Silke Schicktanz, Claudia Wiesemann, Sabine Wohlke, editors. Teaching ethics in organ transplantation and tissue donation. Universitatsverlag Gottingen; 2010. Pp81. ISBN 978-3-941875-40-1

Ever since the first organ transplant was successfully performed in the 1950s, controversies surrounding the scope and consequences of this medical intervention have attracted more attention than its potential human benefit. While the medical world finds in it the potential to provide effective treatment for end state organ failure, the various steps involved in the treatment? selection of donor and recipient, the process and stages of decision making, the diverse cultural and religious practices and beliefs – raise complex ethical challenges. Religious institutions often view the very idea of organ transplantation skeptically. Yet it has evolved as a widely accepted medical practice and continues to give hope to millions of patients, across the world, who suffer from potentially life-threatening ailments.

Organ transplantation offers several novel solutions to intricate medical problems and consequently enhances the quality of living and reinstalls hope in the lives of millions. But it simultaneously generates different responses in different cultures and introduces certain insoluble moral dilemmas. For instance, the ethical problems it raises in a liberal democratic environment would be characteristically different from those in more traditional communitarian societies with strong patriarchal social norms and values. This book edited by Silke Schicktanz, Claudia Wiesemann and Sabine Wohlke introduces a number of such ethical dilemmas by presenting cases from diverse socio-cultural contexts and exploring ways to tackle them.

The book has three parts; the first deals with a conceptual analysis of the ethical issues associated with organ donation. The second part extensively discusses several cases that bring out the intricacies of the ethics of organ donation. The third section discusses the prospect of using movies as teaching materials in highlighting the ethical issues in organ transplantation.

The discussion on organ transplantation begins with a working definition of this process – as a surgical replacement of a malfunctioning organ by another human organ – and a description of the various types of transplantations practised. After an analysis of the success rates in the transplantation of various organs, the book examines the ethics of organ transplantation and tissue donation in different scenarios where the donors are either living or dead. The authors remind us that, since organ transplantation is a global and transnational endeavour, it raises universal ethical concerns. Yet like any other socio-technological practice, it has to negotiate with culturally mediated beliefs.

After this introductory analysis, more substantial moral challenges are addressed by problematising serious questions about human identity, dignity and the meaning of the human body in the context of organ transplantation. The authors show how the problem of organ commodification and trading further introduces ethical problems. Several factors add to the complexity of the situation. Though, from the outset, commercialisation seems to be objectionable, from many other perspectives it seems to have its virtues. Further, the book examines the ethical problems raised by the possibilities of xenotransplantation. The authors also point to certain issues related to “organ shortage”, as there has been a steep increase in the number of patients in need of organs in recent years.

The section on case studies comprehensively deals with the multiple aspects of the ethics of organ transplantation and discusses a wide range of cases from different backgrounds and attempts to suggest possible solution(s) for them. These cases, though situated in diverse cultural contexts, nevertheless present certain serious ethical issues that have global significance and also highlight the dilemmas arising out of conflicts between traditional moral assumptions and the possibilities of modern technological contexts.

The third important aspect the book addresses is the prospect of exploiting the pedagogic value of movies and using them to interpret, elaborate and critically discuss ethical issues by presenting before the viewers imaginary situations where such issues are encountered. The authors give a list of movies, but do not discuss them in detail.

This book reminds us that the domain of bioethics keeps constantly offering patients and healthcare professionals several such insoluble moral dilemmas, as it is impossible to approach them with a set of norms that are globally fixed. Each context offers a range of ethical challenges, which have to be negotiated, taking into account several social, cultural, religious, economic, and legal factors.

The book addresses some vital issues of tremendous contemporary value, but the reader may reasonably expect a little more discussion on some of the problems presented. The authors take for granted that the readers are familiar with certain moral concepts and issues, identity, meaning of body, etc, which have different connotations in different cultures. The section on cases is arguably the most interesting part of the book and leaves room for a lot of discussion. This makes the book a valuable classroom resource for bioethics instructors.

The book reminds us that, despite its strength in contributing to substantial human welfare and happiness, technology often becomes an agent of human alienation.