The book, as the title itself points out, addresses the limits of the altruistic model in organ donation. Said in other words «...altruism as the sole governing element of donation programs, is a problematic issue» and «... that the model of altruistic donation in terms of equity is disadvantageous for the donor family» (p. 17).

In order to achieve those purposes, the author divides the topic into four chapters. The first one is the delimitation of the problem (pp. 17-24). In it, the problematic character of transplants appears in the gratuity model without any kind of retribution from the other involved actors, that is, the recipient and the health institution. The chapter establishes that between the two extremes of marketing the organs and complete altruism, there is room for an intermediate position, which is to receive a certain social and ethical retribution for donation.

Chapter II. «Altruism as a governing element in organ donation» (pp. 25-43) studies, on one hand, the meaning and implications of the concept of «altruism» and, on the other, the empirical results of a case study in where the complex consequences in the family are shown when donations are made from living people. The empirical study shows very well the psychological affectations, economic and social costs of being a donor. In particular, the feeling of reification perceived by the subjects involved is highlighted when going through the entire protocol that focuses on clinical aspects. The author does not remain only in the diagnosis, but proposes improvements to this donation process, where the donors must be addressed with their own name throughout the process, receive psychological attention, absorb the expenses of the donation process, among others. In conclusion: «Address the emotional condition and alleviate as possible the economic impact to the donors-makes a whole society struggle to avoid the consequent negative impact on the culture of donation that we have managed to develop precariously» (p. 43).

The following chapter «Qualitative studies» (pp. 45-68) studies the consequences in donor families of the donation process, but now in cadaveric donations. To six donor families a followed up process was performed so that the implications of the donation could be evaluated. The study shows that there are psychological, economic and social implications in those involved. Implications are given in the grieving process due to the difficulty of accepting brain death and at the same time seeing signs such as breathing or heartbeat. Then there are problems with the grieving process and acceptance of the donation.

In addition, the chapter presents another study of an open population about the possibility of being donors. It is shown, that the fact of discovering that there are economic costs in the donation process, significantly decreases the possible acceptance of donation. It also has clear ethical implications by not having complete information about the donation, process for what it is: «a transgression to the principle of autonomy, beneficence and non-maleficence. The cadaveric donation protocol should establish as the cut-off point, the moment in which the patient is determined to have brain death. From that moment all the derived expenses -for any concept- should be considered part of the organ donation protocol» (p. 67).

The next chapter «Cadaveric donation in reciprocity» (pp. 69-102) is already centered on the central proposal of all the work. It examines the philosophical, legal, medical and social implications of the reciprocal retribution of donation. Likewise, the author does not disdain the possible risks of this perspective, such as converting reciprocity into an «buried form of purchase and sale of organs» (p. 92), in a way that altruistic reciprocity would be converted in selfishness, by having the donor family only addressing their own interests. The possible corruption of the mechanism to obtain social benefits is another jeopardy. The chapter closes with the general conclusions of the presented study.

Among the conclusions, I highlight the following that will be a leitmotiv of the whole book: «The proposal of a cadaveric donation that is not based solely on altruism arises from the need that we see to restructure the aspects that are already presenting problems in the altruistic cadaveric donation model. In particular the economic aspect, because we consider that the fact that the donor family even absorbs part of the expenses derived from the donation protocol, is due to the misrepresentation that the concept of altruism has suffered, that is, altruism equals gratuity... The donor family can be altruistic, that does not mean that they are willing to absorb expenses» (p. 99).

In summary, the author demonstrates well the complexity of the donation protocols and the implications on donors, which sometimes go unnoticed. The research presented is balanced and although some issues, such as the distributive justice, for example, could be extended, it accomplishes very well, what is proposed.

The book is a good example of how bioethics does not necessarily imply sophisticated conceptual elaborations. It has the enormous merit of speaking clearly, arguing with precision balance the conceptual, with the empirical data.