Ethical Issues in Organ Transplantation

Abstract

Clinical organ transplantation has been recognized as one of the most gripping medical advances of the century as it provides a way of giving the gift of life to patients with terminal failure of vital organs, which requires the participation of other fellow human beings and of society by donating organs from deceased or living individuals. The increasing incidence of vital organ failure and the inadequate supply of organs, especially from cadavers, has created a wide gap between organ supply and organ demand, which has resulted in very long waiting times to receive an organ as well as an increasing number of deaths while waiting. These events have raised many ethical, moral and societal issues regarding supply, the methods of organ allocation, the use of living donors as volunteers including minors. It has also led to the practice of organ sale by entrepreneurs for financial gains in some parts the world through exploitation of the poor, for the benefit of the wealthy. The current advances in immunology and tissue engineering and the use of animal organs, xenotransplantation, while offering very promising solutions to many of these problems, also raise additional ethical and medical issues which must be considered by the medical profession as well as society. This review deals with the ethical and moral issues generated by the current advances in organ transplantation, the problem of organ supply versus organ demand and the appropriate allocation of available organs. It deals with the risks and benefits of organ donation from living donors, the appropriate and acceptable methods to increase organ donation from the deceased through the adoption of the principle of ‘presumed consent’, the right methods of providing acceptable appreciation and compensation for the family of the deceased as well as volunteer and altruistic donors, and the duties and responsibilities of the medical profession and society to help fellow humans. The review also deals with the appropriate and ethically acceptable ways of utilizing the recent advances of stem cell transplantation from adult versus fetal donors, tissue engineering and the use of organs from animals or xenotransplantation. Data provided in support of the concept that clinical organ and tissue transplantation can be more beneficial and life saving if everyone involved in the process, including physicians and medical institutions, respect and consider the best interests of the patients, as well as honor the ethical, moral and religious values of society and are not tempted to seek personal fame or financial rewards.

Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation

“…This law mandates that every adult individual who dies is a potential donor unless during his life he specifically declines to participate (44). The proposal of presumed consent was not tested for its effectiveness in the United States and many other countries because it is considered against the autonomy of families of deceased donors.…”

Ethical Aspects of Tissue Engineering: A Review

“…Some articles merely mention that cloning is considered by many to be morally problematic (e.g., Refs. 8,15,35,37,40,42,63,65,68,69,[73][74][75] ); other papers elaborate on the ethical objections to this technique. The objections most often discussed are the objection that the creation of a human embryo specifically for research purposes and its subsequent destruction contravene its moral status, 4,6,9,17,20,43,76,77 the objection that permitting therapeutic cloning will inevitably put us on a slippery slope toward reproductive cloning, 4,9,17,20,29,43,[76][77][78] and ethical questions related to paid egg donation.…”

“…First, several arguments are brought forward against the use of fetal cells, 6,17,37,50,73,[81][82][83] in particular embryonic germ cells: the primary source of these cells is induced abortion, which is in itself a morally controversial intervention; 37,50,73 some argue that using fetal tissue from elective abortion is a way of legitimizing abortion and this will encourage institutions to increase the number of abortions; 6,73 some fear that women might conceive specifically to obtain fetal cells via abortion. 6 Also controversial is the use of xenogeneic cells or materials for TE purposes.…”

Modern techniques in organ transplantation

“…Ta forma transplantacji jest wśród transplantologów uznawana za ostatnią formę ratunku (np. w Szwecji tylko 40% społeczeństwa zgodziłoby się na przeszczep organu zwierzę-cego, zaś 69% na przeszczep od osoby zmarłej i 77% osób od członka rodziny) [22]. Wśród problemów natury technicznej wymienia się m.in.…”