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Ethicists worry sometimes about the psychological damage done to both donors and recipients. How will children react in later life to being conjured up and used in this way? Consider the case of Michelle Kline, a contestant in the 1989 Miss America contest, who received a kidney from her brother 19 months before the pageant. She would not speak to him afterward, although they later reconciled. "The sense of having part of her brother inside her created tremendous tensions," says Renee Fox, a medical-sociology professor at the University of Pennsylvania. The tyranny of the gift: "It was a feeling of overwhelming debt that she could not repay." Conversely, one kidney donor became so depressed after the recipient did not thrive that he killed himself in despair.
There will never be enough cadaver organs to fill the growing needs of people dying from organ or tissue failure. This places higher and higher importance, and risk, on living relatives who might serve as donors. Organs that are either redundant (one of a pair of kidneys) or regenerative (bone marrow) become more and more attractive. Transplants become a matter of high- stakes risk-calculation for the donor as well as the recipient, and the intense emotions involved sometimes have people playing long shots.
Family members become more and more pressed to provide organs to save relatives. It is a bizarre request, of course, difficult to refuse, and can lead to ugly family conflicts. As Alexander Capron, a bioethicist at the University of Southern California, says, "a good medical team knows how to help a potential donor to say no." Often, doctors simply lie and say that the relative who does not want to do it is "not a match."
The most famous controversy over a spurned request led to the courtroom last year. Tamas Bosze, a Chicago bar owner, was told that only a marrow transplant could rescue his son Jean-Pierre, 12, from leukemia. The boy's only potential donors were twin half-siblings born out of wedlock to the father's former girlfriend. Bosze sued the woman in an attempt to compel her to have the children tested for tissue compatibility. She refused, and a court upheld her decision. Last November, Jean-Pierre Bosze died.
Federal law now prohibits any compensation for organs in the U.S. In China and India, there is a brisk trade in such organs as kidneys. Will the day come when Americans have a similar marketplace for organs? Turning the body into a commodity might in fact make families less willing to donate organs, says Capron: "A family would be willing to say, 'We gave Joey's kidneys away.' But would they say, 'We sold Joey's kidneys?' I don't think so."
The new technology of transplants disturbs everyone's model of the natural order. The human being has not been in the habit of walking around with someone else's heart in his chest. Or of breaking into the temple of someone else's body and making off with its faucets and pipes. There is adventure in the possibilities, and hope for some who would otherwise be doomed. But the issues lead into strange, unprecedented territory. It will require time and experience to explore.
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CREDIT: From a telephone poll of 1,000 American adults taken for TIME/CNN on June 4-5 by Yankelovich Clancy Shulman. Sampling error is plus or minus 3%. "Not sures." omitted.