Ethics and Organ Transplantation • Anatomically identical to allografts, closer to

autografts in terms of the recipient’s immune

Transplantation response
• It is the act of surgically removing an organ from • Xenograft -Replacement of an individual’s
one person and placing it into another person. defective organ with an organ harvested from
• Transplantation occurs because the recipient’s another species - Source of organs for human
organ has failed or has been damaged through use: primates (genetic similarities to humans) and
illness or injury. pigs (large availability)

Organ Transplant Increasing Organ Donation

• The transfer of a whole or partial organ from one • Limited Resource
body to another. • Cadaveric Organs
• Removal of an organ from: A deceased donor – Mandated Choice
 A living human person – voluntary donation
• For the purpose of replacing the recipient’s – Presumed Consent - a person is presumed to
damaged or failing organ with a working one from have consented to organ donation in the case of
the donor site their accidental death.
– Incentives
Which organs can be transplanted: – Prisoners
• Liver • Kidney • Lungs • Pancreas • Heart
• Intestine Informed Consent
• Diagnosis
History of Organ Transplant • Nature and purpose of treatment
• 1954 living relating kidney transplant( Dr. • Risks and benefits of treatment
Joseph Murray and Dr. David Hume Boston) • Alternatives – Risks and benefits
• 1962 cadaveric kidney transplant by (Dr. Joseph • Risks and benefits of not having treatment
Murray and Dr. David Hume Boston)
• 1963 lung transplant (Dr. James Hardy Increasing Organ Donation
Mississippi) • Living Donors – Buying and selling of organs
• 1967 liver transplant( Dr. Thomas Starzl • Unfair pressure on economically disadvantaged
Colorado) and heart transplant(Dr. Christiaan • Wealthy people have unfair access
Barnard South Africa) • Donor and recipient safety
• 1981 heart/lung transplant(Dr. Norman
Shumway California) Organ allocation
• In 1983, the FDA approved cyclosporine for use • “Those who are dangerously wounded must be
in organ transplantation, and the first lung tended first, entirely without regard to rank or
transplant patient survived more than six years. distinction. Those less severely injured must wait
until the gravely wounded have been operated
Types upon and dressed. (Hinds 1975, 6)
• Autograft - A transplant of tissue from one to • Limited resource
oneself Skin grafts, vein extraction for CABG, • Distributive justice
storing blood in advance of surgery – How to fairly divide resources
• Allograft - Transplanted organ or tissue from a – Equal access
genetically non – identical member of the same – Maximum benefit
species
• Most human tissue and organ transplant Distributive Justice
• Equal Access
• Isograft -A subset of allografts in which organs – Everyone should be able to access it equally
or tissues are transplanted from a donor to a – Length of Time
genetically identical recipient (e.g. identical twin) – Age of recipient
• Reasons for equal access: exclude individual WHO Guiding Principle 4
worth from equation • Non-maleficence
– Exclude Medical “worthiness” i.e. smoking • Minors and legally incompetent people
– Exclude Social “worthiness” i.e. prisoners – No cells, tissues or organs should be removed
from the body of a living minor for the purpose of
Distributive Justice transplantation other than narrow exceptions
• Maximum benefit allowed under national law.
– Maximize the number of successful transplants – Specific measures should be in place to protect
– Medical need the minor and, wherever possible the minor’s
– Probability of success assent should be obtained before donation.
• Reasons for maximum benefit: limited resource
and should avoid waste WHO Guiding Principle 5, 6, and 8
– Second transplant • Beneficence
– Factor in medical outcome • Cells, tissues and organs should only be
donated freely without any monetary payment or
Current Organ Distribution System reward of monetary value.
• Medical need • The prohibition on sale or purchase of cells,
• Probability of Success tissues and organs does not preclude
• Time on Waiting List reimbursing reasonable and verifiable expenses
incurred by the donor, including loss of income, or
WHO Guiding Principle 1 paying the costs of recovering, processing,
• Autonomy preserving and supplying human cells, tissues or
• Cells, tissues and organs may be removed from organs for transplantation.
the bodies of deceased persons for the purpose
of transplantation if: WHO Guiding Principle 7
– (a) any consent required by law is obtained, • Non-maleficence
and • Physicians and other health professionals
– (b) there is no reason to believe that the should not engage in transplantation procedures,
deceased person objected to such removal. and health insurers and other payers should not
cover such procedures, if the cells, tissues or
WHO Guiding Principle 2 organs concerned have been obtained through
• Beneficence exploitation or coercion of, or payment to, the
• Physicians determining that a potential donor donor or the next of kin of a deceased donor.
has died should not be directly involved in cell,
tissue or organ removal from the donor or WHO Guiding Principle 9
subsequent transplantation procedures; nor • Justice
should they be responsible for the care of any • The allocation of organs, cells and tissues
intended recipient of such cells, tissues and should be guided by clinical criteria and ethical
organs. norms, not financial or other considerations.
• Allocation rules, defined by appropriately
WHO Guiding Principle 3 constituted committees, should be equitable,
• Autonomy, Non-maleficence, Justice externally justified, and transparent.
• In general living donors should be genetically,
legally or emotionally related to their recipients. Ethical issues
• Informed, voluntary consent • Is the human body a commodity?
• Professional follow up ensured and organized • How should decisions be made about who
• Selection criteria receives scarce organs?
• Non coercive (by force) • Who should pay for transplants?
• Should one person receive several organs or
several persons receive one?
• Should one person have a second transplant
when the first one fails or should a different
person be given a first chance at a new organ?
• Should organs be donated to those persons
who have abused their bodies by drinking and
smoking or only to those whose organs are
damaged by disease? • Should state or federal
law makers be involved in transplantation?

Certain Guidelines
• The functional integrity of the donor as a human
person should not be impaired, even though
anatomical integrity may suffer.
• The risk taken by the donor as an act of charity
is proportionate to the good resulting for the
recipient. • The donor’s consent is free and
informed.
• The recipients for the scarce organs are
selected justly.

Organ Market:
Controversy
• The vicious cycle
– Needs money, has organ.
- Has money, needs organ.
Main Issues on Organ Trade It is contrary to the
dignity of the human body and depersonalizing
• Organ sale promotes coercion and exploitation
of people, especially of the poor. Insufficient
screening compromises quality of organ and
health of both donor and recipient
• It promotes poor quality of care as a result of
poor standards of donor selection and inadequate
screening for transmissible disease

All those who need such a gift should receive

it, rather than only those who could pay.
• There is favor for those who have the resources
to purchase these “entities”.
• Discrimination “It makes human organs a
commodity for profit and sale.”

"Sometimes our light goes out but is blown again

into flame by an encounter with another human
being. Each of us owes the deepest thanks to
those who have rekindled this inner light." –
Albert Schweitzer