Do Gifts Create Moral Obligations for Recipients?

Abstract

In "An 'Opting In' Paradigm for Kidney Transplantation," David Steinberg proposes increasing the number of cadaver kidneys available for transplantation through an "opting in" scheme to encourage people to prospectively agree to organ donation at death. Steinberg's proposal includes a critique of the ethical justification for live donor transplantation, and an argument in favor of this new approach. We argue that Steinberg's primary argument against live donation (i.e., the unacceptable risk argument) is not sufficiently compelling to consider lessening our reliance on this practice. With regard to Steinberg's proposed "opting in" scheme, we focus on a fundamental conceptual problem in the proposal: implicit in Steinberg's proposed "opting in" scheme is the idea that gifts create corresponding and reciprocal duties on the part of potential recipients. We reject this conception of donation and gifting, which we argue relies on a mistaken understanding of altruism. Instead, we suggest that while organ donation is a meritorious act, it is not one that is legally or morally required.