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The values of psychotherapy

some bearing on certain kind of moral discussion, for instance, 'Results of an Audit of Living Related Renal Allograft Donation from a Single Centre', all the way to those which are more or less entirely moral philosophy, though having some bearing on what one should or should not do in transplant surgery, for example, 'Is There a Universal System of Ethics, or Are Ethics Culture Specific?' There is an attempt here to cover all of the current ethical debates in transplantation medicine; the book includes papers related to living donor organ donation, to the buying and selling of organs and the growing international business in transplantation, to the problems associated with cadaver explantation, and to the difficulties of fair distribution of the restricted numbers of organs available for transplant. At the same time, the volume gives an idea of the state of the art in transplant techniques, and some sense of where the cutting edge of this branch of medical science might be. Partial liver transplants, domino heart transplants, pig-person transplants, fetal tissue transplants, all have articles devoted to them in these pages. An omission, however, is any direct consideration of the current position on artificial organs. Organ Replacement Therapy, looked at as a philosophical discussion of moral issues, will inevitably leave something to be desired. The arguments of the lawyers, theologians, philosophers and doctors, are unavoidably underdeveloped. The first, and more significant, consequence of this is that fundamental assertions made by contributors sometimes escape scrutiny. For instance, in the discussion of brain death (is it tantamount to death?) all participants base their arguments on the distinction between 'person' and 'human being' and the impression given is that this is a settled fact of life. It is nothing of the sort. A second, less serious, consequence is that where other assumptions (for instance that clinicians should be involved in organ allocation decisions) are put under the microscope, and subjected to useful inspection, the discussion is shortlived and inconclusive. It is perhaps most accurate to describe this book as a panoramic snapshot (if that is not a contradiction in terms) of the huge and complex scenery of transplant medicine and ethics at a particular moment in its evolution. Most interestingly, that panorama shows distinct and, on occasion, contradictory, cultural perspectives. One instance of this is the discussion of the morality of rewarded gifting (that is, offering an organ donor something, over and above compensation, for the donation of his or her organ). Into this discussion are fed views from India, Iran, and Pakistan, as well as the perhaps more familiar perspectives of Western Europe and North America. The value of Organ Replacement Therapy, then, lies not in its taking a moral idea and subjecting it to rigorous and careful philosophical scrutiny, but rather in its being a source book of differing points of view and rich examples, worth extended philosophical reflection.