CCP DEBATE 2016TOPIC:

“NON ALTRUISTIC DONATION IS A MEDICALLY ACCEPTABLE PRACTICE”

PROPOSED BYVIDYAJYOTHI PROFESSOR REZVI SHERIFF

MD FRCP FRCPE FRACP FCCP FNASSL FSLCGP FIMACGP

SENIOR PROFESSOR OF MEDICINE, KOTELAWALA DEFENCE UNIVERSITY

EMERITUS PROFESSOR OF MEDICINE, UNIVERSITY OF COLOMBO

CONSULTANT PHYSICIAN AND NEPHROLOGIST 

OPPOSED BY DR. DUNCAN RONALD FORSYTH MB ChB FRCP MA

CONSULTANT GERIATRICIAN ADDENBROOKE HOSPITAL CAMBRIDGE UK

 

DISCLAIMER I don’t claim to be a professional debater.

This is my first time to have taken on a challenge of this magnitude. I have undertaken this task as an academic exercise.

CCP told me that I had to propose and a British person named Forsyth will be opposing. I presumed this to be Mr. Bruce Forsyth the comedian, Television Journalist !!!. It was only 03 weeks back I realized that it was our CCP friend and geriatrician Dr. Duncan Forsyth and so some of my slides was meant for Bruce !

DEFINITION

WHAT WIKIPEDIA SAYS…•Altruism or selflessness is the principle or practice of concern for the welfare of others. Altruism or selflessness is the opposite of selfishness. •Altruism in biological organisms can be defined as an individual performing an action which is at a cost to themselves (e.g., pleasure and quality of life, time, probability of survival or reproduction), but benefits, either directly or indirectly, another third-party individual, without the expectation of reciprocity or compensation for that action.

•Much debate exists as to whether "true" altruism is possible in human psychology

Steinberg suggests a definition for altruism in the clinical setting, that is "intentional and voluntary actions that aim to enhance the welfare of another person in the absence of any quid pro quo external rewards".

DEFINITION… WHAT EXACTLY ARE WE DEBATING ?

Cells - Stem Cells, , Sperms ,Eggs , Nervous Tissues Tissues - Blood, Serum , Plasma, RBC, WBC, Platelets, Cornea, Bone, Skin, hair Spaces Organs - Bilateral / Unilateral

Non Altruism = Sale of Body Parts. Altruism = Donation of Body Parts.Do we have rights over our body ?What we

Donate

“Non Altruistic Donation is a medically acceptable practice” “ Should people be allowed to sell their own

organs? ”

CCP DEBAT

E 2016 For eg: buying and selling kidneys should be allowed

1998: First successful hand transplant performed in France2011: First successful full face transplant performed in the US

PENIS TRANSPLANTATION•  From Wikipedia, the free encyclopedia• Penis transplantation is a surgical transplant procedure in which a penis is

transplanted to a patient. The penis may be an allograft from a human donor, or it may be grown artificially, though the latter has not yet been transplanted onto a human.• 2006 allotransplant procedure• The first such procedure was performed in September 2006 at a military hospital in

Guangzhou, China. The patient, a 44-year-old male, had sustained the loss of most of his penis in an accident. The transplanted penis came from a brain-dead 22-year-old male. Although a surgical success, the patient and his wife suffered psychological trauma as a result of the procedure, and had the surgery reversed 15 days later.  Following this, Jean-Michel Durbernard, who performed the world's first face transplant, wrote that the case "raises many questions and has some critics". He alluded to a double standard, writing:

THE DIFFERENT TYPES OF ORGAN DONORS:

Types of Living Donor Transplants•Kidney (entire organ)• Liver (segment)• Lung (lobe)• Intestine (portion)•Pancreas (portion)

Living-Relative-Stranger

Cadaver

Cadaver after brain death

• Kidney• Heart• Liver • Lungs• Pancreas• Intestine• Heart

valves• Connectiv

e tissue

Cadaver after natural death

• Cornea• Bone• Skin • Blood

Vessels

•Sri Lanka has donated 1961 to date •To Sri Lankan 34600.• Internationally to recipients in 17 town in 57 countries 53830.•Donation for research 30,000.•Total 118,430 over 55 years

Sri Lanka has a proud track record of altruistic donation

culture which no other country has matched

THEREFORE THIS DEBATE IS ON ALLOWING TO SELL ONES OWN ORGANS”

1.Our Organs are our property and we can and have the legal right to sell our own property

2.It will encourage donation as there is a Global Shortage of Donors and it will save lives and reduce the misery of HD

3.Single Cash infusion for relief of poverty if it is substantial

Organ Sales currently illegal in Sri Lanka… I say YES because

Sale of whole person… NO to ‘Slavery’… It is illegal

Trade In Human Organs

BUYING AND SELLING OF ORGANS Paying people to donate their kidneys is one of the most contentious ethical issues being debated at the moment.

The most common arguments against this practice include:• Donor safety• Unfair appeal of financial incentives to the economically disadvantaged• Turning the body into a money-making tool• Wealthy people would be able to access organs more readily.

THOSE WHO SAY “NO”… THEIR ARGUMENTS

Feel corruption of vulnerable persons.

Possible exploitation of poor is likely and richer folk have

greater access… equity issues.

Creation of a organ sales marketCreation of agents and middle menTrade and price war for different organs

WHAT THEN IS THE REMEDY TO COUNTER THESE ISSUES

Then – legalize it. - Have standard prices. - Have people to police it.- Single government purchaser of kidneys.- Single government supplier of kidneys donors - Eliminates the Middle Man - Eliminates waiting lists- Will hopefully eliminate corruption - Not altruistic / Non Directed Donation

Only issue is the dignity of society Vs number of lives saved

WHAT ABOUT BUDDHIST VIEWS Buddhism strongly supports donation of body parts eg: Cornea donations

Buddhism supports and advocate altruismLord Buddha told his disciple to forget THE ACT OF DONATION soon after, to get the maximum benefits of the donation

Living donation is more meritorious than cadaveric donations

“Much debate exists as to whether "true" altruism is possible in human psychology”

AS A MOSLEM, FROM MY RELIGIOUS PERSPECTIVE

Islam – Support altruistic donation to save lives - Prohibits buying & selling of organs - No Issues of giving a “gift” or “hadya” to donor or family (not an agreed price which makes it a sale)

• All these negotiations happen outside of theConsultation Room. Doctor is not involved.

• Do we as doctors have the right to police our patients activities? Is intrusion into our patients private affairs medically acceptable?

With the death of a person the soul leaves the human form and doesn’t have anything to do with the body. The body is left to become dust. Therefore donation of organ from a dead only would give a life to another person and he would have a meaningful life. As the holi scripture says, all human beings are dependent on each other therefore they should help each other even in death.

A CHRISTIAN VIEW

OTHER ISSUES … SURVIVAL… HD VS KT

• Man 40-45 Survival approx. 06 years on HD Survival… >20years on KT

• Woman 55-59 Survival approx.05 years on HD Survival… 16years on KT

Survival benefit… Live Donor Better than Cadaveric donor

2016 Update: John Vella- Cadaveric series

DO WE ALLOW OUR FARMERS (NEARLY 60,OOO) WITH CKDU TO DIE WITHOUT A

KIDNEY JUST TO SAFE GUARD OUR SOCIETAL DIGNITY TILL WE FIND A SOLUTION ?

FEATURES OF THE IRANIAN KT DONOR PROCUREMENT PROGRAM

OTHER REASON FOR ADOPTING AND CONTINUING COMPENSATED AND REGULATED KIDNEY TRANSPLANTATION IN IRAN• Use of Altruism has failed to alleviate organ shortage• Renal transplantation from living-unrelated donors is

steadily increasing worldwide• Proposals of some ethicists regarding shortage of

transplantable Kidneys are disappointing and unacceptable

• Results of the Iranian model of paid Kidney Transplantation are encouraging

• Compensated and Regulated Kidney Transplantation has prevented illegal and Commercial Transplantations in Iran

• Iranian model is very different from Commercial Transplantations Carried out Elsewhere

A LONG WAIT FOR A KIDNEY USA

GLOBAL DONOR SHORTAGE 2011 US Appeal court by group of cancer patient made it

legal to pay about USD 3000 legally for bone marrow donor challenging Federal law banning buying and selling bodily organs – but it must be collected by peripheral apheresis ( not anesthesia and long needles )

John Hopkns Berman institute of Bioethics “If we compensate donors who give by apheresis and more people end up receiving stem cell transplant May be we should think about this for other kinds of donation”

This will be a subject of much debate in Ethical & legal circles especially when it comes to selling eggs & sperms. I can foresee the Chinese grabbing this opportunity selling sperms to the US to reduce their population & increasing their foreign reserves !!!

ADVANTAGES AND BENEFITS OF LIVE VS CADAVERIC DONATION 5000 people with CKD5 die every year in national waiting list in USA Lists in the US alone from 100,000 wait listed. • Eliminates need to be placed on National list • Survival rates (Short & long term) better Living donor –18yrs Vs

Cadaveric donor -13yrs• Recipients know donor / medical history/ lifestyle before KT. If

Family, genetically similar – less rejection • Living donor Kidney always start functions immediate Vs Sleepy

Kidney (Cadaveric) • Shortens waiting time for others • Transplant better than Dialysis - Doubles life expectancy. Life

saving treatment. • May avoid dialysis altogether… Preemptive transplantation • Surgery can be planned one and not as an emergency as in

cadaveric • Psychological benefit for both Donor & Recipient.

IN CONCLUSION… I SUPPORT THE PROPOSAL THAT “PEOPLE SHOULD BE ALLOWED TO SELL THEIR

ORGANS UNDER REGULATED CONDITIONS DISCUSSED AS IT IS A LIFE SAVING CONCEPT

If legal compensated and regulated living – unrelated donor renal transplantation program is in place, it may be more ethical to perform a renal transplantation from an unpaid volunteer living-related donor or spouse who is under some degree of family pressure or subject to subtle emotional coercion.

I hope I have raised many questions in your mind so that you can reflect and form an opinion on the

ethical, moral, legal issues raised in relation to Live Donor Kidney Transplantation in Sri Lanka. There is

no easy and simple answer as patients individual circumstances can be quite varied not withstanding

socio cultural and religious values.

AcknowledgementsDr. Habeeba Sheriff - SJGH

Denu Dabare – Secretarial AssistanceWorld Wide Web articles

THANK YOU