Colloquium: A Promise-Acceptance Model of Organ Donation

Ought we always to honor the wishes of the dead to donate their organs? If so, why? Is it ever ethically permissible to allow a family veto to override an individual’s express wish to donate? Ethical and legal theorists have proposed various models to answer such questions. I argue that a Consent Model, though natural, does not accord with the best understanding of donor autonomy. I then assess a Gift Model and a Promise Model, arguing that both fail to capture important data about the ability to revoke one’s organ donor status. Instead, I outline a novel alternative approach: a Promise Acceptance Model, under which becoming an organ donor is construed as accepting a promise that the state makes to you to use your medically suitable organs for transplant after you die. I argue that this model, which implies that family vetoes are impermissible, is compatible with current practice and captures the data the other models struggle to accommodate.