The book, as the title itself aims at, addresses the limits of the altruistic model in the donation of organs. In other words that «… altruism as the sole regulating element of the donation programs, is a problematic issue» and «… that the altruistic donation model in terms of equality is a disadvantage for the donor family» (p.17).

For the achievement of theses purposes, the author divides the topic in four chapters. The first one is the delimitation of the problem (pp. 17-24). In it, it is presented the problematic character of the transplants in the model of total gratuity, without any kind of retribution by the other actors involved, that is, the receptor person and the health institution. In the chapter, it is established that, between the two extremes of commercializing the organs, and total altruism, fits an intermediate position which is to receive certain social and ethic retribution, due to the donation.

In Chapter II. «Altruism as a regulating element of the organ donation» (pp.25-43) it is studied, on one part, the meaning and implications of the concept of «altruism», and on the other hand the empiric results are shown that a study of cases where the complex consequences in the family when living people make donations, is shown. The empiric study shows very well the psychological consequences, and the social ones, of being a donor. Particularly it is highlighted the sensation of reification that the involved subjects perceive by passing through all the protocol which is centered in the clinical aspects. The author does not stay only in the diagnostics, but proposes improvements in that donation process, where the donors must be attended and taken care with their own name, through the whole process, to receive psychological advice, and absorb the expenses of the whole donation process, among others. In summary: «To take care of the emotional affliction, and ease as much as possible the economical impact of the donors, makes that all the society should fight to avoid the consequential negative impact in the culture of donation, that scarcely we have achieved to develop» (p.43)

In the next chapter «Qualitative Studies» (pp. 45-68), the consequences in the donor families from the process of donation are studied, but now in corpse’s donations. Six donor families were given a follow-up, in a way that the implications of the donation could be assessed. The study shows that there are psychological, economic and social implications in the involved people. Implications are given in the mourning process, due to the difficulty to accept brain death, and at the same time see signs as the breathing or the cardiac beat. Then, there exist problems with the mourning process and the donor acceptance.

Similarly, the chapter presents another study to the open population, about the possibility to be donors. It is shown that the fact of discovering that there exist economic costs in the donation process itself, diminishes significantly the possibility of donor acceptance, and has clear ethical implications, by not having available a complete information of the donation process, for what it is:»… a transgression to the principle of autonomy, of beneficiency and no-maleficiency… The protocol for corpse donation should establish as a cut-off point, the moment it is determined and declared that the patient has brain death. Beginning at that moment, all the expenses incurred for any concept whatsoever, must be considered as a part of the protocol of organ donation» (p.67).

The following chapter «Corpse donation in reciprocity» (pp.69102), focuses now in the central proposal of the entire job. Reviews this way the philosophical, legal, medical and social implications of the reciprocal retribution of the donation. Similarly, the author does not spurn the possible risks of this perspective, as it could be to convert the reciprocity into a «buried form of purchase- sale of organs» (p.62), meaning that the altruistic reciprocity, would be converted in selfishness, by the donor family, in attending and taking care only, of their own interests. The possible corruption of the process or mechanism, in order to obtain in this way, social benefits, is another danger. The chapter ends with the general conclusions of the presented study.

Among the conclusions, I want to highlight the next one, which is going to become the leitmotiv of the whole book: «The proposal of a corpse donation that will not only be based on altruism, emerges from the necessity we see of restructuring all the aspects that are already presenting problems, in the altruistic corpse donation model. Specially the economic aspect, because we consider that the fact that the donor family, also has to absorb and cover part of the expenses derived from the donation protocol, and it is due to the misrepresentation and distortion which the concept of altruism has suffered, that is to say, altruism is equated with gratuity… The donor family can be altruistic, but that does not mean for them to be ready to cover expenses». (p.99).

In summary, the author shows well the complexity in the donation protocols, and the implications affecting the donors, which sometimes, go unnoticed. The research presented is balanced, and even though some topics, such as the distributive justice, for example, could be enhanced, she achieves what she wanted to aim at.

The book is a good example of doing Bioethics, which not necessarily implies the use of sophisticated conceptual lucubrations. It has the great merit of speaking with clarity, discuss with precision, and balance the concepts with the empirical data.