Organ transplantation is a medical procedure in which a donor gives up an organ for transplantation into the body of a recipient with the purpose of substituting a damaged or missing organ. The procedure is a significant medical advancement that has gained traction in recent years for both positive and negative reasons. On one hand, organ transplantation may be the last resort and salvation for a person suffering from a debilitating or even terminal condition. Statistically, out of the total of 2,200 operations, 50% of lung recipients survived for more than 5.5 years, thus, receiving a chance to live a longer and healthier life. However, the issue of distributive justice occurs when a resource is scarce, and someone in the decision-making position needs to decide who gets to receive it. This essay seeks to answer the question as to whether it makes medical and ethical sense to accept organ transplantation within a family.
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Before approaching the ethical side of the subject, it is important to outline general health requirements for organ transplantation. Both donors and recipients need to adhere to the national regulations when deciding to participate. The US legislation on organ transplantation requires organ donors to be in good physical and mental health. Obviously, an organ donor needs to be of age – at least 18 years old. Only candidates with normal weight can enter the pool (body mass index under 35). The following conditions will exclude a person from the pool of candidates:
- uncontrolled blood pressure;
- organ diseases;
- infectious diseases (“Living Donor Requirements”, n.d.).
Lastly, live organ donors need to have a strong support system to help them overcome the physical and emotional challenges that organ transplantation implies. Anyone who meets the aforementioned requirements can become an organ donor, be it a friend, a relative, a coworker, or even a kind stranger. However, according to the 1984 National Organ Transplant Act (United States), buying and selling organs is illegal. It is also against the law to bribe a person to become a donor or guilt trip them into donation.
Potential organ recipients also undergo an evaluation procedure to decide whether they will be on the list for organ transplantation. Each hospital might have their own regulations regarding donor organ distribution. Typically, however, the assessment criteria include the distance between the donor and the recipient, the severity of the illness, and wait length. Organ recipients are checked as to whether they are able to tolerate surgery. For example, a patient may not tolerate anesthesia, making the procedure dangerous for their health. Potential organ recipients are also checked for cancer – any malign growth is an exclusion criteria safe for skin cancer in some cases.
Now, the policies regarding organ donation obviously include the permissible types of relationships between the donor and the recipient. One may argue that the intra-family donations should not be even up for a public discussion since this decision should be personal if not private. However, as Kluge points out, organ donation is more than an altruistic gesture or a gift (12). Presenting a gift from one person to another occurs without an intervention by a third party, e.g. giving another individual a household object, jewelry, or other things that they might like or need. Donating an organ requires medical assistance at each stage, which transforms a presumably personal decision into a societal phenomenon. Therefore, as long as organ transplantation is not possible without using external resources such as health workers and medical equipment, it will be regularized.
Family Donors: Ethical Considerations
As it has already been mentioned, family members can and do donate organs to each other. Just like in case with any organ transplantation, the procedure is not devoid of ethical conflicts. To approach the issue of intra-family organ transplantation, one should assume the two main categories that it can be divided into:
- living donor transplantation;
- non-living donor transplantation.
Each of the cases presents its own set of challenges. When it comes to non-living donor transplantation, even given the consent of the donor, the rest of the family may be reluctant to act on his or her will. The phenomenon of organ donation refusal is well-researched in medical and psychological literature. For instance, Duffner and Harris argue that the donor’s relatives often cannot proceed with donation due to their grief (330). Their bereavement does not allow them to mutilate the body of their deceased relative, which is understandable. One may imagine that even within a family, this would complicate the procedure. Knowing that the harvested organ would serve a good purpose saving another relative’s life does not make processing the loss any easier.
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At the same time, organ transplantation within a family eliminates the issue of unequal or unfair distribution – at least partly. According to Dunhaf and Harris, families often refuse to execute the deceased relative’s will due to their mistrust in the healthcare system (329). They used to love the person dearly and they would hate the idea of his or her organs being transplanted to someone who presumably does not deserve such grace (Dunhaf and Harris 329). One example is a series of medical scandals in Germany in 2010. The medical community uncovered that doctors involved in the procedure found a way to fast-track patients’ cases to make the preferred ones to reach the “destination” faster (Dunhaf and Harris 329). The families of the deceased donors were rightfully enraged: something that they saw as an altruistic gesture and a sacrifice became a means to manipulate the system.
By 2012, the situation in Germany had aggravated to the point that the resource had become extremely scarce, dropping by as much as 40%. One may presume that probably the second significant reason for families’ reluctance is not knowing the organ recipient. This leads to the first advantage of intrafamily transplantation. A family member deciding to donate within a family knows exactly who will receive the organ. They do not have to worry about distributive justice – instead, they see that their sacrifice pays off well.
The second major advantage of donating within a family is the presence of a support system, which of course, is relevant in the case of living donor transplantation. As it has been mentioned before, the procedure puts a strain on a donor’s physical and mental health. Organ transplantation typically requires a longer period of recovery from the recipient as opposed to the donor (Ahmadian et al. 53). If the operation happens within a family, both people may get sufficient support when needed. Moreover, they get to communicate with each other, which may also mitigate the adverse psychological effects of the surgery.
For all its advantages, organ transplantation within a family can be quite problematic. To think, by designating a donor and a recipient, a family is practically granted the right to choose who shall live. As it has already been mentioned, one of the greatest ethical conundrums in organ transplantation is distribution. There are certain policies that prescribe who is “served” first given the scarcity of the resource. Childress speaks at length on the issue of worthiness – the author ponders the mechanisms of selecting recipients apt for transplantation (345). At the end of his reflection, Childress concludes that probably the most just way to go about it would be to employ an algorithm choosing people at random, so that everyone has an equal chance to be selected (354). If a family is entitled to choose, it may mean that they determine the worthiness of a person merely based on the fact of being related by blood.
One may readily imagine situations when a family member would not be normally selected for transplantation on the grounds of their lifestyle, but their family would insist on the operation. A prime example would be helping an alcoholic get a liver transplant. Moss and Siegler argue that this demographic should be lowered in priority when selecting recipients (1295). It does not mean that they will be excluded altogether, but they will have to make lifestyle changes to be eligible. In a hypothetical situation, a family might try to overcome these boundaries by hiding certain facts about a person’s lifestyle. All in all, family dynamics and the emotional component involved make the issue of donation even more complicated than it is on its own.
For all its medical advantages, organ transplantation gives rise to a number of ethical concerns. One of such concerns is exactly how organ transplantation should be regulated to be in line with so-called distributive justice. One way to go about just distribution of the resource is to promote intra-family donations. However, both pros and cons of this type of donation should be considered. In case of a non-living organ donation, a family will know exactly who receives the organ (another family member), so they will be at peace. If the donor is alive, both them and the recipient are likely to receive help and emotional support from the rest of the family. On the other hand, intra-family donations set an unhealthy dynamic. The main issue with family donations would be that families would get to prioritize their relatives before all others, which is unfair in the grand scheme of things.
Ahmadian, S., et al. “Tools for the Measurement of Psychological Aspects of Organ Donation among the Families of Brain-Dead People.” International Journal of Organ Transplantation Medicine, vol. 9, no. 2, 2018, 53.
Childress, James F. “Who Shall Live when not All Can Live?” Soundings: An Interdisciplinary Journal, vol. 53, no. 4, 1970, pp. 339-355
Dufner, Annette, and John Harris. “Trust and Altruism—Organ Distribution Scandals: Do They Provide Good Reasons to Refuse Posthumous Donation?.” Journal of Medicine and Philosophy, vol. 40, no. 3, 2015, pp. 328-341.
Kluge, Eike-Henner W. “Designated Organ Donation: Private Choice in Social Context.” The Hastings Center Report, vol. 19, no. 5, 1989, pp. 10-16.
“Living Donor Requirement.” Web.
Moss, Alvin, and Mark Siegler. “Should Alcoholics Compete Equally for Liver Transplantation?” JAMA, Vol. 265, No. 10, 1991, pp. 1295-1298.