I'D LIKE TO RESPOND to Bernard Cullen's letter ("Giving Our All," January-February 2000) regarding my article "Life on the Auction Block" (November-December 1999). When Cullen says that few people waiting for an organ would want to pressure or coerce donation, I agree and did not mean to imply otherwise. The corruption of the current system and the pressure to go to a market-based system is almost always from monied interests. Cullen is right that an open market for organs is currently against U.S. law, but proposals for such come regularly in ethics texts that are widely used in bioethics courses. When I have taught bioethics to nursing students, I have found a surprising number open to either mandatory harvesting or market systems for organ procurement.
Cullen also states that a strong difference exists between systems of "implied consent," where families can veto an otherwise automatic organ harvesting, and a system of mandatory harvesting. In practice, I doubt that such distinctions hold up. There are too many subtle pressures on families available to doctors and hospital staffs that would make grieving families vulnerable to manipulation. Britain has a system such as Cullen advocates, and the head of Alder Hey Children's Hospital in Liverpool was fired because of the removal of organs from dead children without their parents' consent.
However, I am grateful for Cullen's response. I will use both my article and his response as question starters for my upcoming course "Biomedical Ethics in Christian Perspective" at Fuller Theological Seminary. One of my major purposes in writing the piece was to generate discussion of an issue too often ignored in our faith communities and in public discourse.