Trevor Stammers

We report on two areas in which UK law and ethics seem out of step with each other. 2013 saw the passing of the Human Transplantation (Wales) Bill, which will introduce an opt-out system of organ donation in Wales from 2015. In the first section, we discuss the convoluted evolution of the Bill and some potential problems that we consider may prevent it from achieving its intended goal of increasing the number of organs transplanted. The prospect of being able to enhance human cognition through cognitive-enhancing drugs ("smart drugs") also presents a nexus of questions associated with future ambitions, hopes, and concerns as a society. How these drugs might affect the future of work and employment is beginning to generate wide public engagement in the UK and forms the focus of the second section.

As the demand for organs begins to outstrip availability and waiting lists surge, the pressure to make morally questionable, unethical decisions becomes more likely and trust in transplant medicine starts to erode. The complex ethical web that constitutes this worldwide trade in organs and tissues is analysed by former health professional and medical ethics expert, Trevor Stammers. Key philosophical questions concerning existence, consciousness, and the right to life, connect organ donation and transplantation to real-life case studies including brain death in living patients, legal euthanasia, the creation of human-animal hybrids and organoids, alongside extreme examples of systematic murder driving under-regulated trade. Controversial cases from Japan, Germany, and Singapore are analysed alongside the Spanish, Welsh, and Brazilian experience of transplant opt-out schemes to highlight the variety of threats and challenges to public trust in transplant medicine. Charting these examples provides vital material for debates and discussions in the philosophy of medicine, and medical ethics more generally, with Stammers suggesting viable alternatives to current ethical failings by focusing on the moral arguments that define public trust, moving the debate on transplant ethics in vital new directions.