Beneficence, Justice, Malfeasance and Autonomy in Organ Donation

Ethic - Organ Donation The donation of organs and their eventual transplant have been regarded as a distinct way in which mankind shows and shares its compassion. Cutting out organs from one person and moving them into the body of another is one of the many 20th century medical discoveries that have grown rapidly from a trial and error kind of approach into a medical therapy of choice that treats many ailments and medical conditions today. Sadly and sarcastically the practice has turned into a victim of its own success.

One of the greatest obstacles facing organ transplant globally today is the dire lack of donor organs. For instance in the year 2010 106,879 donor organs were transplanted, according to the World Health Organization (WHO), a figure that is reportedly less than 10% of the need. This means that the current supply of donor organs is far outstripped by the demand. It is this problem that has led to the start of heated public arguments concerning probable executive and regulatory remedial measure to cater for organ donation.

All types of organ donations initiate unique moral issues (Buchler, 2012). Organ transplantation is a positive thing that saves lives and while this is not the cause for contention, the fact that it does depend on a supply of donated organs is. Some of the probable organ donations are regarded as morally unacceptable, and the cause for the donation is known to be important in assessing the general suitability of specific donations (Moorlock, Ives & Draper, 2014; Rudge, Matesanz, Delmonico & Chapman, 2012).

Donor organ supply and transplantations numbers are different worldwide; however there is a general lack of dead donors. This shortage has brought about many models that seek to raise the number of donors; however there have been procedures that are definitely not morally or legally acceptable (Rudge, Matesanz, Delmonico & Chapman, 2012). In this paper the difficult choices linked to the four primary ethical principles that are of significance in the allocation of organs including justice, beneficence, malfeasance and autonomy will be assessed in determining the proposals for donation of organs.

Ethical principles and Legislative requirements Autonomy This principle asserts that every practice is regarded as right if it allows freedom of choice of the individual. Individuals and their activities are never completely autonomous; regardless of this, one can identify specific persons and choices as heavily self-made.

If one of the attributes of practices or actions that differentiates them from wrong is that they reflect autonomy, then it is likely that particular policies could be ethically right, at least at first sight, regardless of whether they are not fully used or don't enhance fair and just distributions.

The key points of consideration are: 1) the freedom to deny accepting an organ 2) independent persons performing non-monetary exchanges 3) distribution by directed donation; and 4) openness of the procedures and regulations that determine distribution to enable concerned parties able to make knowledgeable choices (Rudge, Matesanz, Delmonico & Chapman, 2012). Justice This particular principle demands that all persons are treated without bias. Fairness means that all persons should be given immediate medical access without consideration to their capacity to pay.

The donation and transplant of organs is a difficult concern in medical care justice (Yoost & Crawford, 2015). Malfeasance An individual is free to make a choice concerning donation of his organ when he or she dies. The fact that this does not involve any form of compulsion; it is regarded as true autonomy unlike in some cases of living donations. Via this form of organ donation many patients could profit (beneficence). The donor also suffers no harm (non-malfeasance). Lastly, there is fair allocation of donor organs (justice) (Navin, 2012).

Beneficence This principle entails doing right or good (Yoost & Crawford, 2015). For individuals receiving end-of-life (EOL) treatment who want to donate their organs they can be guaranteed that their wishes would be fulfilled upon their demise. By giving solutions to dilemmas by choosing to donate their organs, they would help boost donor organ supplies. Organ donations is a significant segment of end-of-life treatment and should be fulfilled by the medical practitioners and concerned family (Van, 2010). The ethics of organ donation The transplantation of organs is a multifaceted scientific innovation.

Its effectiveness on the long-term was made likely by the introduction into the field of medicine in 1978 of the first successful immunosuppressive Ciclosporin. Transplantation as an ordinary medical practice was finally embraced followed by a slow change in attitude, that characterized the individuality of a person to a distinct part of the human body, the cerebrum to be specific, and building a key deterministic mentality for the other parts of the body.

For it to happen organ transplant needed a multifaceted association of anesthesia, medical surgery, neurology, legal health care, religious and state regulatory agencies that was discussed in political circles, the media and most importantly the medical fraternity.

The moral concerns of organ transplantation are caused by the possibility that on one hand it is a very risky procedure while on the other hand it is a very useful practice that raises questions of individuality, integrity of the body, mentality towards the deceased, and the communal and representative significance of body parts in humans. The term organ transplantation indirectly gives unique moral implications. The term "donation" for instance shows that an individual is doing something willingly to profit someone else.

But "Donors" can be deceased or individuals in vegetative state; no longer able to function. In other instances organs are removed or harvested without the prior authorization of the deceased "donor." In moral discussion, this issue about sufficient wording has to be considered. In this paper the donor's and recipient's viewpoints will be separated.

The questions that will be posed are: which individual could and should give or "donate" an organ? Who can get or utilise an organ? Deceased donors In the majority developed nations the main supply of donor organs is from deceased persons or those in vegetative state, while in other nations like Iran and Japan mostly the living give their organs. Brain death is the non-reversible damage or destruction of the entire human brain both the neo-cortex and the brain stem.

A key moral concern is on the role of the right to choose: is direct or implied authorization needed, or does the fact that the individual is dead negate his right/freedom to choose what will happen to his body? Several legislative and moral remedies to these concerns have been suggested globally. Some nations have started what is referred to as an opt-in solution. In this situation a direct authorization by the dead person is needed before death e.g. through a written statement or signing an organ donor card.

Other nations support the use of a mix of both personal consent/authorization and proxy consent which is the alternative incase the individual is not able to make the choice (Schicktanz, 2010). Any deliberations or study of organ transplantation have to take into consideration both living and dead persons donations.

In fact while organ donations from deceased persons have not met the demand for transplantations in all nations, it is not the practice in other nations, and this is the cause of the rapid increase in the utilization of living donors as supply for kidneys and lately livers too.

Many of the contentions and challenges to living donation originate from this and while some favor to concentrate on processes to put a stop to these procedures, many different countries equally stress on the need to work towards autonomy/self-sufficiency by designing successful deceased donations structures (Rudge, Matesanz, Delmonico & Chapman, 2012). Most of the challenges to deceased donations are founded on religious or cultural norms on ways of handling the human corpse.

Several religious groups for example those that worship a single God such as Christianity and Islam have acknowledged that brain death is a form of death for a person and have backed organ transplantation. However other societies refuse to accept that an individual who is still breathing is dead. Cultural or ethnic beliefs about death, in countries like Japan, can go against scientific facts.

This demands that each particular situation is evaluated in terms of the donor's and the recipient's cultural and religious mentality towards organ donation in brain death (Rudge, Matesanz, Delmonico & Chapman, 2012). Living donors This is in many nations viewed as a significant alternative to deceased donations. The frequency of living organ donations is between twenty to ninety percent of all organ donations based on the cultural norms and legislations. The immediate family, marriage partners, friends and at times strangers are regarded as likely organ donors.

While the benefits to the recipient may be many; the donor might risk major health conditions and possibly death. On the donor's part, removal is a non-curative or non-remedial intervention, and the possible risks for him are not commensurated to the benefits. Therefore in his case doctors are breaching the "do no harm" traditional medical ethos asserted in the Hippocratic Oath. But in present-day bioethics regard for the right to choose is considered more important than other moral rules, including that of non-malfeasance (Vaughn, 2013).

Thus one can contend that a potential organ donor who steps up to donate, his wishes must be respected (Schicktanz, 2010). Commoditization and organ trade The concern of illegal organ trade has increased attentiveness among global organizations and moralists, for instance those who are against a market controlled only by the forces of demand and supply fear that this will jeopardize social justice. Additionally based on the ideas of human self-respect they oppose the right of someone to sell his body parts.

Some however contend that this blanket stop of organ trade only leads to underground and therefore poorly controlled markets. The practice of trafficking organs is based on multifaceted social networks. The donors are usually from poverty stricken developing nations; on the other hand the recipients live in rich developed nations. The practice is facilitated by middle men dealing in organs and medical practitioners who are willing to perform the surgery without regarding the law.

The major points that advocate for a free market for organ trade can be categorized into four major principles: i) justice: it is not fair for individuals to die while there are practically supply organs who could outstrip the demand if allowed, ii) freedom: individual's right to choose means that everyone has the freedom to dispose of his body as he pleases, iii) use and beneficence: this could create profits for the donor thus both donor and recipient would have benefited, iv) efficiency: a market controlled by supply and demand, a free market, will make the system more functional and effective and provide supply for the demand.

On the same breath these points can be countered on arguments anchored on similar principles.

Such as i) it is feared that commercializing organ trade will create social injustice whereby only the wealthy will then be able to cater for the costs of an organ transplant, ii) the freedom of the poor will be curtailed by their inferior social class and financial obstacles, iii) true donors who do it voluntarily will be discouraged by commercial "donations" thus reducing donations from this segment iv) turning the human body into a commercial product assumes the sacredness of the human body and the individuality and self-respect (Schicktanz, 2010).

Organ donations from the living are the main supply for organ transplantation globally and are the main point of contention of the practice (Rudge, Matesanz, Delmonico & Chapman, 2012). There is also the risk of non-disclosure where the probable donor may not fully disclose significant medical information, such as the transplanted organ being infected with some disease that could jeopardize the success of the transplant or the general well being of the recipient (Fadare, 2010).

Recommendations To trade or not to trade is the vital question in this whole discourse on organ donation. The solution is based on meeting the 4 essential medical ethic principles of Justice, Autonomy, Beneficence, and Non-malfeasance. The sponsors who back paid living donor programs are not getting the gist of the matter. One could reason further concerning this practice of right to choose what to do with one's body, to more unpleasant practices such as child labor or underage pornography.

The basic values of our world, those of life and liberty are ones that should not be given a price tag. These truths or values are diminished when a financially less capable individual feels that he is forced to risk the outcome of death just for monetary gains. Medical doctors, whose basic role is to offer care, must not engage in this procedure. Moreover, nations have restrictions on individual freedoms when it gets to protection from adverse effects.

Societies don't promote an acceptable practice of trade in human flesh, prostitution, regardless of so called profits to both the seller and buyer. For instance a close scrutiny of the situation where a government backed paid organ.