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The Ethics of Organ Donation
The medical practice of organ donation has seen a remarkable growth through leaps and bounds leading to the primary ethical dilemma. Transplants involve the surgical removal of a damaged or failing organ and replacing it with one from a different donor. From the first kidney transplant in 1954, medical, ethical and legal advances have been made. Besides, organ donation has now expanded to livers, lungs, hearts made possible by the development of anti-rejection drugs, artificial organs, and the use of animal organs for human transplantation. Critical factors such organ type, the distance of the donor from the patient, level of medical urgency and time patients spend on the waiting list are critical in determining the most suitable candidate for organ donation.
Pros and Cons
Ethics surrounding the donor’s perception and knowledge relates to Henrietta Lacks’ story as portrayed in The Miracle Woman. When diagnosed with an aggressive strain of cervical cancer in 1951, doctors took tissue samples without due consent (Bramstedt 39).
This was unethical practice since medical researches require that scientists attain express permission from the respective donors or research subjects. Counterproductively, the doctor’s actions helped in the development of polio vaccine in addition to drugs that cured Parkinson’s disease, hemophilia, influenza, leukemia, and Herpes. It also extended research on cancer treatment, atom bomb effects, cloning, gene mapping and invitro fertilization (Bramstedt 39).
Debates on organ donation are often based on two primary factors including how to allocate the scarce organs and how to increase the overall donor pool size. The two lines of arguments are vitally important since organ scarcity is a reality that needs to be addressed and allocation policies must also be taken into account. One of the primary principles of a liberal society is that individuals must be judged based on their choices. This makes it mandatory for the medical and legal fraternity to make straight choices on who deserves to be saved, and who does not. Choices must, therefore, be made between those with illnesses with natural causes versus the self-induced ones (Jox, Galia and Georg 83).
Proponents of organ transplantation believe that the procedure is valuable, meaningful and worth offering to all who need it. However, the fair distribution of available organs raises a critical ethical dilemma. Distributive justice calls for the fair distribution of the available transplant organs hence, ethically, it is extremely difficult to determine the ‘right’ way to distribute organs. As outlined by the University Of Washington School Of Medicine, organ distributive justice requires that all individuals get an equal share according to need, effort, contribution, and merit. The distributive justice of equal access further requires that the allocation of organs be based on the length of waiting time and age. Hence, equal access distribution of transplantable organs must be free from any biases of income level, sex, and race or geographical distance from the organ.
Supporters of organ donation argue that the practice serves to save lives allowing some people to give incredible gifts to others. Saving the lives of dying individuals by increasing the organ donor pool further allows for timely transplantation and hence reduced mortality. The damage caused to the specific organ such as kidney or liver is also easily reversible through transplant besides, advances in medical science allows for many lives to be saved by transplants. The fact that surgeons and other doctors can be trusted to honor the rules that surround organ transplantation is a further call to allow the procedure. Additionally, the fact that legalization of organ transplant serves to curb organ trafficking justifies the practice.
Opponents of organ transplant present multiple arguments to support their position. At the center of their argument is the dysfunction and the multiple complications that often arise from transplant. The fact that considerably large proportion of donors is living people, and that this increases their mortality and morbidity rates calls for an abolition of the practice. Additionally, the fact that donors may lack the actual information of the multiple risks involved in the procedure calls for the ethical reconsideration of the process. Statistics also indicates that the survival rates of grafts in living donors are much less than those of deceased donors leading to severe health complications in patients (Perrin and McGhee143).
Another primary argument presented by opponents of organ donation is the fact that, shortage of organs does not match the number of patients in need of them. This implies that many patients die to wait for the organs hence creating an unfair field for those who have waited for the longest time periods. It has also been argued that since most organs are from the diseased, it is unethical to remove organs from the deceased without his or her expressed wish and permission. Besides, for terminally ill patients, the possibility of death could be hastened so as to secure the organ needed by a patient on the waiting list. Since all individuals have the right to accept or refuse permission for their organs, some dying individuals may feel pressured or selfish should they refuse to donate their organs. One crucial example is the case of Henrietta whose family learned about the existence of the cells harvested from their mother after 25 years. This prompted to question whether the John Hopkins Scientists had indeed killed their mother to harvest her cells (Bramstedt 39).
Shortage of available organs presents the key ethical dilemmas surrounding organ transplantation. The fact that not everyone in dire need of a transplant gets one plus the criteria with which a donor is determined presents fundamental ethical challenges. The United Network for Organ Sharing (UNOS) reports that 78% of individuals in critical need of organ donations remain on the waiting list until they die. Statistically speaking, an estimated 106 individuals add to the organ donation list each day, while on average, 17 patients die each day while awaiting an organ donation. Besides, while the demand for these organs continues to increase, the number of these organs remains fairly constant.
Another critical ethical dilemma is the issue of individual worth when considering organ distribution. According to Jox, Galia, and Georg, medical worth biases could hinder deserving patients from reaching to the top of the waiting list (118). Besides, the fact that individual worth does not necessarily determine medical worth and that, it is inherently difficult to differentiate who is worthy and who is not worthy of medical procedure. Conversely, opposing ethicists argue that individual worth is important when considering organ distribution. To illustrate the idea, Perrin, and McGhee, argue that, equal access to donor organs is not fair since some individuals have ruined their organs by their lifestyle choices. She, therefore, argues that equal access to distribution organs is never fair for those whose irresponsible behavior increased their need for organs.
The argument of all-out benefit in which the goal of a specific transplant being to see to it that a maximum number of successful transplants is achieved and also presenting considerable ethical challenges. Factors such as medical need and the probable success of a transplant are based on the argument that, since organ transplants are valuable, they should be given to people who will benefit maximally to recipients. Hence to avoid wastage of organs, there is the need to rank transplant candidates by either how long a patient is likely to live after receiving a transplant and how sick the specific patient is. Efficacious transplants are therefore measured based on one’s life years with life years being the number of years the patient lives after a transplant.
Jox, Ralf J, Galia Assad, and Georg Marckmann. Organ Transplantation in Times of Donor Shortage: Challenges and Solutions. New York: Routledge. 2015. Internet resource. Accessed on 13th Nov. 2015 at https://books.google.co.ke/books?id=OPJUCgAAQBAJ&pg=PA99&dq=Organ+Transplantation+in+Times+of+Donor+Shortage:+Challenges+and+Solutions&hl=en&sa=X&redir_esc=y#v=onepage&q=Organ%20Transplantation%20in%20Times%20of%20Donor%20Shortage%3A%20Challenges%20and%20Solutions&f=falseKnight, Robin. Transfusion and Transplantation Science. London: Oxford University Press. Accessed on 13th Nov. 2015 at: https://books.google.co.ke/books?id=jVicAQAAQBAJ&pg=PP2&dq=Transfusion+and+Transplantation+Science&hl=en&sa=X&ved=0CBsQ6AEwAGoVChMIgMaRm_GMyQIV1DSICh2mYwsE#v=onepage&q=Transfusion%20and%20Transplantation%20Science&f=falsePerrin, Kathleen, and McGhee, James. Quick Look Nursing: Ethics and Conflict. New York:
Jones & Bartlett Learning. Accessed on 13th Nov. 2015 at: https://books.google.co.ke/books?id=Bw7YtziwSKwC&printsec=frontcover&dq=Quick+Look+Nursing:+Ethics+and+Conflict&hl=en&sa=X&ved=0CBsQ6AEwAGoVChMIwr2Q1_GMyQIVjJSICh2DAAPK#v=onepage&q=Quick%20Look%20Nursing%3A%20Ethics%20and%20Conflict&f=falseBramstedt, Katrina A. The Organ Donor Experience: Good Samaritans and the Meaning of Altruism. Lanham, Md: Rowman & Littlefield Publishers, Inc, 2011. Internet resource.