University of Innsbruck

Faculty of Humanities 2, Department of American Studies

SE Ethical Issues in American Medical and Legal Narratives
Course number: 610002 (SS 2008)

Ethical problems concerning organ
transplantation in 21 Grams
by
Stefan Hinterholzer

Date of handing in: 29th April 2008

Table of Contents

Introduction 3
1. Alejandro González Iñárritu′s 4
2. Definitions and General Problems 5
2.1. Definitions 5
2.2. Requirements for Heart Transplantation 6
2.3. Organ Shortage 7
3. Decision Making 10
3.1. The Decision to Donate an Organ 10
3.2. The Role of Relatives 11
3.3. The Decision to Receive an Organ and Medical Treatment 14
4. Psychological Problems 17
4.1. Research 17
4.2. Identity Confusion 19
5. Interest Groups 21
5.1. The Organ Recipient 21
5.2. The Deceased Donor Organ 22
5.3. The Donor′s Relatives 23
Conclusion 25
Bibliography 26

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Introduction

"How many lives do we live? How many times do we die? They say we all lose 21 grams... at the exact moment of our death. Everyone. And how much fits into 21 grams? How much is lost? When do we lose 21 grams? How much goes with them? How much is gained? How much is gained? Twenty-one grams. The weight of a stack of five nickels. The weight of a hummingbird. A chocolate bar. How much did 21 grams?"1

Paul Rivers leaves us with al these questions before he dies, and in fact, we need al these questions in order to reach a deeper understanding and to make sense of the movie. So, how much do 21 grams weigh? And what are these 21 grams. It is tempting to give a relatively simple answer from a medical or religious perspective. We may say that gases exhaust from our body or even that the soul escapes from
the body when we die. But this movie goes a step further.
These 21 grams apparently weigh so little but in the end weigh a lot. These 21 grams are the happiness of a family, the target of revenge, the reason for struggle, they are life itself. So our lives are dependent on these 21 grams, which shows that life is real y fragile. And this leads us to the topic of this paper: organ transplantation. Organ transplantation gives us the possibility to save another person′s life when our life is already over.
For many people it is self-evident to donate an organ when someone else′s life can be saved through that, and it may seem that there are no real problems or questions concerning organ transplantation, but there are. Organ transplantation is a much more controversial issue as most people might believe and there are definitely a number of ethical problems concerning organ transplantation.

^{1 21 Grams. Dir. Alejandro González Iñárritu. Perf. Sean Penn, Naomi Watts, Benicio Del Toro. DVD. Focus Features, 2004.}

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The aim of this paper is to analyze Alejandro González Iñárritu′s movie 21 Grams and to describe the problems and questions connected with organ transplantation that come up. In order to provide a solid basis for the analysis, necessary background information will be presented and connected with the movie. First of al , the director wil be presented briefly. Then, general questions and problems concerning organ transplantation in 21 Grams wil be discussed and final y more complex issues (decision making, psychological problems and interest groups) wil be dealt with.

1. Alejandro González Iñárritu′s

Alejandro González Iñárritu was born in Mexico City in 1963. He started his career with directing several television productions before he had his breakthrough with his Spanish movie Amores Perros in 2000. This production resulted in a lot of attention for Alejandro González Iñárritu who was and stil is regarded as an extraordinary representative of a new generation of directors. Amores Perros is also often regarded as the first great masterpiece of filmmaking in the new mil ennium. After having produced the movie 11′09′01 about the influences of the World Trade Center terror attacks, he had his breakthrough in the USA with his first English movie 21 Grams. His most recent success is Babel for which he won seven Golden Globes and seven Oscars among many other prices.2

Alejandro González Iñárritu uses a very special way of narration. His movies are anything but linear. There are numerous jumps between different moments in the present and the past. Alejandro González Iñárritu depicts the lives of different characters who are al shattered and broken in a way and links there life through a

^{2 cf. "Biography for Alejandro GonzáLez IñáRritu." The Internet Movie Database. 26 Mar. 2008 <http://www.imdb.com/name/nm0327944/bio>.}

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superordinate theme: shattering love (Amores Perros), the worth of life (21 Grams) or speechlessness (Babel). The lives of the characters are led together and merged.

2. Definitions and General Problems

2.1. Definitions

Organ transplantation is defined as "a surgical operation where a failing or damaged organ in the human body is removed and replaced with a new one"3 We can distinguish between living organ donation and cadaveric organ donation. Living organ donation means that people who are stil alive donate an organ. This can happen in two ways: one may donate one organ of a paired organ set (e.g. kidney) or a part of an organ that wil stil be able to function after the operation (e.g. liver, lung). If a living organ donation is not possible due to a missing donor or the impossibility of transplantation (e.g. heart), there is the possibility of cadaveric organ transplantation, which means that organs are taken from a dead body. Patients needing cadaveric organ transplantation are placed into a waiting pool.4

As living organ donation does not play a role in 21 Grams we can solely focus on cadaveric organ transplantation in the analysis. Therefore, there wil be made no further distinctions in the fol owing chapter and "transplantation" will stand for "cadaveric organ transplantation".

^{3 Ethics of Organ Transplantation. Center for Bioethics. 2004. 27 Mar. 2007 <http://www.ahc.umn.edu/img/ assets/26104/Organ_Transplantation.pdf>. p. 5.
4 cf. ibid. p. 7-8.}

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2.2. Requirements for Heart Transplantation

There are certain requirements that patients have to fulfil in order to receive a donor heart. First of al the patient′s heart disease must be in its final stadium, which consequently means that the patient would die soon if he did not receive an organ heart. Furthermore, the patient′s life expectation after the transplantation must be several months to several years. This means that patients who e.g. suffer from other severe il nesses that seriously reduce their life expectation general y do not receive a donor heart. This is also the case for people with mental disorders as they probably cannot mental y cope with the transplantation process and their lives after it. 5

General y, the so cal ed "maximum benefit"6 rule is applied. This means that two main factors are taken into consideration:

- Medical need (i.e. the sickest people are given the first opportunity for a transplantable organ).

- Probable success of a transplant (i.e. giving organs to the persons who wil be most likely to live the longest).

We can now apply this theoretical background on Paul Rivers′ situation. First of al we can state that Paul is definitely in the final stadium of his heart disease. He cannot manage his daily life alone, is lying in bed most of the time and cannot even breathe independently without respiratory equipment. He also desperately needs a donor heart because he would die soon otherwise as his heart and his body are going to col apse. But apart from his serious heart disease, Paul is a healthy and even relatively young man, which means that he would have a positive life expectation after the operation. And he would not even gain several months to years ­ he would probably even gain decades of life years. Paul fulfil s al the requirements for an organ transplantation and seems to be the perfect candidate for this. But there are

^{5 cf. Pyrek, Mieczyslaw. "Ethische Fragen Und Probleme Bei Organverpflanzungen." Diss. Leopold-Franzens-UniversitäT Innsbruck, 1988. p. 72.
6 cf. Ethics of Organ Transplantation p. 16.; Hope, Tony. Medical Ethics. A Very Short Introduction. Oxford: OUP, 2004. p. 95.}

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