ORGAN DONATION
Organ donation
Organ donation is the removal of the tissues of
the human body from a person who has recently
died, or from a living donor, for the purpose of
transplanting.
Organs and tissues are removed in procedures
similar to surgery, ad all incisions are closed at the
conclusion of the surgery.
Simple, effective steps can be taken to provide a
traditional funeral viewing whenever this might be
desired.
People of all ages may be organ and tissue donors.
In numerical terms, donations from dead donors far
outweigh donations by living ones.
The laws of different countries allow either the
potential organ donor to consent or dissent to the
donation during his or her life time, or allow the
potential donors relatives to consent or dissent.
Due to cultural issues and different legislative
possibilities, the number of donations per million
people varies substantially in different countries.
Organs and tissues which can be
donated
Organs that can be procured include: the heart, intestines,
kidneys, lungs, liver, pancreas. These are procured from a
brain dead donor or a donor where the family has consent
for donation after cardiac death, known as Non-heart
beating donation.
The following tissues can be procured: bones, tendons,
corneas, heart valves, femoral veins, great saphenous
veins, small saphenous veins, pericardium, skin grafts, and
the sclera (the tough, white outer coating surrounding the
eye). These are only procured after someone has died.
Organs that can be donated from living donors include part
of the liver or pancreas and the kidney.
Recipient protection
To protect the person receiving an organ,
various health and safety tests are
conducted.
Because an organ transplant requires immune
suppression, it is important that the organ not
be infected with a disease that could harm
the recipient.
These tests are not perfect, but organ-
related infections are relatively rare.
Legislation regarding organ
donation
There are four different legislative
approaches to the donation, if the donor
has not explicitly dissented.
The least restrictive approach is the
dissent solutions, according to which the
donor has to explicitly dissent to donation
during his lifetime.
According to the extended dissent
solution, relatives may dissent in the event
the potential donor has not consented.
The different legislative approaches are the main
reason that countries like Spain (27 donors per
million inhabitants) or Austria (24 donors per million
inhabitants) have higher donor rates than Germany
(13 donors) or Greece (6 donors).
In most countries with the dissent solutions, there
is no waiting list for donations, or the list is short,
while most countries with consent solutions have
substantial organ shortages.
The reason for this is that, in both situations, most
people do not explicitly state their wishes. Thus, in
a country requiring dissent, most people will not
have dissented, while in country requiring consent,
most people will not have consented.
Bioethical issues in organ
donation
Since in the mid-1970s, bioethics, a relatively
new area of ethics, has emerged at the
forefront of modern clinical science. Many
philosophical arguments against organ
donation stem from this field. Generally, the
arguments are rooted in either deontological
or teleological ethical considerations.
Deontological issues
Pioneered by Paul Ramsey and Leon Kass, few
modern bioethicists disagree on the moral status of
organ donation.
Certain groups, like the Roma (gypsies), oppose
organ donation on religious grounds, but most of the
worlds religions support donation as a charitable
act of great benefit to the community.
Issues surrounding patient autonomy, living wills,
and guardianship make it nearly impossible for
involuntary organ donation to occur.
In issues relating to public health, it is possible
that a compelling state interest overrules any
patient right to autonomy.
From a philosophical standpoint, the primary
issues surrounding the morality of organ
donation are semantically in nature.
The debate over the definition of life, death,
human, and body is ongoing.
For example, whether or not a brain-dead
patient ought to be kept artificially animate in
order to preserve organs for procurement is
an ongoing problem in clinical bioethics.
Jewish medical ethics accepts organ donation as a
meritorious charitable act but with 2 condition; the
donor be deceased before removal of the organ and
the organ be treated respectfully.
The ethical problem stems from a lack of consensus
on the definition of deceased. According to the
strictest interpretation of halachah, deceased
means the cessation of all brain stem activity.
For most organs, this point is too late for the
donation to be medically useful; nevertheless, for
the adherent to this view, any prior removal would
be tantamount to murder.
Given the nature of the market for donated
organs, the second condition would limit
donation to a case where there is a known and
ready need for that specific organ.
Alternatively, a promise can be made to ensure
a proper burial for a donated organ in the event
that it is transplanted.
A movement to promote organ donation from
Jews to the general population in consonance
with halachah has been spearheaded by the
Halachic Organ Donor Society.
Teleological issues
On teleological or utilitarian grounds, the moral
status of black market organ donation relies
upon the ends, rather than the means.
Insofar as those that donate organs are often
impoverished and those that can afford black
market organs are typically well-off, it would
appear that there is an imbalance in the trade.
In many cases, those in need of organs are put
on waiting lists for legal organs for
indeterminate lengths of time-many die while
still on waiting list.
Organ donation is fast becoming an important
bioethical issue from a social perspective as
well.
While most first-world nations have legal
system of oversight for organ transplantation,
the fact remains that demand far outstrips
supply.
Consequently, there has arisen a black market
often referred to as transplant tourism.
The issues are weighty and controversial. On
the one hand are those who contend that those
who can afford to buy organs are exploiting
those who are desperate enough to sell their
organs.
Many suggest this results in a growing
inequality of status between the rich and the
poor. On the other hand are those who contend
that the desperate should be allowed to sell
their organs, and that stopping them is merely
contributing to their status as impoverished.
Further, those in favor of the trade hold that
exploitation is morally preferable to death, and
insofar as the choice lies between abstract notions
of justice on the one hand and a dying person whose
life could be saved on the other hand, the organ
trade should be legalized.
Conversely, surveys conducted among living donors
postoperatively and in a period of five years
following the procedure have shown an extreme
regret in a majority of donors who said that given
the chance to repeat the procedure, they would
not.
Additionally, many study participants reported a
decided worsening of economic condition
following the procedure
These studies looked only at people who sold a
kidney in countries where organ sales are already
legal.
Legalization of the organ trade carries with its
own sense of justice as well.
Continuing black-market trade creates further
disparity on the demand side: only the rich can
afford such organs.
Legalization of the international organ
trade could lead to increase supply,
lowering prices so that persons outside
the wealthiest segments could afford
such organs as well.
Exploitation arguments generally
come from 2 main areas:
Physical exploitation
Financial exploitation
Physical exploitation suggests that the
operations in question are quite risky,
and, taking place in 3rd world hospitals
or back-alleys, even more risky. Yet, if
the operations in question can be made
safe, there is little threat to the donor.
Financial exploitation suggests that the
donor (especially in the Indian subcontinent
and Africa) are not paid enough.
Commonly, accounts from persons who have
sold organs in both legal and black market
circumstances put the prices at between
$150 and $5000, depending on the local laws,
supply of ready donors and scope of the
transplant operation
In Chennai, India where one of the
largest black markets for organs is
known to exist, studies have placed the
average sale price at little over $1000.
Many accounts also exist of donors
being postoperatively denied their
promised pay.
Sources
Which Organs Can Be Donated for Transplantation? New York Organ Donor
Network.
United Network for Organ sharing : Organ Donation and Transplantation.
BBC News | Health | Fatal cancer passed on by organ transplant
CBHD: Transplanting HIV Positive Organs Into HIV Positive Patients- by Gregory
W.Rutecki
Abs-Cbn Interactive, Two Indonesians plead guilty in Singapore organ trading case
Straitstimes.com, CK Tang boss quizzed by police.
Zargooshi J (2001). Quality of life of Iranian kidney donors. J. Urol 166 (5): 1790-
9. PMID 11586226.
Goyal M, Mehta RL, Schneinderman LJ, Sehgal AR (2002) . Economic and health
consequences of selling a kidney in India. JAMA 288 (13):1589-93.PMID 12350189.
Why a Kidney (street value:$ 3000) sells for $ 85000
Poor Pakistanis Donate Kidney for Money-washingtonpost.com
BBC NEWS| Programmes | This World | Irans desperate kidney traders
JAMA-Abstract: Economic and Health Consequences of Selling a Kidney
in India, Oct 2, 2002, Goyal et al. 288(13) : 1589.
Inside Kidneyville: Ranis Story
The New Cannibalism
a b http;//press.psprings.co.uk/bmj/may/consent01088.pdf
Organizacion Nacional de Trasplantes
http:news.yahoo.com/s/20070718/hl_afp?
helathbritainorgan_070718135143
More countries hope to copy Spains organ-donation success
Corrections.com-The largest Online Community for Corrections: Jails
and Prisons. The waiting list for life.
a b c d American red cross- Statements from Religions". American
Red Cross. Retrieved on 2008-07-22
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