Organ Transplantation and Ethics

Organ Transplantation and Ethics

When looking on the face of it, there seems to be little reason to question the ethics behind the idea of transplanting organs. Transplanting organs is arguably one of the greatest achievements of today. Tens of thousands of people are given a chance to start a new life through the selflessness of others. Even though this is the way things look, unfortunately right under the surface lurks a jungle of ethical dilemmas and controversies which have threatened to undermine the entire practice of transplanting organs.

According to Chadwick and Schuklenk, organ transplantation is the surgical removal of a body organ, such as a kidney, from one individual (the organ donor) and placement of the organ in another individual for the purpose of improving the health of the recipient. (393). The first successful transplant was done among identical twins in 1954 and in fraternal twins in 1957. The first heart transplant, although unsuccessful, took place in 1967. The patient had died due to rejection of the organ. Since then, anti-rejection drugs led to the successful transplants between non relatives. Today, many different types of transplants are used. They include liver, kidney, heart, lung, and even transplants of tissues in the brain.

There are three different sources as to where a recipient may receive his/her donor organ. Organs may come from what is known as live human donors. (This is when the organ(s) being donated comes from a living person.) Live donors always have the right to refuse whether or not they would like to donate their organs. Usually, it is more stressful on a person to make a decision of "no" when the person needing the transplant is in their own family. This may cause them to feel a burden of responsibility and maybe even guilt. Then, on the other had, there are live donors that feel we have a moral, if not legal, obligation to help others anyway that we can. (Chadwick & Schuklenk, 394)

In the article, "The World Became Flesh -- The Holy Father Speaks on Organ Transplants," Pope John Paul II speaks of the "nobility" of the decision to offer without reward a part of one's own body for the health and well-being of another person, and characterizes it as "a gesture which is a genuine act of love." (1) He also feels that considering the organs for exchange or trade must be considered morally unacceptable because when you use the body as an object, you are violating the dignity of a human person.

Secondly, organs may come from cadaver donors, (which ultimately come from dead bodies). Usually, people who are willing to donate their organs upon death carry around a donor card. This card shows the person handling the body, the deceased's wishes. Most people feel that it is unacceptable to take a person's organs without checking if they have a donor card first. This is because we like to have an interest in controlling what happens to our bodies after death. Others feel that the interest of the deceased is not nearly as relevant compared to an alive person that will not remain alive much longer without a transplant.

A third source in which we can receive transplants is through xenotransplantation. This is when the organs come from non humans. These organs usually come from non humans or animals. Animal activists feel that it is unethical to inflict pain in animals for the sake of helping a human. The shortage of human organs for transplantation has led scientists to search for new ways to help patients needing transplants. Attempts are being made to develop animal organs that can be transplanted into humans. Both pigs and baboons are being developed for transplantation.

Another ethical issue regarding organ transplants is whether or not a person should be allowed to receive a second transplant if the first one should fail. Data show that "retransplant recipients at similar levels of urgency do significantly worse than primary transplant recipients, a difference that increases with each successive transplant" (Ubel, et al, 272). Though I don't believe those who have already received a transplant should be prohibited from receiving another, careful and objective consideration should be given to these cases. Reasons for the organ failure and current condition of the patient must be evaluated to determine if the retransplant candidate will make best use of the function of the organ. Preference of the scarce organs should be given to the patient whose chances of long-term survival are best.

Since there are many more recipients than donors, how do we determine which patient should get the transplant first? Should a wealthy person get it over a poor person? Should an American citizen get it over an immigrant? Or should a person with a better probability of surviving receive the transplant?

In Transplantation Ethics, Robert Veatch outlines an interesting way of assessing need. This approach takes into consideration a person's entire life when determining who is worst off. A 17-year-old and an 80-year-old both dying of heart failure are equally bad off, but this perspective allows that the person who has had 63 more years of life is better off, so the 17 year old is the most in need of the transplant (Veatch, 341).

Of course, it would be silly to base the transplant simply on the age of the neediest patients. Efficacy, or expected survivability, must also be considered. Currently, our system of allocation gives priority to those who are the sickest or most in need of a transplant. But sometimes those who are the sickest and in the most immediate need will not receive the same benefit from the transplant as someone whose medical