Introduction
In the novel “My Sister’s Keeper” written by Jodi Picoult, a fictional story is told of a young girl who was conceived in order that her blood is harvested from her umbilical cord to be used on her elder sister who was suffering from a cancer of the blood and bone marrow. This is known as organ farming. Whereas this is fictional, it has true representation of the diseases and misfortunes we suffer as humans in our bodily organs and our only hope for cure or at least treatment lies in organ transplantation.
Organ transplant is not a simple matter but one with very many facets. It has been practiced for a very long time now and scientific research is only proving to get better hence providing much better solutions to our problems. It is a very crucial part of medicine since its remarkable results are known to save lives in some cases. In this paper, the following scope will be covered briefly: the various organs that can be transplanted, the donors involved, moral issues raised as a result and also the various concerned legal aspects.
The Medical Aspect
Organ transplantation can be defined as the removal and replacement of a body organ from a donor to a recipient (Bioethics, 2004). Organ transplantation takes place when a body organ is fatally damaged or fails to work.
The most common causes of organ failure are diseases and accidents which are yet again heavily dependant on the type of organ affected. Most of the organs widely known to be transplanted include: kidneys, lungs, liver, heart, pancreas and intestines. The most popular of them all is the kidney (Postnote, 2004). Others are the skin, cornea and bone marrow (Bioethics, 2004).
Once an organ has been identified by a doctor as needing transplantation, the agonies of the process then begin. The patient is referred to a transplant center and is to their “dismay” put on a national waiting list, after a “series of interviews, physical and medical tests” (Winters, 2000, 11) to determine the suitability of the recipient to be. The waiting period which ranges from weeks to years, is mainly dependent on the availability of the organ to be transplanted (Winters, 2000).
The donors could either be living or recently dead (Bioethics, 2004). The latter type of donation is called cadaveric organ donation while the former is the living organ donation (Bioethics, 2004).
Donation from those who are dead is determined by different parameters when it comes to the medicine of transplantation: “the manner, time and place of death” influence the “suitability of donation” (Postnote, 2004, p. 1). It must have been indicated beforehand by the prospective donor in full knowledge of his/her family to avoid legal complications (Bioethics, 2004). Cadaveric donation is guided by the “dead donor rule” i.e. “the patients must be declared dead before the removal of any vital organ” (Truog & Miller, 2008, p. 1).
This issue has been a source of controversies especially about the precise definition of death (Truog & Miller, 2008). The cadaveric organs are then preserved awaiting their recipients. Living organ donation is only possible for organs that are two in number or can function efficiently when part of it has been removed (Bioethics, 2004). Once doctors make the call that an organ has been found, the waiting comes to an end and the next step is now to do the transplant.
The recovery phase is heavily influenced by the type of organ transplanted and the disease that the patient was ailing from (Winters, 2000). A transplant does not guarantee a 100% success process. A patient’s body may experience what is known as “rejection where the body fights off the newly implanted organ” (Bioethics, 2004, p. 8).
Among the solutions to this is provided by medication in which the patient has to be under “immunosuppressant drugs” to avoid this reaction (Bioethics, 2004). Others include extensive tissue matching between the donor and recipient to ensure a good match, “improvement of surgical techniques” (Postnote, 2004, p. 1), developing good “postoperative care” and improving “organ preservation methods” (Postnote, 2004, p. 1) has been key in reducing rejection among patients.
A brief History
Organ transplants date back to the year 1906 when Dr. Edward Zirm performed the first cornea transplant (History, n.d.). The following are notable timeline events: 1954- first kidney transplant, 1962- first cadaveric kidney transplant, 1963- first lung and liver transplant, 1967- first heart transplant (History, n.d.) In recent times, 1996- the first “split liver” transplant was done and in 2000 the “first culture of human embryonic stem cells” (Bioethics, 2004, p. 11) was done.
Other major milestones covered include: “development of anti-rejection drugs to increase success, incorporating animal organs in the transplantations, invention and use of artificial organs, splitting organs and stem cell research” (Bioethics, 2004, p. 9). With the increasing medical advancements, the only way organ transplantation is going is forward even with the changing times. However, there are some ethical concerns raised concerning this practice.
Ethics and Organ Transplantation
Statistics from various parts of the world have confirmed the overwhelming need for organs yet shortage of supply is evident. A case in point is in the United Kingdom in 2004 where 7,236 people were on the waiting list yet only 2,867 were successfully operated on (Postnote, 2004).
Currently there are 110,734 people on the waiting list according to statistics from the United Network for Organ Sharing (UNOS, 2011). This and many unmentioned numbers show that many people actually die while on the waiting list to acquire an organ. As Truog (2005) in his article mentions that since there is an imbalance between the demand and supply especially from the cadaver organs, thus many have resorted to living donors (Truog, 2005).
The dilemma further continues since once the donation has been made, what criteria is used to choose the recipient and is it acceptable by all? This is referred to as the distribution justice where various methods are implored in making such decisions, for instance:
- “Equal access; which disregards considering a person’s worth in determining whether they get an organ or not and also ignores race, age and distance” (Bioethics, 2004, p. 15)
Those who do not agree with this, use the argument that if a person’s lifestyle led to their demise, then they shouldn’t have a transplant. Others even include prisoners as not worthy of undergoing transplantation.
- “Maximum benefit” (Bioethics, 2004, p. 17); which focuses on the end result i.e. highest chances of success as the basis of making the decision: “Moral questions arising from this include: what defines success in transplantation; is it the patient’s length of life or the functionality of the organ?” (Bioethics, 2004, p. 17).
The distribution methods enforced differ by countries, but a general consensus established by UNOS, summarizes the criteria to: “medical need, probability of success and time on the waiting list” (Bioethics, 2004, p. 17).
Different types of donations also raise different moral questions. Living donors for example, and whom they decide to donate to (Truog, 2005). These can fall in the following categories; directed donation (for friends and family), non-directed donations (targets anyone on the waiting list) and finally the direct donation to a stranger (Truog, 2005).
For direct donations, a donor could feel obliged to do so negating their sense of free will, for non-directed donations, the donors are normally scrutinized to make sure their intentions are without foul and for the last group, their donations to strangers should be free of race, religion or gender biasness (Truog, 2005).
Another area of contention is donors who do so with the mentality of making a source of income from their actions which definitely brings a divide between the rich and poor, placing those with enough resources at an advantageous position (Bioethics, 2004). Other donor sources (Bioethics, 2004, p. 28) that provoke questions are:
- “Animal sources”- specifically pigs and baboons. Question is; will humans be susceptible to animal diseases as a result?
- “Artificial organs”- is it a cost-efficient alternative? What happens if the organ fails again?
- “Stem Cells”- isn’t destroying human embryos in the process to obtain stem cells, morally wanting?
- “Aborted Fetuses”- the irony of using an aborted fetus’s organs to save infants is overwhelming and it would lead to organ farming.
With all these questions in mind, policies have been devised to regulate donation and distribution of organs (Bioethics, 2004).
The Legal Aspect
Three major policies have worldwide acceptability and they are listed as follows:
- “Opting- In System/Family Consent” (Hartwell, 1999, p. 1) – which “requires explicit consent form the donor and/or his relatives incase he did not indicate his desire to donate during his lifetime” (Hartwell, 1999, p. 1).
- “Opting-out/Presumed Consent” (Hartwell, 1999, p. 1) – which allows removal of organs unless the donor had “explicitly opposed donation” (Hartwell, 1999, p. 1). Here the family need not be consulted.
- “Pure Presumed Consent” (Hartwell, 1999, p. 2) – its compulsory for the donor to use the court to express his/her wishes of not wanting to donate (Hartwell, 1999).
The necessity to have rules and regulations that clearly define organ donation cannot be overemphasized since without such, crude methods will characterize this noble process (Hartwell, 1999).
Such methods have even been witnessed as ongoing e.g. the selling of organs which evolved from having financial incentives with the intention of increasing donors (Bioethics, 2004). The World Health Organization, WHO, has also championed such efforts by providing a set of guiding principles some of which (guiding principles 1 and 3) have already been mentioned in the above three policies. Other “guiding principles” are:
- “Guiding principle 2”- When a physician is involved in declaring the donor’s death, should not be directly involved in all transplantation processes.
- “Guiding principle 4”- minors should not be involved in transplantation.
- “Guiding principle 5, 6, 7 & 8”- using monetary ways to obtain organs is strongly discouraged and any fore knowledge about such information by the physicians should stop them from proceeding with transplantation.
- “Guiding principle 9”- distribution of organs should be on the basis of “medical need” and not bias considerations. (WHO, 2011, p. 1).
Conclusion
Organ transplantation is viewed as a science that has been used to impact a lot of change to people’s lives. Though there are some unfortunate events of rejection happening, the positive effect it is having on saving lives and making others better is an understatement.
Those who have undergone successful transplants are the living proof scientists and researchers need as a motivation in order to continue their widespread influence. With the rules and principles being obeyed to the letter, a fair distribution and allocation of organs is expected hence providing those in need with an equal and promising chance.
References
Bioethics. (2004). Ethics of Organ Transplantation. Web.
Hartwell, L. (1999). Global Organ Donation Policies around the World. Web.
History. (n.d.). History of Organ and Tissue Donation. Web.
Postnote. (2004). Organ Transplants. Web.
Truog, D. R. & Miller, F. G. (2008). The Dead Donor Rule and Organ Transplantation. Web.
Truog, D. R. (2005). The Ethics of Organ Donation by Living Donors. Web.
UNOS. (2011). Working together. Saving lives. Web.
WHO. (2011). Ethics and Health. Web.
Winters, A. (2000). Organ Transplant: the debate over who, how and why. New York, NY: The Rosen Publishing Group.