Organ Transplantation

Abstract

            Organ transplantation is not only a medical but also an ethical issue. Organ recipients and donors face ethical challenges in terms of organ transplantation. The state must develop the policies of equitable distribution of the organs for transplantation.

            Introduction

            Over 98000 people in the U.S. are awaiting an organ transplant. Although transplant surgeries are now fairly routine and can give their recipients the gift of new life, the road to getting a transplant can be long and narrowing. Living with immunosuppressive drugs and strong emotional responses can also be more challenging than families can imagine. The problems associated with transplantation are ethical and economic, including the expense of the procedure and the cost of long-term monitoring and support of the patient. Many of the technical problems are gradually being overcome, and solutions are being constantly improved. In order to ensure that all patients have a chance to find the necessary organ, the state should promote and encourage organ donation in line with the development of equitable organ allocation among those who need transplantation.

            Ethical issues regarding the donor

            “A person may will to dispose of his (her) body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering” (Flaman, 1994). However, not all sick and suffering in the U.S. have a chance to survive, even when they have sufficient financial resources for that. The major ethical concern revolves around the issue of taking transplant organs from the deceased. The question remains unclear, whether a living but sick person has the right to request an organ from a dead person to save his (her) life. Simultaneously, we keep using dead bodies for various medical purposes, including students’ medical practice, but reject an ethics of saving the lives of numerous patients who would not survive without a new organ. This issue still remains unresolved. The state should not simply increase the supply of organs; it should promote the criteria of equitable organ distribution. People should be encouraged to donate their organs after they decease. The state should guarantee equal access to organ transplants for everyone who requires transplantation regardless social, financial, and medical state of the patient. Donating organs should no longer be considered an ethical issue. In order to provide the basis for equitable organ distribution, the state should primarily develop a set of benefits for those who would like to donate an organ. The increased supply of organs for transplantation will make their equitable allocation possible without breaking the basic civil rights of donors.

            Ethical issues regarding the recipient

            The major ethical conflict stems from the ethical principle that “nobody has a claim on organs or tissue of any person, living or dead. The sick should thus accept the tissue and organs freely offered by others as a gift” (Flaman, 1994). When we speak that the state should develop global policies and ethical standards regarding organ transplantation, we do not imply that the state should claim its rights onto human organs. In no case should the state violate personal and civil rights. Ethical policies in the field of organ transplantation should maintain the balance between ethics and law: informed consent and open agreements of both the recipient and the donor are the critical elements of such policies.

There are several aspects which the state can and should resolve in the ethical organ transplantation debate. First, the state should provide informational campaigns among population: people should be aware of the fact that they can donate their organs after they die. The potential recipients should have the right to make agreements with potential donors. These measures will substantially increase the chances of those who spend decades in waiting for a suitable organ. Second, the state is critically responsible for the quality of organs it offers to its citizens. “Proper safety measures should be followed to protect transplant recipients from receiving AIDS and hepatitis viruses” (Flaman, 1994).

Equitable distribution of organs is an extremely specific ethical problem, but there are several alternatives a state can consider in the desire to promote healthy living for its citizens.

Ethical issues regarding allocation of limited resources

The demand for human organs always exceeds their supply. The availability of organs for transplantation is another concern of the state. In order to resolve the discussed availability of organs, the state has to consider several different alternatives. First, the state is to develop the set of selection criteria. “A widely used and approved criterion of selection is to give priority to those who have great need and who are expected to benefit greatly. For example, it does not make sense to give a limited number of available organs to those who will not benefit or who are expected to live marginally longer but suffer much with the transplants” (Flaman, 1994). In this context, there is still no clear understanding of how one can benefit of an organ being transplanted. There is no clear understanding of how we can prioritize someone in his need for organ transplantation. When we say that someone will hardly benefit of organ transplantation, we seem to justify our inability to provide each citizen with a chance to live. Each patient must have an equal chance to have a new organ. Certainly, priority criteria are extremely important, but the state must equally satisfy the needs of “priority patients” and those “who can wait”.

We cannot neglect the high costs of organ transplantation. For many, the price of a new organ remains an unachievable goal and the direct path to death. When a state is called for resolving the ethical issues of equitable organ allocation, there are several elements to consider. First, the state should make organ transplantation available not only physically, but financially. The state must develop a system of financial procedures for those in need. Second, the issue of equitable distribution is invariable linked to the issue of justice and access to medical aid. To provide each sick and suffering patient with an organ will mean to provide one with full and just access to medical care according to the basic ethical principles recognized in the society. Third, “the average cost per life year gained from a transplant can be significantly lower than alternative treatments. In addition, the recipient of a successful transplant often contributes much more to the economy through work” (Flaman, 1994). Thus, the state is primarily interested in promoted equity organ allocation policies among its citizens. It is interested in encouraging people to donate the organs of their deceased relatives for the benefits of those who are still alive. This will also mean that all citizens of the state have equal and fair access to medical services.

Ethical issues regarding procurement of organs

            Is it correct to inform the society about one’s need in an organ transplant? As long as the state is not able to promote equitable organ allocation procedures, media publicity is ethically justified. Media publicity does not simply increase the public awareness of the need for transplants; it also increases the state’s awareness of the problem. The state should deal with equitable allocation of organs for transplantation; ultimately, equity approaches in organ transplantation will eliminate the necessity to make the organ transplantation issues public.         “Voluntary or expressed consent involves a person making known their free offer to donate one or more of their organs and/or bodily tissue” (Flaman, 1994). An open informed consent is a necessary element when an organ is being donated. Equity policies in the area of organ donation should be based on the principles of the open informed consent, and public awareness about the issues and benefits of organ donation. The problem is not in the fact that people do not want to donate their organs. The problem is that the society is extremely undereducated when it comes to ethics and medicine of organ transplantation. “People should be encouraged to consider organ and tissue donation as a ‘legacy of love’” (Flaman, 1994). The state cannot claim its rights on human organs; these are the owned by a person, and the state should provide a person with opportunities to take decisions about these organs. A person should be able to donate, to sell, or to give an organ for free at any time and in any life circumstances. This is another step towards equitable distribution of organs among those who need them. People should be educated, and should not hold fears about organ donation and transplantation, but this education is hardly possible without active participation of the state.

            Conclusion

            The state should develop equitable distribution policies in the field of organ donation and transplantation. The state must provide all sick people with a chance to buy or receive an organ for free. The state should develop a set of selection procedures, which will not be solely based on “priority” criteria. Ultimately, the society should be materially and non-materially encouraged to donate organs; the society should be aware of issues and benefits of organ donation, and the state should do everything possible to increase the supply of organ transplants, and to equitably distribute them among those who need them to survive.

References

Flaman, P. (1994). Organ and tissue transplants: some ethical issues. University of Alberta.

Retrieved March 15, 2008 from http://www.ualberta.ca/~pflaman/organtr.htm