Ethical problems concerning organ transplantation in "21 Grams"

Seminar Paper, 2008

27 Pages, Grade: 2


Table of Contents


1. Alejandro González Iñárritu’s

2. Definitions and General Problems
2.1. Definitions
2.2. Requirements for Heart Transplantation
2.3. Organ Shortage

3. Decision Making
3.1. The Decision to Donate an Organ
3.2. The Role of Relatives
3.3. The Decision to Receive an Organ and Medical Treatment

4. Psychological Problems
4.1. Research
4.2. Identity Confusion

5. Interest Groups
5.1. The Organ Recipient
5.2. The Deceased Donor Organ
5.3. The Donor’s Relatives




"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 all these questions before he dies, and in fact, we need all 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 really 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.

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 all, the director will be presented briefly. Then, general questions and problems concerning organ transplantation in 21 Grams will be discussed and finally more complex issues (decision making, psychological problems and interest groups) will 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 still 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 millennium. 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 all shattered and broken in a way and links there life through a 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 still 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 will still 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 will be made no further distinctions in the following chapter and “transplantation” will stand for “cadaveric organ transplantation”.

2.2. Requirements for Heart Transplantation

There are certain requirements that patients have to fulfill in order to receive a donor heart. First of all 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 illnesses that seriously reduce their life expectation generally do not receive a donor heart. This is also the case for people with mental disorders as they probably cannot mentally cope with the transplantation process and their lives after it.[5]

Generally, the so called “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 will be most likely to live the longest).

We can now apply this theoretical background on Paul Rivers’ situation. First of all 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 collapse. 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 fulfills all the requirements for an organ transplantation and seems to be the perfect candidate for this. But there are also other factors that should be taken into consideration and that make it questionable whether Paul has really deserved to get an organ heart.

2.3. Organ Shortage

As it is widely known, there is an international shortage of donor organs. The problem is that there are much more patients that need a donor organ than donors who are providing these organs. Apart from the maximum benefit rule, there is another criterion that is used, namely “equal access”[7]. Supporters of the equal access distribution say that “everyone should have equal access to organs because everyone could potentially benefit from the system”[8]. Still, this equal access must also be controlled in some way and there are two main factors that influence the distribution of organs in this case: the length of waiting time (i.e. first come, first served) and the patient’s age (i.e. youngest to oldest).

Still, a lot of people think that there should be more restrictions on the way to getting a donor organ. One of the main concerns is that people who have a healthy lifestyle should be preferred to people who destroy their own health themselves. Consequently drug addicts, smokers, alcoholics or obese people may be disadvantaged in the distribution of donor organs.

Let us take a look at Paul again. We have already found out that he should get a donor heart in principle as his disease has reached a life-threatening stadium and as his life expectation is good. But what about the way he deals with his own health? In one scene, Paul’s wife Marry catches him secretly smoking in the bathroom and is really angry about that:


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

[2] cf. "Biography for Alejandro GonzáLez IñáRritu." The Internet Movie Database. 26 Mar. 2008 <>.

[3] Ethics of Organ Transplantation. Center for Bioethics. 2004. 27 Mar. 2007 < assets/26104/Organ_Transplantation.pdf>. p. 5.

[4] cf. ibid. p. 7-8.

[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.

[7] cf. Ethics of Organ Transplantation p. 15.

[8] cf. ibid.

Excerpt out of 27 pages


Ethical problems concerning organ transplantation in "21 Grams"
University of Innsbruck  (Department of American Studies)
Ethical Issues in American Medical and Legal Narratives
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Ethical, Grams, Ethical, Issues, American, Medical, Legal, Narratives, 21, grams, Film
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Stefan Hinterholzer (Author), 2008, Ethical problems concerning organ transplantation in "21 Grams", Munich, GRIN Verlag,


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