The paper discusses various legitimate standpoints, issues of moral, ethics and interprofessionalism that emerge in the bone marrow donation process and eligibility conditions. Some emphasis is put on how these factors shape the public, societal and judicial approach on the subject of bone marrow donation. The impact of these standards on inference, evaluation and communication in legal and ethical terms is explored.
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A bone marrow transplant (BMT) is a protocol performed to replace worn out or destroyed bone marrow with viable marrow stem cells (Garcia et al., 2013). Bone marrow is a matchless cell product that has a potential for treating life-threatening complications such as cancers. The transplanted stem cells may be obtained from the patient himself, from the donor or from the umbilical cord blood immediately after birth (Garcia et al., 2013). Donor stem cells are harvested in two ways. In the first method, a minor surgery is done when the patient is anesthetized and the bone marrow is extracted from the back of hip bones. In the second method, which is referred to as peripheral blood stem cells apheresis or simply as PBSC, the donor is treated with medicines such as granulocyte-colony stimulating factor (G-CSF) or filgrastim to mobilize the stem cells to enter the blood stream (Garcia et al., 2013). Then the blood is obtained from the donor intravenously and fractionated in a machine to obtain the part of white blood cells containing stem cells.
Bone marrow donors-to-be may decide to donate to ailing loved ones or to strangers. Not everyone can donate bone marrow because certain health related issues may bar a person from being an eligible donor. These factors include old age restriction, life threatening diseases such as HIV/AIDS and autoimmune diseases, pregnancy and the weight of the donor. Garcia et al. (2013) note that the choice to donate may emanate from “the desire to save life, family loyalty, building a positive identity, religious conviction, and social pressure and obligation” (p. 1047).
However, a donation of bone marrow products must not endanger the donor, or disrupt his welfare and autonomy at all. It is therefore the mandate of the donor registry to make sure that the donor fulfills the average health standards, and that “the requested donation does not interfere with the donor’s psychological, economic, personal, moral, ethical, spiritual, and religious standards” (Bakken, van Walraven & Egeland, 2004, p. 226). Undesirable outcomes suffered by a bone marrow donor are several, and should be minimized as possible. Firstly, one is likely to experience health complications such as hemorrhage, pain, discomfort and probable future health risks. Sometimes one suffers from family coercion, hatred or guilt. Additionally, family members may feel compelled to donate when they have a sick loved one and therefore act without consent. Similarly, donors do not have advocates – as it is the case with patients – and may be faced with a daunting and complex process with no one to guide or advise them.
Bone marrow donation laws exist for two major purposes: (1) to help ensure a safe and unbiased donation, collection and distribution and (2) broaden the pool of prospective donors in an endeavor to increase the number of bone marrow stem cells for transplant. Several legislative acts addressing issues such as organ shortage, improved collection and distribution, encouragement of organ donation and procurement in engaging hospitals, health benefits and insurance coverage have been instituted. An example of the law affecting the organ donation, including bone marrow is The National Organ Transplant Act (NOTA) that was passed by the United States Congress in 1984 (Vitale, 2011). The act was passed unanimously to curb the likely commercialization, permanent defacement of the human body, to prevent the commodification of the human body, and unjust exploitation of the poor who may risk selling their organs for money.
Decision making concerning medical procedures purposed to benefit another person is complex. While many bone marrow transplants are autologous, a significant figure, especially childhood transplants rely on donors, even children and adolescents. Hence, medical and legal systems are faced with a challenge to decide when healthy individuals are needed to go through insignificantly risky, but painful routines for the benefit of the critically sick. While adults have the freedom to decide whether to donate, minors do not have this privilege. The society vests powers on the parents to act in the best interest of a child, not powers to use the child’s body for the benefit of another. Thus, in the case of syngeneic or autologous bone marrow transplants where parents may be forced to decide in favor of the sick, it is imperative that there are laws protecting the rights and dignity of the donor. Donors are protected by the legal system in two basic ways. One is through the courts where the judges decide on the possibility of a transplant to proceed and also handle lawsuits that ensue in the event that a donor incurred harm in the harvesting process. The second is through the utilization of legal and judicial specialists in the formulation of policies and procedures.
The key legal issue in BMT is whether the prospective benefits to the donor outweigh the risks and in the minors, whether the parents are permitted to consent to the procedure on behalf of youngsters. The concern about would-be minor’s consent is core to the policies and procedures of many BMT centers. For instance, some centers take each donor’s case before the court and have the analysis procedure planned to give the court full reassurance that the decision to donate was made by all the parties freely and without compulsion.
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The ethical issues arising as pertaining bone marrow donation deal with protecting the interests of both the donors and the patients. The recommendations and rules for the safe and ethical use of bone marrow donors are re-evaluated and revised frequently in order to remain compliant with the dynamic international legal and regulatory demands. Ethical issues such as “eligibility, commitment, obligation, donor autonomy and integrity, the right of involvement and the right to select a volunteer, and the registry expectations” are relevant (Bakken et al., 2004, p. 226). It is worth noting that any volunteer donor is protected by his/her autonomy, which safeguards the donor’s welfare and integrity. It also dictates that the donor be informed about the repercussions involving both him/her and the patient, and also of every step during testing and the donation process.
The donor’s sense of obligation to meet the needs of the patient should be put to check to prevent him/her from being engaged beyond his/her abilities. It is done by the donor center by carefully assessing the psychological and emotional factors-such empathy, contact between the donor and the patient- which are likely to elevate it. Also, the aspect of volunteerism as a basic principle in bone marrow donation as compared to donation of other body organs raises a debatable topic. The World Marrow Donor Association (WMDA) recommends donors not to “be paid, but reimbursed for expenses incurred during the donation process” (Weisz, 1992, p. 185). Legal refusal to compensate prospective bone marrow donors discourages more donors from coming forward and this decreases chances of saving lives of dying patients. The substantial compensations lure thousands of men and women annually to donate ova and sperm to unproductive couples hoping to conceive yet a similar gesture for bone marrow donors to save lives is illegal in the United States and might warrant a five years imprisonment to the culprit (Shaw et al., 2010).
Removal of bone marrow from the list of restricted organs should be implemented. This should be followed by addressing other ethical issues that emerge as a result of the free organ transplant market. Stopping the misuse of needy donors must be addressed if compensation for BMT is to be legalized. Importantly, the procedure by which donors ought to be selected and matched and how much donors should be paid should be addressed entirely. To solve the issue of hiking the bone marrow price, governments aided by medical and economists should institute a fixed sum of money to compensate bone marrow donors.
The campaign for an interdisciplinary approach in the delivery of health has been viewed by planners and practitioners as a broad-minded discourse, in the hope that it would affect positively on the value of services that the public receives (Irvine, Kerridge, McPhee, & Sonia, 2002). Thus, it is common to find professionals sharing the same communicative approaches, methodologies, perspectives, and therapeutic strategy. However, professionals vary in the type of knowledge and expertise that they add to the production of satisfactory patient endings. Likewise, the fields the professionals pursue, the questions and problems that they believe are important also differ.
Patients usually present with complex needs which are categorized as medical and social, thus could only be met by a cooperation between health care and social service providers. The complexity of BMT and the legal, ethical, and moral issues it elicits demands greater involvement of professionals from different fields. Collaborative efforts are required, just from the start of donation legal and medical procedures and in the establishment of bone marrow registries, laws, policy and procedures. Interdisciplinary collaboration is the main drive behind the remarkable breakthroughs in biomedical technology that has seen improved transplantation success, efficiencies and reduction in adverse effects that is comparable to those made in the area of blood transfusion.
Interpretation, Analysis and Communication.
First, consenting to donate an organ is based on personal beliefs. Cultural beliefs, mythologies and religious ideas play an important role in determining agreement or refusal to donate organs. Secondly, the society has a strong judgement over commercialization of organ donation. Social ethics and values prohibit commodification of organs as the process has inherent dangers and corrodes social, moral and ethical values and cannot be an acceptable substitute to organ shortage in any civilized society. It also abuses the Univeral Declaration of Human Rights and the WHO constitution. There is a need for an open and democratic space that has solid social institutions that promote social fairness, political liberty, bodily integrity and other human privileges.
Also, it has been observed that there is an intense and endless racial, class and gender disparities and prejudices in acquiring, harvesting and circulation of organs. The poor, the women, the black and brown donate to the rich, the men and the whites following the old route of capitalism. Though transplantation has been successful as a life-saving tool, the general interpretation is that this ought not to be used to justify the ill-treatment of the poor people as a source of organs for the affluent.
Similarly, misinterpreting the bone marrow donation law may lead to exploitation of the donors, patients or botched up engagements as it opens doors to fraudulence. This transcends into unfruitful judicial proceedings as bone marrow donations are not payable. Undeniably, coverage of such an incidence by the fourth estate leads to tightened regulations by the authorizing body, at times even preventing the clearance of genuine donation cases.
The social division of planning is the main stumbling block that confronts interdisciplinary cooperation in BMT process. In many nations the separation of authority for the provision and delivery of health and welfare services between the national and regional administrations culminate into long and red tape procedures that delay the re-evaluation of laws, guidelines and policies surrounding the advancement of bone marrow transplant technology. Changing the old tradition of health division of labor where medical field exerts dominance over other careers also helps to boost interdisciplinary relationships as it ensures equal professional recognition and also gives equal authority over matters to do health and illness.
Legal, moral, ethical and interdisciplinary topics present donors, the donor’s family, donor center/registry, courts, and legal consultants with innumerable factors to contemplate before arriving at the decision to carry out a donation. As has been shown, these factors are the basis for informed decision making by the government, guardians on behalf of underage donors, and the public to enroll in donor registries. The ethical considerations are also useful for the authorization council to ascertain the qualifications and therefore license health centers as donor registries. In addition, the legal factors could help courts make a ruling as pertaining to issuance of the permit to the donor center to harvest bone marrow, and litigate cases.
Bakken, R., van Walraven, A.M., & Egeland, T. (2004). Donor Commitment and Patient Needs. Ethics Working Group of the World Marrow Donor Association: Bone Marrow Transplantation, 33(1), 225–230.
Garcia, M.C., Chapman, J.R., Shaw, P.J., Gottlieb, D.J., Ralph, A., Craig, J.C., & Tong, A. (2013). Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies. Biology of Blood and Marrow Transplantation: PubMed, 19(7), 1046-1058.
Irvine, R., Kerridge, I., McPhee, J., & Sonia, F. (2002). Interprofessionalism and Ethics: Consensus or Clash of Cultures? Journal of Interprofessional Care: Business Source Complete, 16(3) 199-209.
Shaw, B., Ball, L., Beksac, M., Bengtsson, M., Confer, D., Diler, S., Fletcher, M., & Walraven, A.M. (2010). Donor Safety: The Role of the WMDA in Ensuring the Safety of Volunteer Unrelated Donors: Clinical and Ethical
Considerations. Clinical Working Group and Ethics Working Group of the WMDA: Academic Search Premier, 45(1), 832-838.
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Vitale, M.G. (2011). National Organ Transplant Act’s Ban on Bone Marrow Donation Compensation: Legal Compensation Create a Life, But Not to Save a Life. St. John’s Law Review: Academic Search Premier, 85(1), 1221 -1250.
Weisz, V. (1992). Psycholegal Issues in Sibling Bone Marrow Donation. Journal of Ethics & Behavior: Business Source Complete, 2(3), 185-201.