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Ethics refer to them as a set of “well-founded standards of right and wrong that prescribe what humans ought to do in terms of rights, obligations, benefits to society and fairness” (Spinoza, 2006, p. 12). Law on the other hand refers to a system of rules usually enforced by a set of institutions and used to regulate the behavior of individuals in a community or a country that recognizes such rules (Spinoza, 2006, p. 13). Both ethics and law are important in guiding the behavior of medical practitioners to achieve better outcomes. This paper analyzes the ethical issues associated with organ transplantation and how such issues can be addressed within the framework of nursing ethics and law.
Organ transplantation is the act of “moving a body organ from one body to another or from a donor site in the patient’s own body, to replace the recipient’s damaged or absent organ” (Winters, 2000, p. 17). The organs that can be transplanted include the kidney, heart, eyes, and liver. Organ transplantation is one of the breakthroughs in the field of medicine. It has particularly helped in saving several lives which could have otherwise been lost due to organ failures. Despite its success, organ transplantation has been associated with serious ethical concerns which undermine its applicability. The main ethical concerns associated with it are as follows.
Procurement and Distribution of Organs
While organ transplantation has been widely accepted by doctors, patients, and even the law, the question of how to procure the organs legitimately and efficiently remains unaddressed. Besides, distributing the limited organs among the many patients is an ethical dilemma yet to be addressed. The methods of obtaining the organs include donations by good Samaritans, paired exchange, deceased donors, and living donors (Winters, 2000, p. 45). Obtaining organs from deceased donors remains controversial because there has never been a consensus on the definition of death (Trung & Miller, 2008, p. 323). Deceased donors are normally brain-dead (higher functions stops) even though their body organs could be kept alive through life support machines. However, some believe that brain-dead individuals are not completely dead. Thus it is not right to take their organs to benefit another patient. On the other hand, organs obtained from the body after all brain functions have stopped might not be helpful. Consequently, it will be very difficult to obtain organs from deceased donors if death is defined in terms of a situation where all brain functions have stopped. Personal beliefs in terms of convictions considered to be true and a reflection of essential values about life and death have always been used in response to this ethical dilemma. Thus the definition of death in a particular community determines the procurement of organs. In some cases, the law is used to guide the process of procuring organs (Trung, The Ethics of Organ Donation by Living Donors, 2005, p. 125). However, what is lawful might not necessarily be ethical and this further complicates the process.
The distribution of organs is also an ethical dilemma as doctors find it difficult to determine who needs the organs most. Ideally, the organs should be distributed on a first-come-first-served basis. However, fair distribution of the organs has always been difficult due to personal interests, prejudice, and ethnocentrism associated with medical practitioners (Brezina, 2009, p. 57). To ensure distributive justice, the ethical principle of beneficence and justice should be upheld. Thus there should be fairness, equality as well as relativism regarding organ distribution.
According to the ethical principle of autonomy, the patient should be allowed to decide whether to undergo organ transplantation or not. In cases whereby the patient can not communicate, the decisions on organ transplantation have always been taken by the patient’s relatives. To avoid the ethical dilemma on consent, some practitioners think that organ transplantation should be automatic unless the patient says no (Brezina, 2009, p. 65). Interest groups, however, oppose automatic transplants on the ground that it violates the patient’s constitutional right to make personal choices.
Payment for Organs and Transplantation Surgeries
Due to the short supply of organs, money has been used to regulate their demand and supply. Some individuals sell their organs to patients while hospitals curry out organ transplants only on patients who are willing and able to pay for the service. The legality of selling organs remains controversial as some believe that it helps in increasing the supply of organs (Philips, 2004, p. 78). The sale of organs has also been opposed since it promotes organ trafficking and transplant tourism. Besides, organ trafficking puts the recipients at risk of contracting diseases since the sellers usually avoid the organ screening process. While the law rejects the sale of organs, it might be unethical to let patients die for fear of breaking the law by buying organs. According to the ethical principle of non-maleficence, the risks associated with the sale of organs can be reduced by regulating the process to benefit both the donor and the recipient of the organ (Philips, 2004, p. 79).
There has been debate on whether the limited organs should be given to individuals who contribute to their organ failures through irresponsible behavior such as alcoholism. Such individuals are normally stereotyped and discriminated against regarding organ transplantation (Kavanagh, 1991, p. 189). The ethical principle of justice, however, calls for equal treatment for all patients irrespective of their socio-economic backgrounds.
Effectiveness of Organ Transplants
Organ transplantation is associated with the problem of organ rejection. Consequently, patients must take anti-rejection drugs for the rest of their lives to suppress their immune systems. However, this strategy makes the patients vulnerable to infections as their immune systems become suppressed (Ringos, 2011, p. 33). Responding to this ethical dilemma calls for full disclosure of the consequences of organ transplants. The doctors must tell the patients all the possible negative consequences and benefits of organ transplants. The patient should then be able to make an informed decision regarding the transplant.
The above discussion indicates that ethics and law play an important role in enhancing better outcomes in the field of medicine. They not only guide the behavior of medical practitioners but also help in making decisions that determine the future of patients. Even though organ transplantation is an accepted treatment method, its applicability is undermined by the ethical concerns surrounding it. Some of the ethical concerns associated with it include procurement and distribution of organs, consent, and paying for the organs (Brezina, 2009, p. 34). To address these ethical issues, it is important to observe the ethics and laws which govern the practice of medicine.
Brezina, C. (2009). Organ Donation: Risks, Rewards and Research. New York: Diane Publishing.
Kavanagh, K. (1991). Values and Beliefs. In C. Joan, Conceptual foundations of Professional Nursing Practice (pp. 188-192). St. Louis: Moshy Year Book.
Philips, J. (2004). Organ Transplants: How to Boost Supply and Ensure Equality. New York: Rosen Publishing Group.
Ringos, P. (2011). Organ Donation After Circulatory Death. American Journal of Nursing, 111(5), 32-38.
Spinoza, B. (2006). The Ethics. Middlesex: Echo Library.
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Trung, R. (2005). The Ethics of Organ Donation by Living Donors. New England Journal of Medicine, 9(2), 120-130.
Trung, R., & Miller, F. (2008). The Dead Donor Rule and Organ Transplant. New England Journal of Medicine, 10(1), 320-350.
Winters, A. (2000). Organ Transplants: the Debate Over Who, How and Why. New York: Rosen Publishing.