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The Ethics of Organ Donation

The medical field has made significant advances over the years which have resulted in the development of cures for hundreds of diseases leading to lower mortality rate and higher chances of recovery from ailments for people. This has undoubtedly improved the quality and/or prolonged the lives of many patients. In the past few decades, inventions and scientific breakthroughs in the biological field have resulted in the prevalence of access to sophisticated equipment and advanced diagnostic procedures that were once only in the reins of research institutes and few specialized hospitals. Arguably one of the most novel innovations has been the use of donated organs in transplantation surgeries. The transplantation process often refers to the replacement or removal of ailing body organs. This practice has literally given patients whose dysfunctional organs would have otherwise been an irrevocable death sentence in earlier years a chance to live longer.

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The fundamental reason for organ transplantation is to restore health or extend the life of the ailing patient. However, a scarcity in the number of organs available has limited access to the organs despite their high demand. In addition to this, debates mostly on moral and ethical grounds have been developed dwelling mostly on the ethical standards surrounding organ donation.

The Center for Bioethics defines an organ transplant as “a surgical operation where a failing or damaged organ in the human body is removed and replaced with a new one” (1). This kind of procedure can be undertaken on any body organ that has a specialized function such as the heart, the liver, kidneys, intestines and the pancreas. The various types of transplants may be broadly categorized as human to human and animal to human transplantations. The most prevalent form of transplantation at the present is human to human organ transplant which involves acquiring the required organ from a human being. Organs from human donors can be obtained from recently deceased people or from a living donor who are in most cases close relatives of the patient. The acute shortage of available organs has led to a situation whereby majority of the people who need organ transplants are not getting them on time or have to wait for long periods of time to get the organs. The United Network for Organ Sharing (UNOS) which maintains a real-time database of the status of people awaiting organs reveals that over 106,612 people are currently on the waiting list for organs in the USA. On the other hand, it is estimated that 20 patients die on a daily basis while waiting for an organ for transplantation. It is therefore evident that the current sources for getting organs are inadequate (Center for Bioethics, 14). Due to this shortage, incidences of illegal organ sale have cropped up in various parts of the world as desperate patients try to go around the long processes experienced before qualifying for an organ transplant.

Agreeably while the act of organ donation is welcomed in the medical circles as well as by the general citizenry, many controversies have developed based on how donated organs are acquired and the criteria followed during their distribution. This paper shall therefore evaluate the ethics of organ donation. Several of the arguments raised by ethicists and medical practitioners in regards to the ethical dilemmas faced in organ donation and distribution as well as their counter- arguments shall be looked at to create a better understanding on the ethics that surround organ donation. Arguably, while organ donation offers a means through which lives can be saved, ethical and human safety issues surround the practice.

Bioethics refers to the study of ethical controversies that emerge in the biological and medical realms. Over the decades, ethics and professional code of conduct have become increasingly important in pursuit for the development and sustenance of human health. According to data presented by the United Nation for Organ Sharing (UNOS), organ donations and transplantations are arguably among the most controversial topics amongst bioethicists.

Nowadays, organs can be donated from two sources. They can be obtained from living donors or from cadavers. One of the most vexing ethical debates surrounding the organ-acquisition system in the US stems mostly from the cadaveric method of organ donation. According to US laws, when a person wants to donate his organs, he must obtain a donor card. However, signing the card does not mean he is qualified to donate his organs after his death. Hansen asserts that in order to qualify as a cadaveric donor, the donors must have died from a “traffic accidents, gunshot wounds, or other circumstances that render them brain dead” (14). In other words, to qualify as a cadaveric donor, the brain of the donor must have incurred irreversible damage. After this has been confirmed, the doctors can then proceed to the organ harvesting but only after the family of the donor have consented to the organ donation. This means that the donation process can only proceed if the family acknowledges and signs off to the donation. Unfortunately, a survey presented by Goodwin indicates that, “More than 50 percent of families refuse to donate their organs” (28). Hansen attributes this refusal to the emotional trauma that follows after the death of a loved one (19). The author reiterates that this refusal stems from the general lack of adequate information about the benefits and importance of organ donation. He further asserts that due to cultural and religious differences, many people view cadaveric organ donation as a disrespectful act against the departed. This negative attitude towards organ donation has consequently led to the prevalent shortage in organs for transplantation. On the other hand, finding viable solutions for the shortage has led to many ethical controversies and disputes in the US. For example, many medical practitioners have at times been faced with the dilemma as to whether they should harvest the organs without the consent of the family members or not in order to save a life. In addition to this, others have taken this opportunity to make some extra cash on the side by selling the organs illegally to desperate individuals. Such decisions question the ethical boundaries set to govern organ donation. However, in as much as the act of harvesting organs in such situations seems unethical, lives can be saved in the process.

The distribution system of donated organs in U.S. also presents ethicists and medical critics with a chance to dispute the practice. Ethically speaking, medicine is founded under a very strong principle which is to alleviate human suffering by improving the health of the body and prolonging lives. This means that all medical practitioners have a sworn duty to preserve, respect and maintain life on an objective level. However on many occasions this does not seem to be the case. For example, getting an organ transplant in US is an expensive ordeal and the selection criterion has been rated as unfair by most of the people in the states. The multiple-listing policy which allows patients who are knowledgeable and able to travel to register and be placed on as many transplant waiting lists as possible in different regions has induced ethical debate towards the organ-allocation system. Many scholars and ethicists view this policy as unethical because only the rich can benefit from this policy while the poor wait for years in order to climb up the waiting list. However Hansen defines and supports the policy which is designed to increases patient’s mobility and gives them autonomy (13). In addition to this, the organ allocation criteria, which are suggested by the UNOS, have caused many disputes. In his book, Hansen reveals transplant centers that are responsible for getting patients in waiting lists and mentions how they successfully help the patients. He also elaborately suggests that the reason why people think UNOS’s organs allocation criteria is unfair is because they have included people with unhealthy lifestyles on organ waiting lists (15). However, one of the transplant centers, The “Barnes-Jewish Hospital” argues that society should give a chance to patients who promise to change their lifestyles.

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On the other hand, finding ethical solutions to solving the organ shortage problem has also brewed some debate. Some people suggest that legalizing the organ market will lessen the shortage while others bank on animal organ transplant as the ultimate solution to the problem. The lack of adequate organs for transplantation has resulted in the increased suffering of patients and escalation of their hospital bills. Wilmut note that due to the shortage in organs caused by a lack of a market oriented means for acquiring the organs and long waiting lists, many patients have to bear with painful medical procedures such as dialysis as they await organs for an indefinite number of years (112). Some patients end up dying as they wait and the medical expenses reach an excess of $50,000 per year.

Due to the desperation that springs as a result of organ shortages, many wealthy people opt for buying the organs from the black market where priority is given to the highest bidder. In his literature, Demme reports that some of these organs found in the black market are obtained through horrible means such as drugging unwilling victims and performing involuntary nephrectromy on them to obtain the desired organs (48). Reports of the illegal organ traders not paying the donors as promised are also rife thus highlighting the lack of ethics and injustices that exist in an illegitimate and unregulated market. Creating a legitimate framework for commerce in organs would lead to a condition whereby the donors would be paid their dues and the regulated environment would ensure that cases of involuntary nephrectromy would be greatly reduced. The cost per organ would also be greatly reduced since its inflated cost is mostly as a result of the monopoly that illegal traders hold in the market. Consequently the establishment of a legal market for organ donors would suffice in the abolishment of the unethical practices used in obtaining these organs in the black markets.

In a bid to find a lasting solution, other people have suggested transplanting animal organs into humans and cloning human organs as a means to tackle the organ shortage problem in the future. Some of the basis under which animal organs have been objected against is rumored to evolve around the problem with organ rejection and infections which make transplantation of the same a risky procedure. However, Wilnut asserts that new generations of immunosuppressive drugs as well as improved medical procedures have made it possible for transplants to be accepted by the body with increased safety for the patient (56). This means that the traditional restriction of organ donations to be primarily from close relatives for compatibility issues has been removed by these new drugs. With the waiting list growing by the day and the current reliance on human donations not meeting the needs, turning to animal organs presents a viable solution which would lead to increased availability hence shortened waiting time for patients.

In addition to this, more research is underway which aims at producing animals (clones) whose blood groups and organs are genetically engineered to survive or be accepted by the human body. Upon the success of such innovative venture, the issue of compatibility will be resolved as well as that of the organ supply shortage that is evident globally from the long waiting lists in different areas. On the same note, cloned or genetically engineered animals have been known to breed faster (2 to 3 years) and will therefore produce harvestable organs at a much faster rate than humans thereby catering for the organ deficit. Noticeably, being mammals, the difference between the human and most animal organs is slight and if the aim of such transplantations is to preserve and save lives then it is a cause worth taking.

Since there are not enough organs for everyone who needs it, the right and moral way to distribute organs has been widely discussed. Some people may think organs should be distributed according to medical needs, personal merits or social contribution. Wilmut suggests that the distribution of these scarce organs should be based according to “a potential recipient’s blood and tissue types, immune-system status, length of time spent on the waiting list, and medical urgency” (52). The criteria suggested by the author seem to be ethical and fairer.

However, some critics as well as ethicists claim the UNOS suggested organ allocation criteria are unfair because they includes people on the organ waiting list with unhealthy lifestyles, like tobacco smokers, alcoholics and aged members of the society(70years and above). They claim that these types of patients should not have an equal opportunity to receive the organs as opposed to patients who take care of their health properly. Hansen asserts that since the transplant centers are responsible for placing patients on the waiting list for donated organs, “the decisions of putting alcoholics, smokers and other people with unhealthy lifestyles on organ waiting lists are made by individual transplant centers, not the UNOS” (8).

In 1984, the National Organ Transplant Act illegalized the market of human organs. Some of the grounds on which the ban on organ sales was made were on the arguments against profiteering from such business. Goodwin, one of the adherent proponents for legitimizing organ sales explains that this is an irrelevant argument all the other parties involved in the transplantation process (physicians, hospitals and recipients) profit in some manner from the transplantation (145). As such, it is only the altruistic donor who does not reap any tangible benefit from the transplant. It would therefore be justifiable for the organ donor to be monetarily compensated for their organs since some of the other parties involved, most notably the surgeons and hospital also make financial gains from this endeavor. It is therefore unethical to dictate that the donor makes no gain from his organ while not imposing the same on the other parties in the process.

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As such, opening up the organ harvest market is one of the solutions suggested to solve the organ shortage problem. However, this has stirred up a large number of complaints and debates in the U.S. while some people believe that legalizing the organ harvest market benefits society and can solve the organ shortage problem in the U.S, others feels that opening up organ market is unethical and immoral. Kaserman and Barnett reiterate that if there is a market for organs, the organ donation rate will increase significantly because of economic incentives (124). In addition to this, the authors refer to the September 11 terrorist attacks as an example to point out that it is wrong for people to think opening up organ marketing is unethical. He says that “more than twice the number killed in September 11 terrorist attacks died due to a shortage in organs available for transplantation” (127). It is completely unethical to let so many people die every year simply because some people think it is wrong to donate their organs or pay organ donors.

Despite the various arguments presented in favor of commercialization, there exist some real threats to legalizing human organ sales. A particular fear is that this trade would invariably lead to the poor especially of the third world countries being preyed upon by the rich from developed countries. This is a well founded fear and an unethical move considering the fact that majority of the buyers in black markets are rich people from developed nations Chopra document how poverty combined with the allure of easy money make a poor man from Brazil sell one of his kidneys to a rich Israeli (8). This is a classic case of how the desperation of the poor can be exploited should this trade be legalized. Despite arguments that the selling of body parts leads to the donors faring better as a result of the money earned, research demonstrates that the sale of organs does not alleviate poverty as proponents for the same insinuate. A study by Goyal et at shows that in India “87% of those who sold a kidney reported deterioration in their health status… and of those who sold a kidney to pay off debts, 74% still had debts 6 years later (1591)” In such scenarios, paternalism (which in this case involves the government coming in to protect the poor people from themselves) may not only be necessary but actually preferred.

Also, while there are valid reasons for blocking the introduction of trade in organs, we must not fail to consider that without a legitimate market for organs, the black market continues to flourish mostly at the expense of the donors who do not receive nearly adequate compensation for their organs. In addition to this, the current organ shortages have led to human rights crises in countries like China where organs from executed criminals are harvested and sold off. In a rather shocking twist, this unethical behavior continues to thrive despite the widespread condemnation of the practice by human rights groups all over the world.

Furthermore, as has been demonstrated in this paper, the reliance on altruism has resulted in untold suffering and death of patients as they wait for organs to become available. This is unethical and goes against the very principle on which medicine is founded, that is to alleviate human suffering by improving the health of the body and prolonging lives. It is therefore the ethical and moral obligation of medical professions and the society at large to seek out any feasible ways though which the unnecessary suffering and death of the patients can be alleviated. The use of animal organs and the legitimization of organ commerce present the best means through which a lasting solution can be found.

Ideas such as the cloning of human organs should therefore be enacted in order to supplement the number of organs available for use. To support this statement, Wilmut suggests that cloning only part of the human body is ethical. He suggests cloning parts of the human body can indeed supplement on the organ shortage experienced globally (536). Although there are still lots of obstacles and criticism in transplanting animal organs into human and cloning human organs, in the near future when technology is improved, these two solutions may be broadly used to increase the availability of human organs and solve the shortage problem.

Organ donation induces various ethical controversies in US. One of the widely concerned controversies about it is the equality of the organ-allocation system in the U.S. The other controversy is solving the organ shortage problem. This can be countered through the legal buying and selling of organs in an established market. This paper set out to explore the ethical standards that evolve around organ donation in the United States. The various arguments developed by different scholars and ethicists have been discussed. Recommendations such as the approval of xenotransplantation as well as legalizing commerce in organs donation have been suggested as means through which the shortage in organs can be tackled. In additional to this, the ethical boundaries surrounding these methods have been discussed and possible remedies made. The animal to human transplantation has pulled in a lot of ethical controversies over the decades and as discovered, the risks prevail over the potential benefits that can be accrued from this method. On the other hand, the advantages to be gained by commercializing organs for transportation far outweigh the perceivable risks. As such, commercialization of this area will not only improve the ethics that govern the practice but also offer a solution to a problem that is claiming more lives on a daily basis. However, care should be taken to ensure that this trade is not exploited by unscrupulous person for their own benefits at the cost of the organ donors and recipients who should be the beneficiaries of these new measures.

Works Cited

Center for Bioethics. Ethics of Organ Transplantation. Center for Bioethics, 2004. Web.

Chopra, Aunj. “Harvesting Kidneys From the Poor for Rich Patients.” US News and World Report. 2008. Web.

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Demme, Richard. “Ethical Concerns About an Organ Market.” Journal of The National Medical Association. 102 (2010): 46-50. Web.

Goodwin, Michelle. Black Market: The Supply and Demand of Body Parts. New York: Cambridge University Press, 2006. Print

Hansen, Brian. “Organ Shortage.” CQ Researcher. 13 (2003): 153-176. Web.

Kaserman, David and Barnett, Hubbard. The U.S. organ procurement system: a prescription for reform. USA: American Enterprise Institute, 2002. Print.

Wilmut, Ian. Perspectives on Contemporary Issues: Reading Across the Disciplines. Boston: Wadsworth, 2008. Print.

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