EthIcal Issues assocIated wIth organ transplantatIon Assist.Prof.Dr. Mehmet KARATAS Dept. of History of Medicine & Ethics

Definition of Death Irreversible loss of consciousness, loss of spontaneous breathing with the loss of heartbeat The death or loss of brain cells are necessary for the determination of death in medical terms Brain death occurs in every death

Possible Reasons for Brain Death Acute myocardial infarction, bradycardia, tachyarrhythmia, hypothermia, hyperthermia, anaphylaxis, cerebral attacks, anesthesia, trauma, electric shock, lightning strike, drowning in water, electrolyte disturbances, renal failure, toxic causes Elderness Chronic diseases etc.

Determination of Death Anaesthetist Neurologist or Brain Surgeon

Legal Basis International Documents Medical Ethics Charter Patients’ Rights Directive Organ and Tissue Transplantation, Storing and Law (1979) Organ and Tissue Transplantation Services Regulations (2000) Turkish Medical Association Code of Professional Ethics in Medicine

Law No. 2238 Must be above 18 Consent in the presence of physician and two witnesses Donors life should not be endangered Buying/selling is forbidden Advertisement is forbidden The donor should not be mentally deranged Donor’s spouse needs to be informed The names of the Receiver and Donor should be kept hidden

Law No. 2238, and Ethical Dilemmas Unless otherwise noted, corneas can be taken without permission In accidents or natural disasters organs can be taken without consent Unclaimed bodies can be used in educational institutions after 6 months of kepting

Directive The regulation, which entered into force in 2000, governs the principles and procedures with regard to the opening, running and surveillance of Tissue Typing Units and Organ and Tissue Transplantation Centres which perform the transplantation and the principles and procedures to be complied with by the public and private organizations to which they are affiliated to

Organ Transplant Service Execution The National Coordination Committee Scientific Advisory Boards (6 member per board) Board of Coordinators (5 member) National Organ and Tissue Transplantation Services Co-ordination Centre (Ministry of Health) Organ and Tissue Transplantation Data Processing Center Organ and Tissue Transplantation Regional Coordination Centers (Istanbul, Ankara, Izmir)

The National Coordination Committee Undersecretary of the Ministry, Medical Services General Manager, Heads of the Scientific Advisory Boards of Heart-Lung-Heart Valve, Liver, Kidney, Cornea, Bone Marrow Transplantation, Immunology, Dialysis, Intensive Care Coordinators Chairmen and Chairman of the Scientific Advisory Boards

The National Coordination Committee In order to bring the organ and tissue donation services to a modern, the Department of Organ and Tissue Transplantation Services and the Organ Transplantation Services Unit were established within the General Directorate of Curative Services of our Ministry. The objective of the system is to ensure that, with a fair allocation and in conformity with the scientific rules and medical ethics, organs and tissues from cadavers are delivered to the most suitable patients and transplantation centres in the shortest time possible and that they are transplanted the most suitable patients. The committee works on to improve national coordination system and follows the developments in the world

Scientific Advisory Boards Heart-Lung-Heart Valve Liver Kidney Cornea Bone marrow Immunology Intensive Care

Scientific Advisory Boards When applying to open up a organ and tissue transplant center the board evaluates applications. Two members of the Scientific Advisory Board members will attend on behalf of the General Directorate of Treatment Services by three people, including a member of organ and tissue transplantation centers prepare for inspection on site inspection report and the National Coordination present to the Board Monitor the work of organ and tissue transplantation centers Determines strategies in organ and tissue transplants in the country to determine the measures to be taken, suggest plans and programs for the development of the service

Board of Coordinators Coordinators working with Organ and Tissue Transplant and Centers for Organ and Tissue Resource Centers elect five members and form the Board of Ministry. The Committee shall elect a chairperson from among its members. Coordinators of the Board direct organ transplant services, and carry out studies in order to find a solution to the problems encountered and to provide communication between the coordinators.

References F. Başak ÇAKMAK/Bilal GÜNENÇ, İnönü Üniversitesi Tıp Fakültesi, translation Tolga GÜVEN, Marmara Üniversitesi Tıp Tarihi ve Etik AD ders notları Gürkan SERT, Hasta Hakları Robert M VEATCH, Medical Ethics Emine ATABEK, Mebrure DEĞER, Tıbbi Deontoloji Konuları Hasta Hakları Yönetmeliği, 1998 Klinik Araştırmalar Hakkında Yönetmelik, 2011 Çağlar Boyu Tıp, Roche Yayınları http://en.wikipedia.org/wiki/Main_Page