ETHICAL ISSUES IN ART'S AND

ORGAN TRANSPLANTATION

By :Group 8

2011510087 HITENDRA SINGH

2011510089 HASHITA HADA

2011510090 KASHISH JAFRI

2011510091 KULDEEP MEENA

2011510092 MAULIKA POONIA

2011510093 MONIKA KULHARI

2011510094 LAKSHMAN SINGH CHOUDHARY

2011510095 AJAY JAKHAR

2011510097 PROMOTH SIVA PREM KUMAR

2011510098 ASWATHY PUSHPAKARAN GEETHA

2011510099 DINUDAS

2011510100 MONICA JOSEPH

REPRODUCTIVE TECHNOLOGIES

NEW HOPE TO INFERTILE COUPLE

‘Infertility’ is clinically accepted as the inability to conceive after 12 months of actively trying to conceive.

ASSITED REPRODUCTIVE TECHNOLOGIES

A medical intervention developed to improve an ‘infertile’ couple’s chance of pregnancy.

One of the best achievement in the field of reproduction.

SOME ART ‘S

1.IVF

2.SURROGACY

3.CLONING

IN VITRO FERTILIZATION

IN VITRO (OUTSIDE)

FERTILIZATION( OVUM +SPERM)

WHAT IS IVF?IVF broadly deals with removal of eggs from the woman fertilizing it in the laboratory and transferring the fertilized eggs into the uterus after a few days later.

Following cause may be considered for IVF

• Failed ovulation induction•Tubal diseases•Endometriosis •Idiopathic infertility

4 basic steps1. Superovulation2. Egg collection3. In vitro fertilisation4. Embryo transfer

ALMOST 3 EMBRYOS

IVF cycle

Many embryos created. Healthy ones kept but defective embryos are destroyed.

Healthy embryos can be transferred to woman or they can be frozen for use at later date. Sometimes they are experimented on.

Do you support the idea of producing human embryos for

medical purposes? Why?

Not supporting new production

Superovulation procedure will be risk because of excess usage of drugs

But….

We support the use of frozen embyos or other

unwanted healthy embyos for stem research……

because

An early embryo that has not yet implanted into the uterus does not have the psychological, emotional or physical properties that we associate with being a person.

An embryo in the earliest stages is not clearly defined as an individual

A fertilized egg before implantation in the uterus could be granted a lesser degree of respect than a human fetus or a born baby

Before day 14, the embryo has no central nervous system and therefore no senses. If we can take organs from patients who have been declared brain dead and use them for transplants, then we can also use hundred-cell embryos that have no nervous system.

If we destroy a blastocyst before implantation into the uterus we do not harm it because it has no beliefs, desires, expectations, aims or purposes to be harmed.

Louise Brown, On July 25, 1978, in Oldham

FIRST IVF BABY

KANUPRIYA AGARWAL (DURGA))

WORLD’S SECOND AND INDIA’S FIRST TEST TUBE BABY On oct 03 , 1978

Dr. Subhash Mukhopadhyay

• She born just 67 days after Marie Louise Brown was born.

• Dr. Subhash Mukhopadhyay was invited by the Kyoto University in 1979 to present his findings during a seminar in Japan but denied a passport by the Indian government.

• The depressed physician committed suicide in 1981.

Durga's birth was caught in ethical and moral controversies

The physician's achievements were not recognised at first.

Today there are more than 3 million IVF Babies

Fertilization is confirmed before implantation can occur.

Gives women with damaged oviducts, the carry their own fetus.

Sometimes it may give opportunity to older ones .

ADVANTAGES

Rajo devi lohan with her daughter Naveen

She become mom in 70 through IVF

1. No pregnancy

2. Multiple pregnancy

3. Ectopic pregnancy

4. OHSS – ovarian hyperstimulation syndrome. Managed conservatively

DISADVANTAGES

Nadya Suleman, the California mother who became known as the “Octomom” after she gave birth to octuplets in 2009

Average cost of total treatment $10,000 - $25, 000 (American dollars)

Industry generates $ 2 billion per year.

IVF INDUSTRY

Israel is the world capital of in vitro fertilisation

The second highest rate of IVF procedures is in Iceland,

Another noteworthy fact is that Israel provides free, unlimited in vitro procedures for its citizens for up to 2 children per woman, under 45 years of age.

TOP IVF COUNTRIES

We can help any couple to have a baby, no matter what their medical problem !Third party reproductionEmbryo adoptionDonor eggsSurrogate uterus

THE PROMISE OF ART'S

SURROGACY

“surrogacy is an arrangement in which a women carries and gives birth to the baby for the couple who want to have a child ”

What is surrogacy?

Substitute..?

TYPES OF SURROGACY

•TRADITIONAL SURROGACY

•GESTATIONAL SURROGACY

Surrogate is genetically related to child

Surrogate is not genetically related to child

ALTRUISTIC SURROGACY

TWO KINDS OF SURROGACY ARRANGEMENTS

COMMERCIAL SURROGACY

Cindy reutzal act as surrogate for her daughter Emily jordan in 2012

Cindy reutzalEmily jordan

What will be relation of child to the surrogate…?

Mike jordan & Emily jordan

Commercial surrogacy is legal in india since 2002

INDIA….why?

•Low cost

•Abundance of medical expertise in the field.

•Inter- country commercial surrogacy is unregulated.

ADVANTAGES

1. A Good Alternative to Adoption2.Good option for couples who are of the same gender and single parent.

Surrogacy for homosexuals…?Illegal in india.

But legal in many other countries like holland, belgium , canada, spain

As a doctor, patients decision is our concern(autonomy) but be sure to respect law ( justice)

No interfere in personal life .

Legal aspects varies in different countries

DISADVANTAGESissues in surrogates

Baby gammy with his surrogate momPattaramon Chanbua

Gammy’s biological parents with his twin sister Pipah

Baby Manji--stateless baby, july 2008 in India

 Male homosexual couples, single foreign men and women, nonmarried couples and couples from countries where surrogacy is illegal

Surrogacy is provided to single men and women who are indian citizens

AAMIR – KIRAN ‘S SURROGATE BABY BROUGHT SURROGACY ISSUES IN INDIA INTO SPOTLIGHT In 2011

CELEBRITIES OF INDIA

SHAHRUKH KHAN – GAURI ‘S 3RD BABY BOUGHT PREGNANACY THROUGH SURROGACY INTO CENTRE STAGE IN INDIA in 2014

SOME SURPRIZES IN THE WORLD OF ART'S…..

CLONING

The production of multiple, exact copies of a single gene, DNA fragment, cell line, or organism.

recombinant DNA technology, reproductive cloningtherapeutic cloning

3 types of cloning technology

DOLLY AND LAN WILMUT, in 1996

ADVANTAGES

Genetically-Modified Animals

Transgenic Animals

Infertility Patients

Cosmetic Surgery

New Possibilities for Organ Transplants

Rejuvenation

Health Improvement Opportunities

DISADVANTAGES

Abnormal Gene Expression

Telomeric Differences

Extremely High Failure Rate

Problems During Later Development

HUMAN CLONING IS IT POSSIBLE?

It may be like this?

Is it a good idea to use cloned humans for organ transplants? Why?

Cells seem to have a defined life span built into them.

Eg:"Dolly" was created from a cell that was about six years old; this is middle age for a ewe. Dolly's cells were also middle-aged. She was expected to live only for five years, which is shorter than the normal life span of 11 years.

If this is also true of humans, then cloned people would have a reduced life expectancy.

The cloning technique could take many years off their life

Do you think cloned humans will have the same talents as the original one? Why?

Some talents seem to be genetically influenced.

There is no guarantee that the first cloned humans will be normal.

The fetus might suffer from some disorder that is not detectable by ultrasound. Disorders may materialize later in life.

They may be born disabled.

Experiments conducted: Failed Experiments

1999 2002

A company called Clonaidannounced that they successfully cloned thefirst human. Experts say it is impossible for thecompany to clone a humandue to inadequatetechnology.

Scientists secretly placed a humancloned embryointo a pig. The cell onlylived to be 32 days old.

Panayiotis Zavos, a fertility doctor, claimed he has cloned 14 human embryos and implanted 11of them into four women.

The experiment was conducted in a secret laboratory most likely in the Middle East.

None of the women became pregnant

This is Cady, who died at age 10 ina car accident. More recently, Dr.

Panayiotis Zavos infused her DNA into a cow's egg to study human cloning.

HUMAN CLONING EXPERIMENT in 2009

India does not have specific law regarding cloning but has guidelines prohibiting whole human cloning or reproductive cloning. India allows therapeutic cloning and the use of embryonic stem cells for research proposes

THERAPEUTIC CLONING A NEW WAY TO ORGAN TRANSPLANT

ORGAN TRANSPLANTATION

What is organ donation?It is the process of removing organ or tissue from a live ,dead or recently dead person to be used for another person.

The person who donates is DONOR and who receives is RECIPIENT.

WHAT CAN BE DONATED?

ORGAN DONATION

TISSUE DONATION

Valery Spiridonov set to be first for world's first full HEAD transplant by Dr Sergio Canavero to happen about in 2017

“is it actually possible to fuse two spinal cords and stop the recipient’s body from rejecting the new head?”

TYPES OF DONOR

Living donor

Cadaver donor

PENIS TRANSPLANT , IN 2014Surgeons at Stellenbosch University and Tygerberg Hospital performed a nine-hour operation to attach a donated penis.

Took place on Dec. 11, 2014, but was not publicly announced until this MARCH 2015while doctors waited to see how the patient would recover.

TYPES OF DEATH

BRAIN DEATH CARDIAC DEATH

Elijah Smith a columbus man said he wanted to be an organ and tissue donor

Elijah Smith a columbus man said he wanted to be an organ and tissue donor

After his brain death the family don’t want his organs to be harvested.

After his brain death the family don’t want his organs to be harvested.

People of all ages.Any healthy willing person.Only one exception is that HIV and ACTIVE CANCER patients cannot donate

MEDICAL REQUIREMENTS

In INDIA around 6000 people die every day waiting for organ transplant.

Every 17 minutes someone dies waiting for transplant.

Every 13 minutes someone is added to a waiting list.

STATUS IN INDIA

INTERNATIONAL ORGAN TRADE

Developed by WHO due to the shortage of an indigenous “supply” of organs, where potentialreceipients travel abroad to obtain organs through commercial transactions

PROS CONS

Religious reasonsFamily beliefsMisconceptionsDonors are scared of their own health

A single donor can save more than one life.

People who are certified brain dead are capable of donating many body parts

Organs can be donated after death and can be 'banked'

Potential donors are easy to find

AS THE TECHNOLOGIES AIMS FOR THE WELL BEING OF EVERY PERSON.....

But…ETHICAL ISSUES

Never ends

WHAT IS AN ETHICAL ISSUE?

We are future doctors

We must have idea to solve Such dilemmas

Recognise that a dilemma exist

Dissect the problem

Do you need more information?

Identify and apply any relevant legal or professional guidelines

Is the issue resolved?

NoYes

Can you justify the dilemma with sound

arguments?

Analyse the facts

Is this issue resolved?

Yes

No

Seek help of a BIOETHICIST

WHAT IS “BIOETHICS”?

Bioethics: “a field of study concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, such as organ transplants, genetic engineering, and care of the terminally ill”

PRINCIPLES OF BIOETHICS

AUTONOMYRespect a person’s right to make their own decisions

Teach people to be able to make their own choices

Support people in their individual choices

Do not force or coerce people to do things

‘Informed Consent’ is an important outcome of this principle

BENEFICENCE( To do good)

Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-being, improve a person’s potential, improve quality of life

‘Benefit’ should be defined by the person themselves. It’s not what we think that is important.

Act on behalf of ‘vulnerable’ people to protect their rights

Prevent harm

Create a safe and supportive environment

Help people in crises

do not to inflict harm on peopledo not cause pain or sufferingdo not incapacitatedo not cause offencedo not deprive people do not kill

NON-MALEFICENCE(to do not harm)

Treating people fairly

Not favouring some individuals/groups over others

Acting in a non–discriminatory / non-prejudicial way

Respect for peoples rights

Respect for the law

JUSTICE

Distributive Justice – sharing the scarce resources in society in a fair and just manner (e.g. health services, professional time)

How should we share out healthcare resources?

How do we share out our time with patients?

Deciding how to do this raises some difficult questions

Patients should get…..

an equal share ? just enough to meet their needs ?what they deserve ?what they can pay for ?

Ethics 2 broad philosophical

theories

CONSEQUENTIALISM

DEONTOLOGY

It is not only our duty to know ethics but also how to handle it in a wise manner

THANK YOU…