The case for reform of the so-called system of cadaveric procurement of solid organs for transplantation

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Moreton, J, 2025. The case for reform of the so-called system of cadaveric procurement of solid organs for transplantation. PhD, Nottingham Trent University.

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Abstract

The purpose of this doctoral thesis is to critically scrutinise contemporary systems allowing for the removal of essential to health/life organs for transplantation and the case for their reform. Central to this scrutiny is a sociological, political, and ethical critique of current approaches to defining and determining death. I argue that the objective of securing more transplantable organs has been allowed to drive modern approaches to definition and determination at the cost of their credibility. Indeed, I argue that these modern brain and/or circulatory-based approaches make a mockery of the dead donor rule (DDR). Their reform is imperative and must be grounded on an appropriate approach to ethics.

The thesis makes three key original and significant contributions to the field. Firstly, whilst criticism of modern approaches to defining and determining death is nothing new, it develops a novel approach to their substantive critique. Secondly, it dovetails this critique with a more complete analysis of the process by which contemporary approaches have (from a sociological and political perspective) established and maintained themselves. This analysis advances the case that their existence is not only substantively problematic but the product of the reification of an inappropriate use of medical power, critical to which has been the normalisation of the idea that death is a medical matter rather than a spiritual or metaphysical one and resultant investment of modern medical approaches to death with an almost mystical level of authority. Thirdly, when it comes to the specific question of how contemporary approaches to death should be reformed, the thesis is the first piece of work that goes beyond the fairly limited use of different approaches to ethics to forge a comprehensive analysis of the comparative merits of key specific approaches. The significance of the thesis naturally flows from these three points of originality given that the credibility of so-called cadaveric organ procurement systems and of approaches taken to determining death are both of high societal importance.

In terms of its methodology, the thesis is not merely critical, but also multi-disciplinary, comparative, and broad-ranging in the materials it draws on. Specifically, its critical focus centres not just on relevant law relating to death and organ procurement but also governance and practice and the discourses that swirl around and intersect with them. As well as law, the thesis draws heavily on ethics, medical science, sociology, and politics. It employs both a case study-based and comparative approach when addressing relevant law, governance, and practice to provide an accurate picture of key differences and commonalities in their process of evolution and maintenance as well as substantive nature.

Item Type:	Thesis
Creators:	Moreton, J.
Contributors:	Name Role NTU ID ORCID Garwood-Gowers, A. Thesis supervisor ALS3GARWOA https://orcid.org/0000-0001-9158-9735 Shimwell, M. Thesis supervisor VOP3SHIMWM UNSPECIFIED
Date:	March 2025
Rights:	The author holds the copyright to this work. You may copy up to 5% of this work for private study, or personal, non-commercial research. Any re-use of the information contained within this document should be fully referenced, quoting the author, title, University, degree level, and pagination. Queries or requests for any other use, or if a more substantial copy is required, should be directed to the author.
Divisions:	Schools > Nottingham Law School
Record created by:	Jeremy Silvester
Date Added:	09 May 2025 15:45
Last Modified:	09 May 2025 15:45
URI:	https://irep.ntu.ac.uk/id/eprint/53569