Introduction
Transplantology has opened up unique opportunities for humanity, but at the same time, it has brought many problems. The problem of transplantology is actively discussed not only by the medical community, philosophers, and lawyers but also by representatives of the Church, civil society, and ordinary people. The ethical problem of transplantology is not a highly technical issue but an important philosophical and social problem.
Main body
Organ transplantation from a living donor is associated with harm to his health. In transplantology, compliance with the ethical principle of “not harm” in cases where a donor is a living person turns out to be almost impossible. The doctor is faced with a contradiction between the moral principles of “do no harm” and “do good.” On the one hand, organ transplantation (for example, kidney) saves a person’s (recipient’s) life. On the other hand, significant harm is caused to the health of a living donor of this organ; thus, the principle of “not harm” is violated. Therefore, in cases of live donation, it is always about the degree of benefit received and the degree of harm caused, and the rule always applies: the benefit received must exceed the harm caused.
Currently, the most common type of donation is the removal of organs and (or) tissues from a dead person. This type of donation is associated with several ethical, legal, and religious problems. Among the most important problems are the difficulty of ascertaining the death of a person and the problem of voluntary will to donate one’s organs after death for transplantation. Moreover, the permissibility of using the human body as a source of organs and tissues for transplantation is from the standpoint of religion. Solutions to these problems are reflected in several ethical and legal documents at the international, national, and confessional levels. There are three main types of organ harvesting from a corpse in the world in the field of organ and tissue donation. For example, routine removal, removal in accordance with the principle of presumption of consent, and removal following the principle of presumption of a person’s disagreement with the removal of organs after his death.
The principle of presumption of consent recognizes a person’s original consent to any action. If a person does not agree to commit the alleged actions, then he must express his disagreement in the prescribed form. The removal of organs is not allowed if the health care institution at the time of removal is informed that during the life of this person declared their disagreement on the removal of his organs. Thus, this principle allows for taking tissues and organs from a corpse if the deceased person or his relatives have not expressed their disagreement.
Obtaining the consent of a person or his relatives to use his organs for transplantation is associated with several ethical and psychological problems. Gaining permission from a person who is in a terminal state is almost impossible for both ethical and medical reasons. Thus, a person, as a rule, is physically in a state where he cannot make voluntary, responsible decisions based on complete and reliable information provided to him in an accessible form (Palchenkova et al., 2020). Communication with relatives of a dying or just deceased person is also an extremely difficult and responsible ethical and psychological task. The time for taking organs is different due to the specifics of the human tissues themselves and to modern technologies for their conservation and transportation.
The advantage of the principle of presumption of consent is that it contributes to a larger number of organs for transplantation. This is because organs are withdrawn from those who have not expressed any opinion on this matter. Nevertheless, there is no significant connection between the principle of organ removal and the number of organs collected. The pluses of the principle of presumption of consent include the fact that this principle forces a doctor to commit, in fact, a violent act since an action with a person or his property without his consent is qualified in ethics as violence. The disadvantages of this principle include the fact that it cannot protect an uninformed person. Moreover, presumed consent generally becomes a means to avoid obtaining an agreement under certain conditions.
Among the advantages of the principle of presumption of disagreement is that when using this model, the doctor is freed from psychoemotional overloads associated with the commission of ethically incorrect actions. Since it is known that a person who commits an action contrary to traditional moral norms is inevitably at risk of destroying the psychoemotional stability of his personality (Makosa et al., 2020). The disadvantage of the presumption of disagreement is that it is excessively difficult for relatives to agree to remove the organs of a deceased loved one.
Conclusion
In conclusion, the principle of requested consent is more effective; it is more consistent with the goals and interests of clinical transplantation and most consistent with traditional ethics. From the point of view of traditional ethics, a person’s will is most taken into account when using the principle of presumption of disagreement. With its kind — the ‘information model’ — the negative mental burden for relatives is minimized. According to the basic ethical principle, the voluntary lifetime consent of the donor is a condition for the legality and moral acceptability of transplantation.
References
Mąkosa, P., Olszyńska, A., Guzik-Makaruk, E., Plywaczewski, E., & Małyszko, J. (2020). Knowledge of law students on the problems of modern transplantology is good but it can always be better. In Transplantation proceedings (Vol. 52, No. 7, pp. 1985-1990). Elsevier. Web.
Palchenkova, V. M., Riabchynska, O., Gorokhovska, O., Stomatov, E., & Myrnyi, S. P. (2020). Legal and moral and ethical problems of transplantation in Ukraine. PalArch’s Journal of Archaeology of Egypt / Egyptology, 17(3), 1389-1396. Web.