Beliefs and values in organ transplantation decision-making

Ethical Values and Issues in Organ Transplantation

Organ transplantation was one of the most important goals of physicians around the turn of the 20th century, especially after the first successful transplant of a cornea in 1905. However, it would take until the middle of the century before surgeons understood the principles of blood typing and transplant organ rejection well enough to perform successful organ transplants. Today, organ transplantation is performed thousands of time every year in the United States with high rates of success. Those procedures enable patients who would otherwise die live years or even decades longer than they could have otherwise.

Generally, modern organ transplantation is permitted throughout the world although several major ethical concerns exist. Those issues relate to the manner in which human death is defined clinically, the selection of recipients from lists that are much too long to save every patient who needs an organ, the prospect of legalized sale of organs for transplant, and the benefits of stem cell science in connection with the creation of organs from the tissue of the patient. Different ethical values in various societies have led to very different approaches to organ transplantation policies that reflect different societal values and social concerns.

Organ Transplantation Ethical Issues

Modern medical technology now enables the prolongation of human life through artificial respiration and support that death no longer occurs spontaneously but by the decision of relatives and medical authorities (Levine, 2008). Recent events have also changed the way the medical community views persistent vegetative states and brain death because of unanticipated recovery of patients long assumed to be in permanent comatose states. In the U.S., the sale of organs for transplant is strictly prohibited but in other countries (such as India, Iran, and Pakistan), such sales are permitted. In China, (by far, already the world's leader in the execution of convicted prisoners), organs for transplantation are procured from executed prisoners (Levine, 2008).

In the U.S., donor organs must be procured from cadavers and there is a perpetual shortage of suitable transplant organs to meet the medical needs of all of those on organ transplant eligibility lists (Harrison, Morgan, & Di Corcia, 2008). As a result, thousands of patients die every year before a donor organ can be found for them. Meanwhile fewer than half the organs from individuals who die (mostly in traumatic accidents) which could be used for transplantation are available because of low participation rates in organ donation card programs. Various studies strongly suggest that public education and informational publicity campaigns can significantly increase participation rates by addressing misconceptions and reducing inaccurate fears about the consequences of signing organ donation consent forms (Harrison, Morgan, & Di Corcia, 2008).

However, some argue that two specific approaches (beyond just increasing organ donation consent program participation) to organ transplantation policies could conceivably eliminate the shortage that currently results in thousands of patient deaths annually. First, there is the suggestion that the sale of donor organs should be allowed; second, it is already clear that stem cell science will eventually make donor organ transplantation obsolete because of the tremendously improved outcome associated with autogenic implantation of organs grown from the patient's own tissues (Levine, 2008). Unlike transplant organ recipients, patients receiving organs grown from their own tissue will not require lifelong anti-rejection drugs that destroy the immune system and typically shorten patients' lives as a result (Shah & Bhosale, 2006). Unfortunately, religious-based objections to stem cell science research throughout the previous American presidential administration unnecessarily delayed progress in that area by almost a decade. During that time, the issue of stem cell research and applications became one of the most divisive areas of differences in moral values in the U.S. (Levine, 2008).

One of the paradoxes of modern medical science and technology is the blurring of the line between life and death, something that was never an issue before modern medicine (Griniezakis, 2007; Levine, 2008). That was the case even before the most recent revelations in 2009 that many patients previously diagnosed as being in long-term persistent vegetative states actually remained conscious throughout their ordeal and that several patients considered to be brain dead according to accepted criteria eventually recovered consciousness (Halpern, Raz, Kohn, et al., 2010). The obvious concern is that inaccurate diagnoses of persistent vegetative states and the premature declaration of death could result in the procurement of organs for transplant from patients who could still recover from their medical predicament. That issue, unlike religious objections to scientific research remains a valid bioethics concern.

The other principal ethical issue in relation to organ transplantation is in connection with the sale of transplant organs. In countries where such sales have been permitted by law, trends have emerged whereby the poor have been exploited in this manner for the benefit of the wealthy (Levine, 2008). On the other hand, there is good reason to believe that the legalized sale of organs for transplantation could be regulated and controlled in ways that allowed society the benefit of increased transplant organ availability without exploiting or jeopardizing the health of the poor (Halpern, Raz, Kohn, et al., 2010).

Conclusion

Organ transplantation has saved and extended the lives of many thousands of patients since its introduction as a viable medical procedure during the second half of the 20th century. Ethical controversies still exist in several specific areas with very different resolutions apparent in different societies. In the U.S., the primary source of organs for transplantation continues to be voluntary enrolment in organ donation programs that procure organs from deceased traumatic accident victims.