Ethical Issues Pertaining to Organ and Tissue Transplants
Introduction
Even though the concept of organ and tissue transplantation has been around for quite some time, the first successful transplantation occurred in the twentieth century. The advancement in the medical field led to acceptance of blood, tissue and organ donations in situations where the donor and recipient were compatible. Rejection became the most challenging aspects in organ transplantation since it is difficult to find completely matching people. Considering successful kidney transplants, the cost of the procedure and the related drugs is affordable compared to the alternative renal dialysis. Transplantations also improve the recipient’s quality of life. The medical filed still carry research and experiments to try to improve the possibilities and medical technology regarding transplantation.
Given that many people can benefit greatly in terms of quality and length of life from tissue and organ transplants, the demand is higher than supply. Transplantation costs related to some tissues or organs are high as well. Therefore, many ethical questions are raised today with respect to the best way to procure the organs, how to equitably distribute the donations and whether the transplant costs should be subsidized. Some of the principles considered in discussing the legal and ethical issues pertaining to donations and transplants include free and informed consent, benevolence, autonomy, non-malfeasance, common good, fairness, integrity, equality and the dignity of human beings. The Guiding Principles of donations and transplants by the World Health Organization (WHO) calls for optimal care for donors and recipients (WHO, 2013). This article highlights the ethical issues surrounding tissue and organ transplantation. It also outlines personal, professional and institutional values underpinning the issue.
Ethical issues pertaining to the donor
The act of writing a will to donate one’s body parts after death to benefit others is often perceived as praiseworthy. It is a noble thing to will the donation of body parts given that it aids the sick and suffering. Considering the advancements in surgical techniques and the means to improve tolerance to transplants, medical transplants deserve support of the law, medical profession and of the general public as a whole (Linde, 2009). Tissue and organ transplants from a deceased person can greatly benefit the living and cannot do any harm to the donor who has passed away. Donating organs is not obligatory; however, some people find transplantation to be against their religious consciences. Some hesitate to sign over their bodies considering the sensibilities of the survivors. It is professional and logical that the donation of organs in any circumstances, should respect the last will of the donor or the formal consent of the family surviving (Fowler, 2008). In any scenario proper respect should always be shown to human cadaver. Even though, the human corpse is by no means at par with a living person, they once bore life. A probably dying potential donor should be provided proper care similar to a critically ill person. It is also advisable that the team providing care of the potential donor should be different from the team meant to perform the transplantation because of potential conflict of interest. Organs should only be removed after the donors death has been validated by a competent authority other than the recipient’s physician. For example, viable organs forma pregnant woman declared brain dead should not be extracted until the immediate family and the responsible medical team comes to terms. This dignifies the life of the fetus and respect to the women. Other concerns include common good and respect to the family’s wishes. This scenario raises the perspectives of ordinary and extraordinary means of preserving life. The medical use of brain-dead patients on life support for research, transplant and training medical students, usually a considerable time after the death may be encouraged to improve sustain the life of the living (Potts & Evans, 2005).
Transplants between living persons have provoked legal and ethical debate. According to OPTN, by 2012, there were a total of 16,417 kidney transplants in the US, 75% from deceased donors and 25 % from living donors (OPTN, 2013). The argument is whether it is legal and ethical to mutilate one person to benefit another. This concerns mainly parts that do not regenerate such as kidney, lungs and corneas. Blood and bone marrow regenerate and are highly accepted. Regarding the former some are not pared like the heart. The principle of free and informed consent should be the foundation of this approach (Fowler, 2008). Both the living donor and recipient should be informed about the likelihood of success/failure, risks and alternatives to the transplant. In a scenario where there is intense pressure to donate, for example, in a family setting where there is a good match, the potential donor should decide willingly. It is immoral for the courts or any other external force to put pressure on a living individual to donate an organ. People should be motivated by charity, which articulates love for others. Both ordinary and extraordinary means of preserving life should be employed in organ and tissue transplants. As much as the extraordinary means seem to be burdensome, that is, painful, risky, inconvenient, very expensive and psychologically burdensome they still improve the length and quality of life of the recipients. However, some invasive surgical procedures end up being a burden to the donor (Marcia, 2009). For example, if a person donates a kidney and after some time develops a kidney failure on the remaining kidney, he is burdened. Consents regarding transplants should also be given by competent people. The consenting donor should be mature enough to understand the repercussions of the procedure.
A guardian should legally consent for an incompetent person, such as a mentally challenged minor or adult to be a donor (Wilkinson, 2007). It is unethical to use children and the mentally challenged individuals as donors because it violates their bodily integrity, risks their survival and has no benefit to their lives. In a medical kidney demand, renal dialysis should be immediate alternative until a willing donor is found. Researchers argue that some circumstances offer psychological benefits to the recipients, for example, in a family with potential donors (Marcia, 2009). They justify such transplants if the benefits outweigh the risks involved in the transplantation, especially in bone marrow transplants. It is also unethical to have another child for the process of a bone marrow transplant. Tissue or organ donation by minors may be permitted in situations where the risks involved are less.
Most Christians oppose various aspects of living donors. They argue that no one should be forced to donate because no one is obliged to donate an organ or tissue. The decision by potential living donors solely lies with the concerned individual. Not even guardians have the right to decide on a tissue or organ donation by their children (Wilkinson, 2007). In this circumstance, Christians and Muslims indicate that the doctor has the special responsibility. The argument is that no one in the family should control whether a donation is truly voluntary. Furthermore, it should be considered that the medical problems that develop are not related to the relationship between the donor and the recipient. This includes guilt feeling, excessive gratitude and dependence.
The widely accepted ethical position regarding the recipients is that they do not have a claim on tissues or organs of any person. They should humbly accept the organs or tissues donated by others. A potential recipient should be adequately informed about the respected risks, benefits, costs and burdens of the transplant and other aftercare. Information can be conveyed by physicians or a competent person. Even the legally incompetent persons should be informed and helped to comprehend some of the aspects relating to their condition. This can be achieved through medical professional dialogues (Butts & Karen Rich, 2013). The wishes of incompetent persons should be respected by guardians in circumstances where they are understood and reasonable. Physicians, nurses or guardians should never place unfair influence on people that need transplants (Butts & Karen Rich, 2013). It is unethical for a potential recipient or family members to blackmail a potential living donor to donate his or her organs. It is also inappropriate for any concerned individual to blackmail or bribe a health care professional to benefit from being positioned on the recipients waiting lists. Recipients and healthcare professionals should also discern themselves from illegal and unethical issues associated with transplantations. They should avoid abuses such as immoral or illegal procurement of tissues and organs. In certain scenarios, the illegally procured organs are as a result of murder driven by the greed of money. Some religions may deprive incompetent individual access to quality healthcare hence the courts should play a role in advocating for viable transplants. For example, competent Jehovah Witness members discredits blood transfusion which may be life saving. This is subject to the fact that blood transfusion is against their doctrines. According to the Code of Ethics of Nurses, health care professionals are obliged to maintain confidentiality regarding a patient’s information (Fowler, 2008). It is also the responsibility of the healthcare fraternity to ensure that proper safety measures or procedures are followed to protect the transplant patients from issues such as receiving hepatitis and AIDS viruses as stipulated in World Health Organization Guiding Principle 3 (WHO, 2013).
The demand for human tissues or organs is usually beyond the supply or available resource. According to the Organ Procurement and Transplantation Network (OPTN), there are 118,060 potential recipients on the transplant waiting list as of May 2013 (OPTN, 2013). This calls for an efficient and fair distribution system for these limited resources. The decisions on who to receive an organ are critical as they may constitute who lives and who dies. A widely approved and used criterion for the distribution of human transplant organs is to give priority to patients that have great need and are expected to greatly benefit from the resources. For example, it is logically to carry out transplants in patients that are expected to live longer than those that are likely to live marginally longer, as well as, continue to suffer much after the transplants. In spite of the biotech and medical technologically advancements, much care should be taken to offer patients real possibilities of life besides extending their life biologically. WHO emphasizes that transplants should add quality to the life of the recipients by not compromising the donors’ lives (WHO, 2013). Healthcare professionals should affirm the criterion by through medical criteria such as tissue, absence of any life threatening disease and blood typing. This would determine the patients’ transplant tolerance. That is, who is likely to accept or reject a transplant? Other factors include the recipient’s motivation, will to live, family support and the ability to take and withstand post-operative directions, for example, taking immune-suppressants.
Transplants should also be administered on a “First Come First Serve” basis. Random selection method should only be used in circumstances where there is an equal chance. The underlying factor should be that need and benefit are almost the same among the potential recipients. Some scholars argue that distribution should be done on social merit, worth or demerit. For example, they consider it fair to give priority to a woman with young children over a minor or to an experienced practicing doctor over an intern. With respect to demerit, for example, the question is to give someone who was an alcoholic or smoked heavily to be denied a lung or heart transplant. Other criticized criteria include religion, race, pay, age and gender.
The supply deficit of various human tissues and organs has motivated the research and development in cloning, as well as, the synthetic or artificial development of substitutes for organs and tissues (Marcia, 2009). Some of the substitutes and artificial replacement technologies include hearing aids, false teeth, synthetic lenses, artificial joints or limbs, synthetic and mechanical heart valves, insulin, renal dialysis, pacemakers and genetically engineered growth hormones. These technologies are very costly to develop, and so is the cost of the related transplant. Complications can hike the cost of a simple transplant procedure. As much as the average life output of a transplant beneficiary may be low, public funds should be channeled to ensure that the financially challenged society members can also undergo transplants. Some economists argue that ailing people are less economical; hence the public funds should be allocated in other sectors of the economy for economic growth. In contrast, a successful transplant may contribute more I the economy in the event that the survivor comes up with innovative ideas pertaining global problems such as energy, climate change and food security.
Buying and selling of human organs violates human dignity. Some argue that allowing human organs and tissues to be freely exchanged for money will increase the supply hence addressing the high demand problem. Turning human parts into commodities of trade would encourage abuses and social problems such as kidnapping and human trafficking. In India, some poor people sell one of their kidneys to alleviate poverty. The World Health Organization (WHO) calls upon its member states to establish appropriate measures meant to prevent the trade in human organs.
Conclusion
Various ethical issues concerning organ or tissue transplants have been discussed in this article. These issues concern the recipient, the donor, limited resource allocation and the mode of procuring tissues and organs. Despite the fact that there has been some incidents of abuses in this field, and there are some gray areas, this article concludes on a positive note.
Organ donation and transplants carried out under proper conditions is welcomed and a modern way of expressing religious charity. It dignifies the donor who unfortunately becomes a life support for the beneficiary. Organ donation is also a sign for respect of the life of others and communion with the society. Giving life to another is an expression of love. It is moral to extend good to another as if it was done to thyself. In spite of this, there are some cases and scenarios for further discussion. For instance, what is the ethics behind a living person with healthy eyes to donating an eye to enable a blind person to see? The other aspects that should be considered are whether the related transplant cost should be linked to taxation and public funds.
There is also a need of education of the heath care professionals and the general public concerning all aspects of tissue and organ transplants. Many people are unaware of the needs, benefits and the shortage of transplant organs. Awareness would also improve the trust of the public in the system.
References
Butts, J. B., & Karen Rich, M. (2013). Nursing Ethics : Across the curriculum and Into Practice. Burlington, MA : Jones & Bartlett Learning.
Fowler, M. (2008). Guide to the Code of Ethics for Nurses: Interpretation and Application. Silver Spring, MD: American Nurses Association.
Linde, E. B. (2009). Consider the ethical issues raised by organ donation, such as how to define death. Then examine your own opinions. Nursing2009 , 28 (31), 28-31.
Marcia, S. (2009). Identifying Ethical Issues From the Perspective of the Registered Nurse . JONA’s Healthcare Law, Ethics, and Regulation , 91-99.
OPTN. (2013, May 3). Data. Retrieved May 8, 2013, from The Organ Procurement and Transplantation Network (OPTN): http://optn.transplant.hrsa.gov/
Potts, M., & Evans, D. (2005). Does it matter that organ donors are not dead? Ethical and policy implications. J Med Ethics , 31 (7), 406-409.
WHO. (2013). Donation and transplantation. Retrieved May 8, 2013, from World Health Organisation: http://www.who.int/transplantation/donation/en/
Wilkinson, T. (2007). Individual and family decisions about organ donation. J Appl Philos , 24 (1), 26-40
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