Improving human organ availability for transplantation: Legal paradigms and policy options.

This dissertation focuses on legal issues and potential solutions to the public policy quandary of the shortage of transplantable human organs. This shortage is examined in light of the relevant clinical, legal, and cultural contexts in which the policy problem is imbedded. Rather than taking the traditional approach of examining only post-death policy options, this analysis seeks to view organ donation and procurement within the whole continuum of the dying process through to the post-death period. Such an examination is necessary, both to consider factors in medical care decision-making which can affect organ viability for transplantation and to suggest different kinds of legal policy options with potential for improving organ supply. Four types of legal policy alternatives are considered in order to address the mismatch which leads to organ shortages: consent law approaches, property law alternatives, options under the police power of the state, and procedural law changes. Variations of these options are discussed and then evaluated for desirability using a uniform set of criteria in order to compare advantages and disadvantages of the different alternatives. The set of criteria includes effectiveness, technical feasibility, political feasibility, efficiency, and predicted side effects. The initial set of ratings of options and relative rankings of the alternatives based on application of these criteria find police power and procedural law options outranking most consent law and property law approaches. These results remained stable despite different weightings of the scoring of the variables on the evaluative criteria. Public policy approaches to increasing organ availability in the U.S. have relied heavily on autonomy-based consent law approaches for increasing donation. The results of this study suggest that further autonomy-based approaches may have little additional potential for enhancing organ availability, as compared to the promise of the other legal approaches considered. In particular, police power and procedural law options deserve further investigation as alternative public policy tools for remedying the growing shortage of transplantable human organs.Dr.P.H.Health and Environmental SciencesLawPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/129582/2/9532448.pd