Organ Transplantation And Donation

Subject: Med Ethics Topic: Organ Transplantation and Donation Shifting /Date: August 15, 2008 Trans group: Paolo Paraiso

Introduction

Types of Human Transplantation

The Department of Health AO 2008-0004 Revised National Policy on Living Non-Related Organ Donors and Transplantation and Its Implementing Structures set “the general guidelines and ethical principles whereby the act of donation and the conduct of transplantation using NON-RELATED donors shall be managed and regulated”.

1.

Autotransplantation – the donor and the recipient of are one and the same individual

2.

Heterologous transplantation – the donor and the recipient of transplantation are 2 different individuals.

DEFINITIONS Organ donation - giving of tissue/organ/body by a person to another person or to an institution Donor - giver who maybe a cadaver, or a living person . A donor who exchanges the organ for money is a vendor Recipient - receiver who may receive directly from the donor or from an institution. A recipient who pays for the organ is a buyer Organ transplant - transfer of tissue/organ from donor to recipient



Animal to human transplantation



Human to human transplantation (cadaver-donor; livingdonor)

Ethical Consideration

1. Donor (deceased or living) 

 The act of donating one’s body or its part after death for the purpose of aiding the sick and relieving their suffering either directly or indirectly is an act of worthy praise.

Attending physician - doctor caring for the patient Transplant team - healthcare providers performing the actual transfer of the tissue/organ

 Never obligatory

Transplant Committee - group created to ensure that the donation process follows professional and ethical standards Organ sale - trading of an organ in exchange of money or similar material. The person or institution who arranges for the trade between buyer and vendor is the middleman. Organ trafficking is trading for profit

 When a dying patient is a probable donor of organs direct care should not involve the transplant team 

 Organs: kidneys, liver, heart, lungs and cornea

Xenotransplantation - transfer of animal organs to human beings.

 Ethically repelling when as a result of the procedure, the personal identity and abilities of the recipient are compromised

ETHICAL ISSUES IN HUMAN TRANSPLANTATION

Is it ethical to mutilate one’s self or allow one’s self to be mutilated so that the body part surgically “harvested’ can be transplanted to relieve someone of pain, to restore someone to normal body functioning, or to prolong someone’s life?

Is a surgical procedure whereby an organ or a tissue, is transferred from one part of the body to another or from one organism to another organism

Deceased (Cadaver) Donor  No body organs may be removed until the donor’s death has been confirmed by a competent medical authority

Gratuity - action/of remuneration received by the donor that constitutes an act of gratitude for the organ given

Transplantation

Deceased (Cadaver) Donor

 Ethical aversion is shown to transplantation of the reproductive organs as this violates the genetic individuality of the recipient



Living Donor –the following should be observed:  There is a proportionate benefit to the recipient, as a result of the transplant procedure

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI

Subject: Med Ethics Topic: Organ

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 The donor is not exposed to greater risks of life or deprived completely of an important body function or functional integrity Types of Body Parts for Human Transplantation 



3.



Unethical when a part of the liver from a living adult donor is transplanted into a child-recipient à adult donor’s liver regenerates within a a reasonable time and the child’s new partial liver develops as the child grows

Body parts that are paired  Non-generating human body parts may be transplanted provided they are paired (kidney)  Ethical as long as there are proportionately justifying reasons, the functional integrity of the body is maintained, and harm to the donor as a result of the transplant is only limited



Cornea cannot be justified à functional integrity would be seriously impaired

Recipient 

buyer à treatment of the human body and its parts as commodities is an affront to human dignity 4.

The principle of free and informed consent

5.

Competency of the donor

6.

Role of parents and guardians in transplantation

7.

Use of human fetus in transplantation

Animals as Source 

Not ethical

 Monetary consideration



Use of insulin extracted from animal pancreas or of cat gut as absorbable sutures is not appreciated at all



Common view:

 Organs for transplant should not be commodities à

 Animals are for the use of man, and their use for the benefit of man is welcomed, provided that the manner of using them is human and respects human sensitivity

manipulation, exploitation and unfair competition easily bred

Observations to consider when making judgment as to who receives a donated organ or tissue: 

THE ORGAN DONOR



Principles of stewardship and nonmaleficience: “Man must take care of his body and do it no harm”



Cadaver donor

Access to health care should be the privilege of the few



Post-transplant rehabilitation possibilities



Post-transplant benefits to the recipient



The ‘social worth’ of the recipient after transplantation

Opposed by the advocates of animal rights who doubt the human therapeutic benefits of transplant procedures that use animal-donor  Ape’s heart to human infant or pig’s liver to a dying human being

 Exert pressure in any manner  Prioritized others, when the rights of other potential recipients are disregarded at the same time

Practice should be ethical also as long as respect for patient autonomy is observed provided that those who intend to put one of their paired or regenerating organs on the market be provided with sufficient information – health risks, financial costs, post-surgery rehabilitation

 Regardless of the good intention of either the seller or the

 Bone marrow transplant and blood transfusion are ethical

2.

Procurement of Organs/Tissues

Body parts that can regenerate





‘First come, first served’

 harvesting organ will do no harm 

Living donor

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 

 Opportunity to say goodbye and receive comfort in their grief

taking away a healthy organ is not taking care of one’s body: no life is saved, no health is restored

THE ORGAN RECIPIENT

Just and proportionate reasons may overrule the violation of stewardship and nonmaleficence  Solidarity, love of neighbor, beneficence and charity  Donation is praiseworthy act of sharing life in keeping with what it means to belong to a human society and to contribute to it, with the goals of medicine and with one’s duty as a Christian



Stewardship dictates that in serious illness, Man has the right and the obligation to take the necessary measures to preserve life and health



A new organ preserves life



To the extent it is available; one has a right to and obligation to get it

Ethical Requirements 

Harm and risk of harm must be minimal and proportionate to the benefits to be derived



Drive to maximize organs may lead to an unseemly haste à organ procurers willing to declare someone dead (dying cannot be killed)

Ethical Requirements: 

Harm and risk of harm must be minimal and proportionate to the benefits to be derived  Not everyone with end-stage kidney disease must have a transplant

 For healthy: organ removed must not be necessary for life or for personal and procreational identity (not brain or gonads), or must be easily regenerated (blood, bone marrow, hair)



 Recipient must be protected against exploitation because of one’s vulnerable state

Donor must be cared for before, during and after the donation  Proper screening, standard healthcare, reimbursement for medical expenses, disability and livelihood lost, prevention of discrimination job opportunity, insurance, HMO, community acceptance



 For a particular patient a transplant may not be good, even if the patient wants



Respect for autonomy must allow the recipient to choose how to get an organ  Requires free and informed consent



There must be just allocation

Intrinsic worth and dignity of the donor must be respected

 Justice would dictate equal benefits for everyone in need

 Free and informed consent must be given



Necessary information should be given: process of matching, chance of success of transplant and permission to refuse



Reasons for donations: moral duties, religious beliefs, external pressures, guilt from the past relationships, identification with the recipient

 

Marginalized vulnerable to exploitation: financial needs and ignorance

Considerations for the family of cadaver donors:  Consent for the donation must be obtained

 When a number of candidates equal based on medical criteria, need and chance of success then the choice of recipient should be on a first come first saved basis THE PHYSICIAN 

Has the positive obligation to provide the best possible care to the patient: either donor or recipient

SOCIETY 

The obligation of the society  To provide for the common good and necessitates that it make organs and transplantation available

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market, not so low as to exploit the vendor, not so high as to coerce the vendor or exploit the recipient, with a ceiling price can be determine

 To be just in the allocation of resources 



Policy against uncontrolled trading in an open market which would allow exploitation or those with more to jump to the cue

Conclusion 

Organ donation and transplantation is a good with one man helping his fellowmen.



It should always be done in the context of sharing, compassion and love

Ethical standards must be ensured to avoid “transplant tourism”

KIDNEY SALES 

Until there are enough organs for all who need them and for as long as some are willing to pay while others are willing top sell, kidneys will be sold, regardless of it being illegal or prohibited

These guidelines promote the principles and values underlying AO 2008-004

Issues 

POLICY STATEMENT

What is the motive of the vendor selling a kidney?



Related and directed à from ties of love and connectedness



Non-related donors with no material exchange à altruistic act



1.

Sales à altruism? Sustain basic needs? Educational needs of children?

Common Good and Solidarity 

Organ donation and transplantation is a way of caring for the other



It is a manifestation of generosity and love



It should be done first and foremost , to save and improve the quality of life of another



Both donor and recipient should benefit from the process

 Need of a poor man may be related to responsibility, charity or altruism 2. 

Non-maleficence

What harm can selling kidneys do? 

A living non-related donor (LNRD) shall be considered only after neither a deceases donor nor a living related donor is available 3 months after the potential recipient is enrolled in the registry



The removal of the organ, its transplantation and all related procedures shall be done only in hospitals accredited by the Bureau of Health Facilities and Services, DOH and by the PhilHealth



Both the donor and recipient shall receive appropriate health care, before, during and after the transplantation



There shall be no conflict of interest



There shall be no exploitation of donor or recipient

 Excluding sold organs may reduce the number of available organs  Allowing a poor man to sell his organs maybe to his best interest by opening a chance to improve his life  A poor vendor may conceal high risk exposure/ behaviors to be acceptable  Selling human organs may change the way vendor and buyer view themselves as possessors of property rather than stewards  Associating the transplant ream to money making may undermine the confidence of the public in the medical profession 

What be the right price for a kidney?



A reasonable price based on the average donors expenses and the economic capacity of the recipient and not on the outcome of the transplant or the

3.

Respect for Person

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

Organ sale is not allowed



Free and Informed Consent shall be obtained from the donor and if married, from the spouse and the recipient.

 Physician, social worker, chaplain, lay person, bioethicist and lawyer

 No deception in the information given, no coercion in obtaining of consent, and volunteerism on the part of the donor and recipient

 Should be familiar with issues related to organ transplantation and donation



 



Special efforts shall be exerted to protect the vulnerable and those with diminished autonomy A substitute decision maker cannot authorize the donation of an organ from another living person, but can authorize the donation of an organ from a deceased person

Composition:

Functions:  Develop and publicize programs to enhance deceased organ donations, prevent conditions leading to the need for organs and prevent abuses in organ transplantation  Evaluate and approved/disapproved every proposed donation and transplantation

4.

Justice and Equity

 Protect donor and recipient  Monitor ethical issues which arise from organ donation and transplantation



Non-directed donated organs shall be allocated equitably among patients with priority based on the objective criteria for medical need and probability of success as specified by the Donation Allocation Guidelines

 “First come, first served” basis

5.



A donor shall be reimbursed for the expenses related to the donation and transplantation (medical, loss of income, inconvenience), but not for the organ itself



Benefits and burdens must be equally distributed



A gratuity should be given to the donor



There shall be transparency in the whole process

Beneficence



There shall be a review of these guidelines every year as more information and experience become available



Revisions shall be proposed as needed

IMPLEMENTING MECHANISMS 1.

Hospital Transplant Ethics Committee



Every hospital should establish a Hospital Transplant Ethics Committee or task an existing Hospital Ethics Committee (HEC) to implement this guidelines

 Recommend sanctions for violations of guidelines to the Hospital administration and records action