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D Price, Cambridge University Press, 2000, £45, pp 487. ISBN 0-521-65164-6
Some lawyers, even some academic lawyers, have developed the happy knack of being in the right place at the right time, without being ambulance chasers. Thus David Price, with not only a timely but a thoughtful and thought provoking examination of organ transplantation and associated questions of commerce and commodity in body parts, seems almost prescient. Did he know, when he set out to compose what has emerged as his elegant and authoritative account and critique, that bodies and body parts were about to become one of the most controversial intellectual properties for years?
Price’s corpus is in three parts; predictably cadaveric organ transplantation and living donors comprise the most substantial elements of his exegesis and critique. While his review largely antedates cell nucleus substitution and the potential therapeutic application of stem cell research, he recognises that this is one of a number of “alternatives” to current transplant technologies that will later require more comprehensive consideration and review. In a third, concluding section, he addresses the troubling issue of “commerce” and the troublesome one of “recipients”. Throughout, his analysis and arguments are driven by the need—as he perceives and defends it—to respond to “medical globalisation”. This entails setting in place an integrated, coherent, and global conception of appropriate and acceptable transplantation practice, and a similarly fashioned and dedicated form of regulation.
Price attempts to stake out what for him would be a coherent and defensible position on organ transplantation that may be of global reach and appeal while yet remaining sensitive to culturally and politically diverse circumstances. As others have concluded, this is no mean task, and yet the attempt is an important and urgent one. Too often, in the absence of some agreed alternative framework for international approaches to modern scientific biomedicine the contemporary default mechanism of market regulation succeeds. Here, Price is shy neither of introducing nor courting controversy. He engages with commerce (it is “too dismissive to simply sideline at least consideration of commercial schemes”), marries doubt about the wholehearted value of intuitionism—(too long dominant in public policy consideration of transplant policy), with an appeal to relativity (“philosophical choice in a specific cultural milieu”), but would divorce the views of potential donors from those of their relatives, clearly preferring an apparently autonomy-enhancing preference for doing as the former (would have) wished, to what the latter would have done.
Price concludes that developed countries which do not facilitate an increase in organs available for transplantation purposes encourage the development of an alternative trade in organs. Thus, exploration of supranational responses to need and regulation are necessary to respect and protect donors, recipients, and health care professionals, while yet encouraging donation and increasing the supply of transplantable organs. One of the keys to unlocking this response is a strong slice of autonomy—so that the premortem wishes of potential donors are neither frustrated nor assumed—and another is a mild draught of commercialisation. Failing this, Price would advocate a system of mandatory choice and adherence to those choices even when they would encompass presently legally dubious practices—such as elective ventilation.
This is a comprehensive and considered book on legal approaches to organ transplantation which, as far as lawyers have been concerned, has been strangely lacking as a companion to a number of excellent studies of the philosophy and ethics of the subject. But Price engages also in those ethical debates and arguments, and compared with many who have surveyed other discrete areas of modern biomedical practice has done so from a broad international perspective; there is, (as one example) more in this essay from the rich and vibrant traditions of South America than in many comparable volumes. This is a particularly welcome addition to the emergent library of international biomedical ethics and comparative law.