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The ethics of organ transplantation is an area of bioethics and medical ethics concerned with the ethical issues surrounding organ donation and transplantation. Organs may be procured from two kinds of donor—deceased donors and living donors—each of which raises distinct ethical issues. Organ procurement from deceased donors raises questions about how to define death, whether defining death matters, and under what conditions it is ethical to harvest organs; procurement from living donors raises questions about the harms and risks that may be inflicted on the donor in order to benefit the recipient, and whether and to what extent the donor's relationship to the recipient is morally relevant. Additional ethical issues are raised by the provision of incentives for organ donation and by the way in which organs are distributed to recipients.

Deceased donors[edit]

Most organs come from deceased donors (also known as cadaveric donors).

Defining death[edit]

Circulatory death[edit]

Circulatory death.[1]

Really death.[2]

Not really death.[3][4]

Brain death[edit]

Brain death occurs

Really death.

Not really death.[4]

Other definitions of death[edit]

Distinction between death of the person and death of the organism; a person can be dead, even if her body is alive.[5]

The dead donor rule[edit]

It is normally supposed that cadaveric organ donation is only permissible once the donor is dead, a provision that is known as the dead donor rule. Some ethicists have criticised the dead donor rule, arguing that there are circumstances in which it may be permissible to procure vital organs from donors who are not yet dead.[6][7][8][9]

Concerns. [10]

Organ donation euthanasia.[11] Organ donation combined with euthanasia is practiced in Belgium.[12]

Donor selection[edit]

Opt-in system[edit]

In other words, explicit consent is needed.

Opt-out system[edit]

Switching from an opt-in to an opt-out system can lead to significant increases in organ donation rates, which in turn can save lives.[13][14]

There is some debate over whether an opt-out system involves consent. According to some authors, those who refrain from opting out have given their presumed or implied consent to become organ donors.[15][16][17] However, some argue that it allows the harvesting of organs without consent.[18]

Than the universe.

Required response[edit]

Idea is to ensure that everyone—or nearly everyone—states whether or not they agree to become an organ donor; in cases where no response is given, next-of-kin would decide.[19]

Routine retrieval[edit]

A duty to leave organs to society.[20]

Organs as a societal resource.[21]

Conditional societal approbation.[22]

For.[23]

Against.[24] We have rights of bodily integrity and personal sovereignty that extend past death, precluding routine retrieval of organs without consent.[25]

Living donors[edit]

non-vital organs are sometimes transplanted from living donors. There are two reasons for utilising organs from living donors rather than deceased donors: first, the supply of cadaveric organs is insufficient to meet demand; and second, transplantation from living donors is sometimes associated with better recipient outcomes.

Non-maleficence[edit]

The principle of non-maleficence is widely recognised as one of the fundamental principles of bioethics:[26] above all, do no harm. Organ transplantation from living donors seems to contradict this principle, since the donor is necessarily subject to harm. Furthermore, the donor is subject to the risk of even greater harm, including the risk of death. The donor mortality rate for living kidney donation is 0.03 percent,[27][28] while the rate for adult-to-adult liver donation may be as high as 0.5 percent.[29]

The infliction of harm on patients is not unique to living organ donation. Indeed, many routine procedures are associated with some harm to patients; surgery is associated with pain, for example. In most cases, these harms are justified on the grounds that the expected benefit to the patient outweighs the expected harm. Living organ donation is unusual in that the donor is harmed in order to confer a benefit on someone else. (Clinical trails pose the same ethical problem).[30]

Ethicists have overwhelmingly rejected the non-maleficence objection to living donor organ transplantation.[31] Some ethicists have argued that, while living organ donation violates the principle of non-maleficence, we ought to reject the principle; it is permissible to inflict harm on patients as long as they give their informed consent.[18]

Weighing risks and benefits[edit]

It is generally recognised that live organ donation is only ethically acceptable if the benefits of the procedure outweigh the risks.[32] Thus, the benefits to the recipient must outweigh the risks to the donor.[8][33][34]

An alternative view is that live organ donation is only permissible if the benefits to the donor outweigh the risks. On this view, harms to one person may not be weighed against benefits to others. This view is supported by.[35] However, it may be argued that psychological benefit only justifies living donation where the donor and recipient are related, and not donation by unrelated individuals.[36]

Drawing on the concept of equipoise in clinical research, some authors have advocated a double equipoise model—so called because it seeks to balance the risks and benefits to two parties: the recipient and the donor. Double equipoise places a limit on the amount of risk that a living donor may undertake, and requires that the expected benefit to the recipient pass a minimum threshold before any risk to the donor is justified.[37] However, even in clinical research, the concept of equipoise is controversial. Some authors argue that clinical equipoise is irrelevant, and that it is the informed consent of the parties involved that justifies clinical trials.[38]

Consent[edit]

Another principle widely considered to be fundamental to bioethics is that of autonomy,[26] which is usually taken to be closely tied to informed consent. Some ethicists argue that when autonomy conflicts with other principles, it should normally take precedence.[39]

However, it is normally thought that there are limits to the extent that consent can justify harm to donors. For example, while it has been argued that healthy individuals should be permitted to sacrifice their lives in order to donate their organs,[40] ethicists have typically argued that such sacrifices would be impermissible.[41][42][43]

According to one survey, most people would be willing to tolerate a mortality risk of up to 21 percent if a loved one needed a liver transplant.[44]

Relation to recipient[edit]

Most living donors are closely related to the recipient. However, some individuals choose to donate non-vital organs anonymously to strangers.[45] In a notable instance living anonymous organ donation, Zell Kravinsky donated a kidney to a stranger, having already given away most of his multimillion-dollar fortune.[46]

Relationship to recipient does not alter level of acceptable risk.[32]

Relation to recipient does alter the level of risk, since family members have duties to one another that strangers do not.[47]

Paired exchange[edit]

Ethics of paired exchange.[48]

Incentives for organ donation[edit]

Altruism[edit]

[49]

Non-monetary incentives[edit]

For. [50]

Giving priority to registered organ donors should they need a transplant.[51][52]

Organ markets[edit]

Several commentators have argued in favour of a market in human organs.[53][54][55]

Economic analysis.[56]

Distribution of organs[edit]

Directed vs. non-directed donation[edit]

Two models of organ donation: one for living donors and another for deceased donors.[57]

Directed donation by deceased donors[edit]

Public opinion.[58]

For.[59][60]

Against.[61]

Non-directed donation by living donors[edit]

Marginal organs[edit]

Moral responsibility[edit]

Some commentators have suggested that people who are morally responsible for their health condition should have[62]

Some ethicists have questioned the extent to which individuals are morally responsible for their lifestyle choices.[63]

[64]

[65]

Emerging ethical issues[edit]

As organ transplantation technology develops, new ethical issues arise. Some emerging ethical issues include the use of animal organs in humans, and the development of organs from stem cells.

Xenotransplantation[edit]

Xenotransplantation is the transplantation of organs or tissues from one species to another. Ethical debates over xenotransplantation typically concern transplantation from non-human animals to humans. Many of these debates are related to broader concerns in animal ethics, including animal rights and animal welfare.

Position paper.[66]

Ethics and law.[67]

Organs from stem cells[edit]

An emerging possibility is the production of organs in vitro using human stem cells.

See also[edit]

References[edit]

  1. ^ Manara, AR (2012). "Donation after circulatory death". British Journal of Anaesthesia. 108 (suppl 1): i108–i121. PMID 22194426. doi:10.1093/bja/aer357.  Unknown parameter |coauthors= ignored (|author= suggested) (help)
  2. ^ Bernat, JL (2010). "Point: Are donors after circulatory death really dead, and does it matter? Yes and yes". Chest. 138 (1): 13–16. PMID 20605812. doi:10.1378/chest.10-0649. 
  3. ^ Truog, RD (2010). "Counterpoint: Are donors after circulatory death really dead, and does it matter? No and not really". Chest. 138 (1): 16–18. PMID 20605813. doi:10.1378/chest.10-0657.  Unknown parameter |coauthors= ignored (|author= suggested) (help)
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Category:Bioethics

Further reading[edit]

  • Caplan, Arthur L.; Coelho, Daniel H.; Eds. (1998). The Ethics of Organ Transplants: The Current Debate. New York: Prometheus Books. ISBN 1573922242.
  • Farrell, Anne-Maree; Price, David; Quigley, Muireann; Eds. (2011). Organ Shortage: Ethics, Law and Pragmatism. Cambridge, UK: Cambridge University Press. ISBN 9780521198998.
  • Miller, Franklin G.; Truog, Robert D. (2012). Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life. Oxford: Oxford University Press. ISBN 9780199739172.
  • Radcliffe Richards, Janet (2012). The Ethics of Transplants: Why Careless Thought Costs Lives. Oxford: Oxford University Press. ISBN 9780199575558.
  • Veatch, Robert M. (2000). Transplantation Ethics. Washington, DC: Georgetown University Press. ISBN 0878408118.
  • Wilkinson, T. M. (2011). Ethics and the Acquisition of Organs. Oxford: Oxford University Press. ISBN 9780199607860.

External links[edit]