Organ donation is the removal of specific tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting them into other persons.
There are also extremely controversial issues regarding how organs are allocated between patients. For example, some believe that livers should not be given to alcoholics in danger of reversion, while some view alcoholism as a medical condition like diabetes.
Healthy humans have two kidneys, a redundancy that enables living donors (inter vivos) to give a kidney to someone who needs it. The most common transplants are to close relatives, but people have given kidneys to other friends; in one case, a teacher gave a kidney to one of her students.
The Spanish transplant system is one of the most successful in the world, but still can't meet the demand. Donations from corpses are anonymous, and a network for communication and transport allows fast extraction and transplant across the country. Under Spanish law, every corpse can provide organs unless the deceased person expressly rejected it. Nonetheless, doctors ask the family for permission (making it very similar in practice to the United States system). The enforcing of helmet wearing for bikers, though, has reduced the number of young healthy donors.
Under United States law, the regulation of organ donations is left to the fifty U.S. states. A Uniform Anatomical Gift Act seeks to streamline the process and standardize the rules among the various states, but it still requires that the donor make an affirmative statement during his lifetime that he is willing to be an organ donor. Many states have sought to encourage the donations to be made by allowing the consent to be noted on the driver's license. Still, it remains an opt-in system rather than the Spanish style opt-out system (which still seeks family consent, however).
Donated organs, blood, and tissues have the potential to spread disease. While donated blood is screened for a wide variety of pathogens, donated organs are usually screened only for the most common and dangerous pathogens, typically HIV, hepatitis, and syphilis. Organ screening is complicated by two factors. First, organs spoil quickly and must be transplanted within hours of being obtained. This limits the amount of time available for pathogen screening. Second, an organ donor is often an accident victim who has succumbed to traumatic injuries -- such a patient has a much higher likelihood of having received blood transfusions in an effort to save his life.
Doctors have reported serious complications and death due to organ transplants from donors infected with herpes, West Nile Virus, cytomegalovirus, Epstein-Barr virus, and even (in one case) rabies. Infection from non-viral pathogens, including candida and the parasite Trypanosoma cruzi have also been reported.
Currently there is a lot of interest in how certain transplants (including bone marrow, stem cell, and bowel) can cause so-called "adoptive transfer" of diseases thought to have a genetic basis (such as Crohn's disease and other autoimmune disorders). While adoptive transfer of genetic disease is clearly not a desirable outcome, the cases so far reported may offer significant insight into how genetic susceptibility leads to a phenotypic manifestation of the disease.
Bioethical Issues in Organ Donation
Since the mid 1970s, a relatively new field in ethics, bioethics, has emerged at the forefront of modern clinical science. Many philosophical arguments against organ donation stem from this field.
Generally, these arguments fall into two camps: teleological and deontological ethical considerations.
Pioneered by such giants as Paul Ramsey and Leon Kass, few modern bioethicists disagree on the moral status of organ donation. Certain groups, like the Christian Scientists and some traditional Jews, oppose organ donation on religious grounds, but most of the world's 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 semantical 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 harvesting is an ongoing problem in clinical bioethics.
Further, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own. Cloning is still a controversial topic, more so when the clone is created with the express purpose of being destroyed for harvesting. While the benefit of such a cloned organ is a zero-percent chance of transplant rejection, the ethical issues involved with creating and killing a clone may outweigh these benefits.
A relatively new field of transplantation has reinvigorated the debate. Xenotransplantation, or the transfer of animal (usually pig) organs into human bodies promises to eliminate many of the ethical issues while creating many of its own. While xenotransplantation promises to increase supply of organs considerably, the threat of organ transplant rejection coupled with the general anathema to the somewhat alien idea decreases the functionality of the technique.
Organ donation is fast becoming an important bioethical issue from a social perspective as well. While most first-world nations have a 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 the transplant trade outside of the United States.
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 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 a waiting list.
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 desperately in need of an organ on the other hand, the organ trade should be legalized.
Legalization of the organ trade carries with it 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 would lead to increased supply, lowering prices so that the poor might be able to afford such organs as well.
Exploitation arguments generally come from two main areas:
- Physical exploitation suggests that the operations in question are quite risky, and, taking place in third-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." This argument generally relies upon the assumption that there exists some financial amount that does indeed constitute "enough," but that the donors in question are not receiving this amount of money in return. Some evidence suggests that in an operation for a kidney the tranplantee pays $125,000 USD. Of this, $20,000 is received by the donor, $40,000 is paid to a private hospital, $10,000 goes on flights and accommodation. This leaves the broker with a profit of $55,000. Some would suggest the donors are not receiving enough and hence are exploited. Other evidence describes brokers as only receiving $10,000.
If, however, neither of the above arguments are valid, the act generally cannot be condemned on a utilitarian basis. Still, the issue remains controversial.