Bodily integrity remains a central issue for organ transplantation. The process of removing an organ from one body and resettling it into another body necessarily requires transgressing the physical integrity of the human body. This process raises different psychological and moral issues with respect to ideas about how we should treat our bodies or the bodies of our loved ones. On the one hand, ideas about the physical integrity of the body play an important role in decision-making by individuals and their families as to their willingness to participate in organ donation programs. For this reason, it is an important consideration to take into account when understanding those factors that can limit the potential supply of available organs for transplantation. On the other hand, ideas of the physical integrity of the body also play an important role in setting constraints on what is viewed as permissible in relation to possible policies or intervention practices aimed at increasing the general availability of donor organs.

My aim in this chapter is to briefly explicate these two issues in relation to bodily integrity and organ donation, and explore some of the potential problems raised in relation to increasing the supply of high-quality organs for transplantation. In the first part of the chapter, I provide a pithy overview of the concept of bodily integrity itself and how ideas about the importance of the physical integrity of the body can come into play in the context of organ donation. In the second part of the chapter, I examine the extent to which the beliefs and attitudes of individuals and their families about bodily integrity act as an empirical barrier to their willingness to be involved with organ donation. In the third part of the chapter, I raise some issues with respect to the extent to which bodily integrity should also be seen as a normative barrier for different practices and policies surrounding organ donation. I conclude by arguing that the idea of bodily integrity admits of different conceptions and interpretations. Not only is this true within philosophical and public policy discourse, but is also reflected in the beliefs and attitudes of lay people. There is a need for both further theoretical work to be done to develop a more nuanced conception of bodily integrity , as well as further practical work that seeks to modify beliefs and attitudes about bodily integrity in the context of organ donation in order to reduce its effect as a barrier towards increasing the supply of high-quality organs for transplantation.

The physical integrity of the human body, and especially whether and in what way we could have a right to bodily integrity , is a topic that remains widely discussed and debated.¹ Given the processes involved with organ retrieval and transplantation, it is evident how ideas of bodily integrity are engaged. It is not so evident, however, how we should understand the nature of the body, its physical integrity, what kinds of interventions qualify as transgressing bodily integrity and whether all instances of transgression must be seen as harmful, wrongful or both.

As more scholarly and public policy attention is given to bodily integrity and its implications, it has become clear that there is a multitude of considerations and interpretations underlying how we understand the physical integrity of the body and what it will mean for policy and practice surrounding areas such as organ transplantation. So much so, it raises the question of whether bodily integrity is an essentially contested concept or whether, in many cases, scholars and practitioners are talking past each other when they believe they are talking about the same thing.² Bodily integrity has been claimed to be grounded in considerations such as ownership, sovereignty , dignity and privacy. The maintenance of the physical integrity of the body is said to be manifested in different ways, such as the preservation of the wholeness, functionality or inviolability of the body. Further, there are also various putative ways of transgressing the physical integrity of the body that are said to be constituted by particular modes of intervention, such as invasiveness, dismemberment, mutilation or destruction. More still, over and above the physical harm that can result from such transgressions of bodily integrity , it has also been claimed that distinctive moral harms, such as devaluation, defilement and deprivation, can also result.

For this reason, it is possible to get very different claims about the nature of physical integrity and just what would be permitted, prohibited or even required from the existence of a right to bodily integrity. This is not only theoretically significant in terms of clarifying and explaining the nature of bodily integrity, but it also has important implications for practice and policy . This is so because, depending on which claims about bodily integrity are being relied on, different answers to the questions of which interventions are acceptable to lay people or which interventions should be morally or legally permissible can be given. For instance, one might claim that bodily integrity is grounded in personal sovereignty in a way that makes the physical integrity of the body inviolable, thereby making any invasive intervention like organ removal after death impermissible without consent. Likewise, someone might claim something completely different. One might claim that a bodily integrity is grounded in human dignity in a way that requires us to maintain the wholeness of the body in a way that prohibits any defiling or destructive modification—even if one wants and would consent to such modification.³ As such, how we conceive of bodily integrity will have important implications for organ transplantation with respect to how likely people will be to want to donate their own organs or the organs of their loved ones and the general acceptability of efforts to increase the supply of donor organs that may be enacted in an effort to save more lives.

Bodily integrity can act as a barrier to organ donation in so far as people are psychologically disposed to reject interventions they view as transgressing the physical integrity of their body or the body of their loved ones. This is so even when they are thinking about their bodily integrity after death. For this reason, one’s personal future intention to donate posthumously or one’s actual family decisions in favor of posthumous donation are less likely to occur because of how transgressing the physical integrity of the body acts as a countervailing consideration.