral Philosophy (pp. 246–288). chapter, Cambridge: Cambridge University Press.
Theological perspective on organ and tissue donation. (n.d.). United Network for Organ Sharing. https://unos.org/transplant/facts/theological-perspective-on-organ-and-tissue-donation/
Thomson, J. J. (1971). A DEFENSE OF ABORTION: The Violinist Analogy. Philosophy & Public Affairs, 1(1), 46-66. https://media.lanecc.edu/users/borrowdalej/phl205_s17/violinist.html
