Introduction
Modern medicine is developing rapidly, and its activities are aimed at improving the quality of life of the population and methods of treating patients, and organ transplantation is a field within this category. The process, however, creates an ambiguous picture concerning the doner. It is necessary to analyze what motivates citizens to participate in lifelong donation due to the significance of the challenge correlating with the developing field of organ transplantation. The causal relationship between external factors and organ donation is important to examine since it can highlight the areas that are to be maximized for a more efficient donation process. The argument presented further is that increasing motivation for organ donation correlates with the improvement of the procedure, emotional fulfillment, and legislative additions, which ultimately facilitate more transplantations.
Low Chances of Risk
The first reason for increasing motivation is that organ transplantation is a high-tech operation. Surgical medical intervention is carried out on the condition that the expected benefit from it for the patient will significantly exceed the operational risk (Lamb, 2020). Thus, the risk of performing an organ transplantation operation exists for two patients, and a beneficial effect is initially expected only for one. The decision to donate life, like any medical intervention, is always associated with a certain risk for the donor, including short-term, and long-term risks arising from living without an organ or part of it, and psychological risks. In the USA, for example, perioperative mortality after donor nephrectomy is about 3 cases per 10,000 operations (Orlando & Keshavjee, 2021, p. 134). More than half a century has passed since the first transplantation, and throughout this period, the question of the impact of the operation on the duration and quality of life of the donor has been one of the cornerstones in transplantology (Orlando & Keshavjee, 2021). The results of the first studies conducted in the late 60s of the last century established a low operational risk and a rapid compensatory increase in the function of a single donor kidney (Orlando & Keshavjee, 2021). Subsequent studies have shown a high level of safety in kidney donation (Orlando & Keshavjee, 2021). However, the emergence of new diagnostic methods and an increase in the number of donors made it possible to change the attitude toward the previously obtained results.
Nonetheless, there is an alternative point of view regarding the long-term prospects for the life of the donor. More recent studies have established the presence of differences in laboratory data in kidney donors (Tayur & Dai, 2018). Tayur and Dai (2018) concluded that kidney donors are at higher long-term risk of cardiovascular disease and mortality compared to controls. However, as the procedures become more efficient and less risky, motivation increases despite the complications. The relative safety of the surgery is not the only motivating factor for becoming a donor, and it is important to highlight the psycho-emotional aspect of the procedure alongside the physical one.
Donation Provides Psycho-Emotional Support
Among other things, it is necessary to note the importance of the psycho-emotional component of this process. The desire of relatives to donate an organ to a loved one often prevails so much over the risk of loss of health that doctors must learn not to follow their lead (Tayur & Dai, 2018). Many potential donors note that their well-being is intertwined with the recipient, and there is a high probability of emotional pressure on such an important issue from family members and the recipient (Russel, 2019). Nonetheless, the emotional component of saving a loved one has a greater role than the problems associated with the loss of one’s organ, which is why individuals feel motivated to engage in organ donation. While the physical and psycho-emotional motivational aspects are essential, the legal implications are primordial and have to be discussed concerning facilitation or limiting donation processes.
Expansion and Development of Legal Regulation of the Situation
An important mechanism of legislative regulation aimed at developing only a gratuitous form of donation has historically been the restriction of possible lifetime donors only to the circle of close relatives of the recipient. The international basis for national legislative acts in this aspect was the guidelines of the World Health Organization, which formulated a general rule on the need for a genetic, legal, or emotional connection between the donor and the recipient (Garwood-Gowers, 2019). There is a group of states in which, despite the initially rigid interpretation of the list of possible donors, there is currently a trend towards an increase in the number of the latter. Thus, the British Human Organ Transplantation Act of 1989 limited the circle of possible living donors to the recipient’s parents, children, siblings, cousins, sisters, uncles, aunts, and nephews (Garwood-Gowers, 2019). Grandparents and grandchildren were excluded, but the Human Tissue Act of 2004 abolished this restriction.
In France, in 2005, relatives of I-III degrees and spouses of recipients were allowed to become lifetime donors, and since 2011, kidney donations between people who have had a close and permanent relationship for more than two years are allowed. In India, the Federal Human Organ Transplantation Act of 1994, except for genetically close relatives, included in the circle of possible donors only the spouses of recipients (Garwood-Gowers, 2019). However, changes made to this law in 2011 and 2014 allowed the removal of organs from grandparents and grandchildren (Garwood-Gowers, 2019). At the same time, there are countries whose legislation still strictly adheres to the principles of only related donation, for example, Poland. In addition, there are a few states in which, on the contrary, there has been a tightening of donation only by genetic and legal relationships after the Istanbul summit in 2008 and reports of commercial organ donations (Garwood-Gowers, 2019). It can be seen that the motivation for lifetime donation is growing among citizens, which entails the need for governments to expand the range of possible donors. Thus, the motivation to donate increases as legislation is more tolerant or vice versa and the driver for legislative change is people’s desire in the first place.
New Ways of Donation
With the predominance of related lifetime donation, the need for organs dictates the need to search for new forms of interaction between donors and recipients. An example of such a programs is paired donation, which is, in fact, the exchange of living donors, which is allowed in Israel, the Netherlands, Australia, and India (Garwood-Gowers, 2019). A broader version of paired donation is the formation of chains of donors, which are being developed in the United States, among which there may be not only living but posthumous donors.
It is important to note that this led to the emergence of international agreements and organizations. Examples of international agreements on donor exchange are the kidney donation program between the USA, Canada, and Australia, the exchange of donor organs between the Republic of Ireland and the United Kingdom, and cooperation in organ donation between Australia and New Zealand (Garwood-Gowers, 2019). For more than half a century, the Eurotransplant system has been actively operating in Europe, responsible for the distribution of donor organs among residents of 8 countries with a population of more than 135 million people (Garwood-Gowers, 2019, p. 78). However, the progress in the development of forms of non-commercial lifetime donation has already crossed the boundaries of only related donations. Forms of altruistic unrelated donation can be divided into directed and non-directed (Garwood-Gowers, 2019). An example of the first form is a non-remunerated unrelated donation, permitted by Canadian law. As a result, people are motivated to donate since they can give consent to organs being transplanted after their death, they can assist people despite borders, and the practice is internationally encouraged. However, it is essential to highlight the limitation of increased donor motivation and pinpoint why the challenge is insignificant due to the additional measures that can be implemented to avoid issues.
Alternative Point of View on International Donation Programs
Critics of the practice of broad donation motivation point out that public petition is not always fair, and to some extent, there is competition among recipients. However, the effectiveness of such programs proves the feasibility of their further development. In the United States, an undirected intravital donation is predominantly developing, while over the past 25 years, there has been an evolution from a complete denial of the possibility of unrelated donation to support for this area of work (Garwood-Gowers, 2019). This made it possible to significantly expand the donor resource in this country. The list of countries in which lifetime donation is possible not only for the recipient’s relatives is growing: both directed and non-directed lifetime organ donation is allowed in the UK, and altruistic non-targeted donation is allowed in the Netherlands, Belgium, and Israel (Garwood-Gowers, 2019). The results of the analysis showed that, from an ethical standpoint, the position of a living organ donor as a patient is very ambiguous. Maintaining a balance between the principles of “do no harm” and patient autonomy requires each state to develop special regulatory mechanisms. This system should not be aimed at obtaining the consent of the donor, but at fully informing him of all the consequences of such a serious decision. Thus, during an organ transplant operation from a living donor, it is the latter that should be the key figure in the entire transplantation process (Tayur & Dai, 2018). As a result, the challenge of over-motivation combined with a lack of knowledge on the subject can be minimized through a thorough explanation of complications, which is the responsibility of physicians working with living donors.
Conclusion
The motivation of life donors increases as the process is becoming increasingly safer from a physical perspective, correlates with emotional fulfillment, and is becoming more encouraged from a legislative viewpoint. The change is significant since the life of multiple people all over the world depends on such improvements as high motivation correlates with a greater possibility of receiving an organ, a surgery that is vital for one’s life and well-being. Motivation, while often having an emotional aspect since most donors are purposefully helping loved ones, is also facilitated by the development of the technology and the saver surgery process as well as the legal implications that minimize barriers. Individuals who are willing to possibly risk their lives to save another human being and are aware of the risks are engaged in a process that is more humanitarian than medical. While policy-making and legislative additions diminish certain challenges, the main motivators are certainly the desire to be helpful and the will to become someone’s savior, which is admirable and is to be recognized.
References
Garwood-Gowers, A. (2019). Medical use of human beings. Respect as a basis for critique of discourse, law and practice. Taylor & Francis.
Lamb, D. (2020). Organ transplants and ethics. Taylor & Francis.
Orlando, G., & Keshavjee, S. (Eds.). (2021). Organ repair and regeneration. Preserving organs in the regenerative medicine era. Elsevier Science.
Russel, E. (2019). Transplant fictions. A cultural study of organ exchange. Springer International Publishing.
Tayur, S., & Dai, T. (Eds.). (2018). Handbook of healthcare analytics. Theoretical minimum for conducting 21st century research on healthcare operations. Wiley.