Organ Transplants Ethical Issues

What are Organ Transplants? Cadaveric organ donation: Involves removing organs from a recently deceased donor. Living organ donation: Involves the donation of one of a paired organ (ex: kidneys) or a portion of an organ (such as a lobe of the liver or lung). The donor's organ system is still able to function after the donation. Living donors are often related to the patient, but that is not always the case.

History In 1954, the first successful kidney transplant was performed in the United States. It was a kidney from a living identical twin donor.

History cont. More than a half of a century after the very first transplant, more than 80,000 people whose death without a donor is certain are on waitlists in the United States waiting for a new lung, kidney, heart, or liver. The United Network for Organ Sharing reports that about half of these people will die without receiving the necessary organs. Human organs are a scarce medical resource and have many ethical issues concerning organ transplantation.

Consent A donor card is the main signal for permission to collect an organ from a potential donor. Also there is an attempt to gain approval from a next of kin or other family members. If a family member isn’t present for that decision then recovery agencies would act solely on the donor card.

Donor Card Concerns There is fear and distrust that if you are a organ donor then less effort would be placed into saving your life if your death meant organs for others. Coercion takes place when signing up for a license, because everyone’s license is marked with the decision to be a organ donor or not.

Allocation Concerns Organ recipients are chosen from a long waiting list after they have been medically determined to be a eligible candidate. The criteria for these lists are weighed upon factors such as age range, causes of failure, and stage of organ failure.

An attempt to balance justice... The United Network for Organ Sharing policy tries to make the decision of organ donating fair by placing criteria on the donating circumstances. These circumstances include; the need for the organ and those with the possibility of the maximum outcome.

UNOS Criteria Maximize the availability of transplantable organs. Maximize patient and graft survival (allograft-human to human transplant). Minimize the deaths while waiting for a transplant.

UNOS Criteria cont. Maximize opportunity for patients with biological or medical disadvantages to receive a transplant. Minimize the effects related to geography. Allow convenient access to transplantation.

UNOS Criteria cont. Minimize overall transplantation costs. Provide for flexibility in policy making. Provide for accountability and public trust.

The UNOS Ethical Position The only ethically sound motivation for donation is humanity. They interpret humanity to be solidarity with the national community and the absence of personal benefit.

Racial Bias Racial bias could effect the way organs are distributed and there has been legislative attempts to reduce discrimination involved in the donation of organs.

Uniform Anatomical Gift Act The following act states that, “Donation of an organ may not be made in a manner in which discriminates against a person or class of persons on the basis of race, national origin, religion, gender, or similar characteristic.”

What are the racial differences? Biological: Hypertensive renal disease in the black community. Different histocompatibility complex antigens

Racial Differences cont. Social: A lower donation rate for African-American than Caucasian. General distrust of the health care system and medical workforce, that means that there is less biologically compatible organs for that specific community and race. Personal: Surveys show: 90% of Caucasians would accept an organ if their lives would be saved by it, compared to only 70% of African-Americans said they would do the same.

Purchasing Human Organs The 1984 National Organ Transplantation Act prohibits the purchase or sale of human organs or tissue. Organ Commerce remains a controversial topic. Notion of property is a major debated area

Notion of Property People think that if one has complete ownership of their organs than they should be able to use them for whatever purpose they choose, even if it means selling them. The other side says that the body is a quasi-property, which means that only the bodily fluids can be sold or purchased not the solid organs.

Critics of Organ Commerce Arguments include: Exploitation, coercion, and violations of the sacredness of a human being. Concerns include: The socially disadvantaged donating their organs for money. Organ theft: Children have been kidnapped and murdered and their organs have been sold on the international market (black market).

Ethical Framework for Organ Transplantation Ethical issues and controversy arise because there is such a need for organs. Many debates stem from fair distribution of the limited number of organs and trying to find ways to increase the number of organs. Prolonging life through transplantation is very sought-after, and many people in the U.S. feel that the allocation system favors those who are financially able to receive these organs.

Past behavior of recipients There is a ongoing debate about a person’s past behavior leading to the need of a transplant and whether or not these people should be eligible for a transplant. Some of these behaviors include: Alcoholism Smoking Drug Abuse Obesity Because of the limited supply of organs, the recipient needs to be considered a “good investment.” If the behavior is not going to change even after the transplant then how fair is that to the people who need the transplant from natural causes of a disease? The controversy is whether or not the people with risky behavior should be eligible for transplantation.

Facts: On average 17 patients die every day while awaiting an organ. On average 110 people are added to the nations organ transplant waiting list each day. In 2003 more than 19,000 transplants were performed. It is illegal to buy or sell organs in the United States.

Moral and Ethical Questions Should those who have a better chance for survival be given priority over other patients needing transplants? Should parents of young children be given priority? Should those whose lifestyle choices damaged their existing organs be given a chance at an organ transplant? Should everyone be required to indicate their wishes regarding organ transplantation on either tax forms or drivers license?

Questions cont. Should consent to donate organs be presumed, so that organs are donated unless a person specifically requests not to donate upon death? Should organs be created through the use of stem cells? Should hospital policies permit organs to be taken from non-heart-beating donors (NHBD) to increase the number of organs available?

Resources http://www.bioethics.umn.edu/resources/topics/organ_transplants.shtml http://www.lhsc.on.ca/transplant/ethics.htm http://www.miracosta.edu/home/lmoon/OTpage.html http://www.molbio.princeton.edu/courses/mb427/2001/projects/01/ethics.htm