Ethics of organ transplantation

In bioethics, ethics of organ transplantation refers to the ethical concerns on organ transplantation procedures . Both the source and method of obtaining the organ to transplant are major ethical issues to consider, as well as the notion of distributive justice.

Sources

Organ harvesting from live people is one of the most frequently discussed debate topic in organ transplantation. The World Health Organization argues that transplantation promote health, but the notion of “transplantation tourism” has the potential to violate human rights or exploit the poor, to have unintended health consequences, and to provide unequal access to services, all of which ultimately may cause harm. Thus WHO called to ban compensated organ transplanting and asked member states to protect the most vulnerable from transplant tourism and organ trade.[1] However, as disincentives becomes a must, adding incentives back, such as improving life condition for organ donors after donation, becomes difficult.[2]

Regardless of the “gift of life”, in the context of developing countries, this might be coercive. The practice of coercion could be considered exploitative of the poor population, violating basic human rights according to Articles 3 and 4 of the Universal Declaration of Human Rights. For example, in the history of major transplant countries, organs from executed prisoners are used to develop their techniques. This practice was condemned by bioethicists [3] and was gradually abandoned and replaced by donation systems[4]

There is also a powerful opposing view, that trade in organs, if properly and effectively regulated to ensure that the seller is fully informed of all the consequences of donation, is a mutually beneficial transaction between two consenting adults, and that prohibiting it would itself be a violation of Articles 3 and 29 of the Universal Declaration of Human Rights.

Even within developed countries there is concern that enthusiasm for increasing the supply of organs may trample on respect for the right to life. The question is made even more complicated by the fact that the "irreversibly" criterion for legal death cannot be adequately defined and can easily change with changing technology.[5] As controversies on the boundary of life and death grow, the debate on when to end end-of-life care and start organ harvesting ensures.

Controversies also raise on how to assume consent of organ donation for dead people. In practice most countries, have legislation allowing for implied consent, asking people to opt out of organ donation instead of opt in, but allow family refusals.[6]

There are fewer debates on animal sources, as historically laboratory animals have been used to develop organ transplantation technologies for prolonging human life, such as using animal organs in xenotransplantation on human. Nevertheless, animal rights activists have objections on what they see as animal abuse such as organ harvesting in bear farms, and religious groups object what they see as consumption of dirty animals.

Organs from artificial origin like stem cells, is a prospect that researchers hope to use one day. However many of such researches are crictised based on the use of human embryo.

Distribution

The shortage of organ donors and the growing waiting list of patients leads to many social issues, such as distribution. In 1994, E. H. Kluge objects the equal access principle based on his argument that people whose need are uncontrollable should be preferred over people who choose a poor lifestyle[7] The donor matching which is supposed to maximize the number of life-years gained is also subject to debate, as people value their organ and the rest of their lives differently.[8] In practice, organ and tissue banks often choose patients in a way that maximize their revenue, those “altruistic” clinics may not have the necessary income to fund research and development to improve quality and availability of care[9]

References

  1. ↑ [Bulletin of the World Health Organization, by World Health Organization, Volume 85, Number 1, January 2007, 1-84
  2. ↑ Organ trafficking and transplantation pose new challenges, Bulletin of the World Health Organization, Volume 82, Number 9, September 2004, 639-718
  3. ↑ Hillman H. Harvesting organs from recently executed prisoners: Practice must be stopped. British Medical Journal, 2001; 323(7323):1254.
  4. ↑ New era for organ donation and transplant in China, by World Health Organization, Volume 90, Number 11, November 2012, 793-868
  5. ↑ Whetstine L, Streat S, Darwin M, Crippen D (2005). "Pro/con ethics debate: When is dead really dead?". Critical Care (London, England). 9 (6): 538–42. doi:10.1186/cc3894. PMC 1414041Freely accessible. PMID 16356234.
  6. ↑ Keeping kidneys, Bulletin of the World Health Organization, Volume 90, Number 10, October 2012, 713-792
  7. ↑ Drawing the ethical line between organ transplantation and lifestyle abuse. E H Kluge, CMAJ. 1994 March 1; 150(5): 745–746.
  8. ↑ Take My Kidney, Please
  9. ↑ Bulletin of the World Health Organization 2010;88:870-872. doi: 10.2471/BLT.09.074542

Further reading

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