ORGAN DONATION

Organ donation

• Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting.

• Organs and tissues are removed in procedures similar to surgery, ad all incisions are closed at the conclusion of the surgery.

• Simple, effective steps can be taken to provide a traditional funeral viewing whenever this might be desired.

• People of all ages may be organ and tissue donors.

• In numerical terms, donations from dead donors far outweigh donations by living ones.

• The laws of different countries allow either the potential organ donor to consent or dissent to the donation during his or her life time, or allow the potential donor’s relatives to consent or dissent.

• Due to cultural issues and different legislative possibilities, the number of donations per million people varies substantially in different countries.

Organs and tissues which can be donated

• Organs that can be procured include: the heart, intestines, kidneys, lungs, liver, pancreas. These are procured from a brain dead donor or a donor where the family has consent for donation after cardiac death, known as Non-heart beating donation.

• The following tissues can be procured: bones, tendons, corneas, heart valves, femoral veins, great saphenous veins, small saphenous veins, pericardium, skin grafts, and the sclera (the tough, white outer coating surrounding the eye). These are only procured after someone has died.

• Organs that can be donated from living donors include part of the liver or pancreas and the kidney.

Recipient protection

• To protect the person receiving an organ, various health and safety tests are conducted.

• Because an organ transplant requires immune suppression, it is important that the organ not be infected with a disease that could harm the recipient.

• These tests are not perfect, but organ-related infections are relatively rare.

Legislation regarding organ donation

• There are four different legislative approaches to the donation, if the donor has not explicitly dissented.

• The least restrictive approach is the dissent solutions, according to which the donor has to explicitly dissent to donation during his lifetime.

• According to the extended dissent solution, relatives may dissent in the event the potential donor has not consented.

• The different legislative approaches are the main reason that countries like Spain (27 donors per million inhabitants) or Austria (24 donors per million inhabitants) have higher donor rates than Germany (13 donors) or Greece (6 donors).

• In most countries with the dissent solutions, there is no waiting list for donations, or the list is short, while most countries with consent solutions have substantial organ shortages.

• The reason for this is that, in both situations, most people do not explicitly state their wishes. Thus, in a country requiring dissent, most people will not have dissented, while in country requiring consent, most people will not have consented.

Bioethical issues in organ donation

• Since in the mid-1970s, bioethics, a relatively new area of ethics, has emerged at the forefront of modern clinical science. Many philosophical arguments against organ donation stem from this field. Generally, the arguments are rooted in either deontological or teleological ethical considerations.

Deontological issues

• Pioneered by Paul Ramsey and Leon Kass, few modern bioethicists disagree on the moral status of organ donation.

• Certain groups, like the Roma (gypsies), oppose organ donation on religious grounds, but most of the world’s religions support donation as a charitable act of great benefit to the community.

• Issues surrounding patient autonomy, living wills, and guardianship make it nearly impossible for involuntary organ donation to occur.

• In issues relating to public health, it is possible that a compelling state interest overrules any patient right to autonomy.

• From a philosophical standpoint, the primary issues surrounding the morality of organ donation are semantically in nature.

• The debate over the definition of life, death, human, and body is ongoing.

• For example, whether or not a brain-dead patient ought to be kept artificially animate in order to preserve organs for procurement is an ongoing problem in clinical bioethics.

• Jewish medical ethics accepts organ donation as a meritorious charitable act but with 2 condition; the donor be deceased before removal of the organ and the organ be treated respectfully.

• The ethical problem stems from a lack of consensus on the definition of ‘deceased’. According to the strictest interpretation of halachah, ‘deceased’ means the cessation of all brain stem activity.

• For most organs, this point is too late for the donation to be medically useful; nevertheless, for the adherent to this view, any prior removal would be tantamount to murder.

• Given the nature of the market for donated organs, the second condition would limit donation to a case where there is a known and ready need for that specific organ.

• Alternatively, a promise can be made to ensure a proper burial for a donated organ in the event that it is transplanted.

• A movement to promote organ donation from Jews to the general population in consonance with halachah has been spearheaded by the Halachic Organ Donor Society.

Teleological issues•

•On teleological or utilitarian grounds, the moral status of ‘black market organ donation’ relies upon the ends, rather than the means.•Insofar as those that donate organs are often impoverished and those that can afford black market organs are typically well-off, it would appear that there is an imbalance in the trade.•In many cases, those in need of organs are put on waiting lists for legal organs for indeterminate lengths of time-many die while still on waiting list.

• Organ donation is fast becoming an important bioethical issue from a social perspective as well.

• While most first-world nations have legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply.

• Consequently, there has arisen a black market often referred to as transplant tourism.

• The issues are weighty and controversial. On the one hand are those who contend that those who can afford to buy organs are exploiting those who are desperate enough to sell their organs.

• Many suggest this results in a growing inequality of status between the rich and the poor. On the other hand are those who contend that the desperate should be allowed to sell their organs, and that stopping them is merely contributing to their status as impoverished.

• Further, those in favor of the trade hold that exploitation is morally preferable to death, and insofar as the choice lies between abstract notions of justice on the one hand and a dying person whose life could be saved on the other hand, the organ trade should be legalized.

• Conversely, surveys conducted among living donors postoperatively and in a period of five years following the procedure have shown an extreme regret in a majority of donors who said that given the chance to repeat the procedure, they would not.

• Additionally, many study participants reported a decided worsening of economic condition following the procedure

• These studies looked only at people who sold a kidney in countries where organ sales are already legal.

• Legalization of the organ trade carries with its own sense of justice as well.

• Continuing black-market trade creates further disparity on the demand side: only the rich can afford such organs.

• Legalization of the international organ trade could lead to increase supply, lowering prices so that persons outside the wealthiest segments could afford such organs as well.

Exploitation arguments generally come from 2 main areas:• Physical exploitation• Financial exploitation

• Physical exploitation suggests that the operations in question are quite risky, and, taking place in 3rd world hospitals or “back-alleys”, even more risky. Yet, if the operations in question can be made safe, there is little threat to the donor.

• Financial exploitation suggests that the donor (especially in the Indian subcontinent and Africa) are not paid enough.

• Commonly, accounts from persons who have sold organs in both legal and black market circumstances put the prices at between $150 and $5000, depending on the local laws, supply of ready donors and scope of the transplant operation

• In Chennai, India where one of the largest black markets for organs is known to exist, studies have placed the average sale price at little over $1000.

• Many accounts also exist of donors being postoperatively denied their promised pay.

Sources

• “Which Organs Can Be Donated for Transplantation?” New York Organ Donor Network.

• United Network for Organ sharing : Organ Donation and Transplantation.• BBC News | Health | Fatal cancer passed on by organ transplant• CBHD: Transplanting HIV Positive Organs Into HIV Positive Patients- by Gregory

W.Rutecki• Abs-Cbn Interactive, Two Indonesians plead guilty in Singapore organ trading

case• Straitstimes.com, CK Tang boss quizzed by police.• Zargooshi J (2001). “Quality of life of Iranian kidney “donors””. J. Urol 166 (5):

1790-9. PMID 11586226.• Goyal M, Mehta RL, Schneinderman LJ, Sehgal AR (2002) . “ Economic and

health consequences of selling a kidney in India.” JAMA 288 (13):1589-93.PMID 12350189.

• Why a Kidney (street value:$ 3000) sells for $ 85000• Poor Pakistanis Donate Kidney for Money-washingtonpost.com• BBC NEWS| Programmes | This World | Iran’s desperate kidney traders

• JAMA-Abstract: Economic and Health Consequences of Selling a Kidney in India, Oct 2, 2002, Goyal et al. 288(13) : 1589.

• Inside “Kidneyville”: Rani’s Story• The New Cannibalism• a b http;//press.psprings.co.uk/bmj/may/consent01088.pdf• Organizacion Nacional de Trasplantes• http:news.yahoo.com/s/20070718/hl_afp?

helathbritainorgan_070718135143• More countries hope to copy Spain’s organ-donation success• Corrections.com-The largest Online Community for Corrections:

Jails and Prisons. The waiting list for life.• a b c d “American red cross- Statements from Religions".

American Red Cross. Retrieved on 2008-07-22

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