Medical Ethics of Organ Donation Including Stem Cell From a Theological Point-Of-View

Organ Donation

There is a space for a small pink sticker on everyone's driver's license which you choose to affix or to leave off of the identification. The sticker signifies that, should you be in a car accident and are declared to be brain-dead with no chance of recuperating, you agree to allow medical professionals to donate your organs to people who are in very dire need of them. When people think about the process of organ donation, they consider the process of removing an organ from one being and implanting it into another being. This is a very glib description of a very complicated issue. The moment that a person decides that they are willing to give up an organ, whether while they are alive or only after their death, they pledge that somewhere another individual will benefit from their body.

There are several ethical questions to address when discussing the subject of organ donation. First, there is the question of whether or not the process of distributing donated organs is conducted in an ethical manner, with the neediest people being at the top of the list for organs. However, often people with a lot of money find themselves much more speedily atop the list than people who do not have a lot of money to spend. Besides this, there are several debates about whether organ donation would be proper even in the most uncorrupt situations. Some groups have declared that it is unethical to donate organs because it is desecrating a healthy human body in order to provide the organ. Also, some religious groups believe that organ donation is defying the will of God; if He wanted the patient to be well then he would heal the ailment rather than having an organ transplant which is science and scientists interfering with His will. Putting those two arguments aside, organ donation is the ultimate gift, giving someone who is otherwise helpless a second chance at life. Thought it might be an immoral choice, depending on the religious or philosophical group one associates with, but it is the most ethical choice a single human can make.

There are two different and distinct types of organ donation; organs can be donated from either a living organism or through the process of cadaveric organ donation (organs harvested from a dead person). Whereas a living donor can usually provide only one organ and then most often the harvesting of the organ is performed for the implantation of another specific person, cadaveric donation can yield several organs, all of which can be given to different people (Ethics 20). The amount of organs which can be retrieved from the deceased depends upon the cause of death. People have been allowed to donate organs by affixing pink stickers to their driver's licenses or checking a box on their tax returns since 1968 with the passing of the Uniform Anatomical Gift Act or UAGA. "The ability of individuals to donate their organs via an opt-in approach to organ donation that honored the free 'autonomous' choice of individuals to donate their organs via a 'first-person consent' or 'donor designation' process" (Woman 114). In order to donate an organ from one body to another, the donor and recipient must have the same blood and tissue types.

One of the primary ethical concerns with reference to the subject of organ transplant is the epidemic of organ shortage in the world. According to the United Network for Organ Sharing (UNOS), there are far too few organs available for an ever-growing list of people waiting for the organs. Some of the statistics that UNOS have determined are quite sad. For example:

On average, 106 people are added to the nation's organ transplant waiting list each day -- one every 14 minutes. On average, 68 people receive transplants every day from either a living or deceased donor. On average, 17 patients die every day while awaiting an organ -- one person every 85 minutes. In 2002, 6,187 individuals died on the U.S. organ transplant waiting list because the organ they needed was not donated in time (Ethics 14).

One of the reasons for the decline in organ donation is that, in the past, many of the organs that were donated came as a result of fatal car accidents. In such circumstances, death is fairly quick and the organs are mostly intact.

However, with increased safety conditions in cars and more strict regulations concerning seatbelts and airbags, these types of fatal accidents are become less and less frequent. Currently, when a person dies from injuries or disease and they are still in possession of viable organs, it has become common practice to ask the next of kin whether or not the organs may be donated, even if the decease never made plans for donation before their demise (Kahn). This has caused some concern because the organs must be harvested soon after death when the loved ones are just beginning to grieve (Wolman 116). Like many components of the organ donation and transplantation debate, whether or not to donate an organ of a loved one while still grieving is questionable ethically. There is the fear that doctors, knowing a person is unlikely to survive, will not make the best efforts to preserve the person's life if they have a patient in need of an almost-ready organ. The primary fears of donation after cardiac death (DCD) include "(1) whether premortem administration of organ preservation agents is acceptable, since they do not benefit the donor, and may hasten death; and (2) how long the interval must be between the onset of circulatory arrest and the declaration of death" (Wolman 117). When a patient is declared brain-dead, they are left on life support systems in order to ensure that their organs remain fully functional for as long as possible. So, even though a person is effectively dead, they are technically, at least partially, alive. Some of the critics of the DCD standard point to the fact that in some cases a heart or brain could be reinvigorated even up to ten minutes after the organ stops functioning (Sanford). There have been several unfortunate cases reported where the supposedly deceased individual was not completely dead when the surgeons began organ harvesting. There have also been cases where the doctor sped up the death of a terminal individual to save other people.

Another concern about organ donation and transplantation is whether or not the process violates the basic and principle ethics of the medical profession itself. The Hippocratic Oath that doctors and nurses must take in order to become medical professionals forces them to pledge they will "First Do No Harm." Cutting into healthy bodies is mutilation and the opposite of this pledge (Brezina 10). So, is the cutting into a human body in order to retrieve an organ for an unhealthy one a similar violation of this credo? In order to find new medical treatments, there is often an experimental stage wherein first lower life forms and then more advanced beings are experimented with. The thesis being that the ends will justify the means. The experimentation will yield a greater good and the suffering of one will benefit the many. This is the same working theory behind organ transplants. Although one person will suffer if the organ is retrieved from a living body, the benefits to the person needing the organ will outweigh the unhappiness. A life here has more value than a single organ and it is the harvesting of a single organ that will save an entire life.

The theological concern about organ donation has to do with medicine and the decisions of humans are defying the will of God by removing a healthy organ and donating it to an unhealthy body. However, what these people argue is flawed because one of the responsibilities of a religious person is to treat every man and woman like a brother and sister and to behave with generosity at all times. Many who have organ transplants consider their gift as an act of God, a real-life miracle, for without the donation they would surely have died (Green vii). If God did not want people to receive organ transplants, why then would He make it so the process were even possible?

In the United States, organ recipients are supposed to be given transplants based on the order in which they were placed on the list and their age. There is a group which is bent on seeing the organ transplantation process made more equal. "To encourage equality in organ transplantation, the equal access theory encourages a distribution process for transplantable organs that is free of biases based on race, sex, income level, and geographic distance from the organ" (Ethics). This is how organ distribution and transplant would occur in an equal society. Unfortunately, in this society, it is quite common for a person with a lot of money or a degree of fame to receive a transplant long before many others who have been waiting months, even years for an organ.

There are also some other criteria which determine who should receive organs and in what order. In an era where necessary organs are in such short supply, it is not just the amount of time someone has waited on the list that indicates if they should receive the transplant. One important question is why the initial organ has failed. If the person requires a transplant because of disease, then the public believes that they are more worthy of receiving that organ transplant (Ethics 16). If, however, the person needs a new organ because of poor life choices, such as needing a liver because of alcoholism, the public believes that they should not get the organ before someone who seems to be more deserving. This meritocracy is related to who is most deserving of the transplant. The number of potential life years gained by the organ transplant is another item for discussion (Ethics 17). Someone's age is one determinant of this potential gain. A younger person is more likely to get an organ than an elderly person who hasn't as much life to live as the former. Also, someone who has already had an organ transplant but either requires a new one due to rejection by the body or a new organ failure will be less likely to receive the necessary transplant.

There is a sad statement of fact which otherwise alters the idea of organs received based on their merit. Nearly a third of the people currently on the waiting list for organ transplants are classified as "inactive," meaning that even if an organ becomes available, the person will not receive the organ (Stein). Either these people are too sick to receive the organ, are determined to not be sick enough, or for some other often unexplained reason have been deemed ineligible. One of the reasons for this is if a person does not have enough money to pay for post-operative care and their insurance will not cover the cost; there is a good chance that they will be labeled "inactive." This is another case of the wealthy having a decided advantage in the acquisition of needed organs than those in similar straights who do not have the same financial resources at their disposal.

Although the process of organ transplantation is ethical, there are components of the program which require reform. There have been several recent occasions where prison inmates have received organ transplants from anonymous donation. A public outcry went up in January of 2010 in the state of California when a prisoner who was in jail for committing a violent crime received a heart transplant. The operation as well as the post-operative lifetime care that the criminal has received and will receive in the future will wind up costing California taxpayers nearly $1 million (Perry). It has been determined that inmates have a constitutional right to healthcare and often receive better medical treatment than other similarly stationed but law-abiding citizens can hope to afford. With the threat of lawsuits decrying the lack of civil rights, criminals often move up higher on the list of organ recipients and receive their transplants more quickly (Perry). Violent criminals are receive organs which, given the shortage of available organs, makes it a guarantee that someone else on the outside of the prison walls will, in fact, die.

Harvesting living organs usually occurs when a loved one volunteers to give his or her body part to someone they care about. Some people who are extremely generous give up a spare organ, like a kidney or a lung with no particular recipient in mind. These people are rare indeed. Were there more of these types of donors, the organ shortage would be greatly alleviated. There are some companies who will pay individuals for their extra organs, a process which many people consider to be highly unethical. Until a few years ago, people could go online and auction their healthy organs to the highest bidder, something that has been made unlawful. According to the Center for Bioethics:

Most experts argue that buying and selling human organs is an immoral and disrespectful practice. The moral objection raised most often argues that selling organs will appeal to the socioeconomically disadvantaged (people who are poor, uneducated, live in a depressed area, etc.) and these groups will be unfairly pressured to sell their organs by the promise of money. This pressure could also cause people to overlook the possible drawbacks in favor of cash incentives (Ethics 26).

The United States has made the selling and buying of human organs illegal since 1984. The National Organ Transplant Act made it illegal for someone to benefit financially from the donation of a kidney. This is designed to ensure that the very wealthy do not receive organs before poorer people who are similarly in need. Even after the passage of the National Organ Transplant Act, the ability of the wealthy to acquire organs far faster than their less financially fortunate counterparts is still an issue for concern to both humanitarians and ethical persons alike.

There are several negative potential consequences of organ donation and transplantation. The first and most possible is that the body could reject the newly acquired organ. The actual definition of organ rejection is "the process where the body fights off the newly implanted organ" (Ethics 8). The body, instead of recognizing the new organ as a part of the body sees it as a bacteria and creates antibodies to destroy the new organ. Not only is the patient still in need of a functioning organ, but the organ that they have received has been wasted. In order to combat the body rejecting a transplanted organ, doctors will prescribe their patients some very strong immunosuppressant medications which will to prevent the creation of these extra antibodies which attack the organ. This, of course, makes the patient very weak and unable to fight off any bacteria or viruses at all.

Besides potential dangers to the organ recipient, the process of organ donation can also be hazardous to living person making the donation. Some of the dangers of becoming a living donor include:

Health consequences -- pain, discomfort, infection, bleeding and potential future health complications are all possible. Psychological consequences -- family pressure, guilt or resentment. Pressure -- family members may feel pressured to donate when they have a sick family member or loved one. No donor advocate -- while the patients have advocates, like the transplant surgeon or medical team (who are there to advise the patient and work in favor of his or her best interests) donors do not have such an advocate and can be faced with an overwhelming and complicated process with no one to turn for guidance or advice (Ethics 25).

This only exacerbates the sacrifice that is required of the donor. Particularly when the person who needs an organ is a family member or close friend, there can be a lot of pressure to give up an organ. Not only will they have to weigh the consequences of the potential for guilt should the loved one not receive the needed transplant and then die, but the donor must also consider how the sacrifice will affect his or her own health. According to the Center for Bioethics, a staggering "86% of people reported a deterioration in their health status after donation" (Ethics 26). Yet, many times familial loyalty outweighs the need for personal safety and many generous people do wind up giving a body part to someone they care about. In this the need to do "the right thing" is most imperative. If so many people view donation of an organ as this right thing to do, then doesn't that alone make the process ethical in the sense that ethics of a society are determined by what the majority of that society's population believe?