Organ transplantation: Application of Ethical PrinciplesThe ethical and legal issues related to organ and tissue procurement and transplantation are often discussed in light of such principles as autonomy, benevolence, non-maleficence, free and informed consent, respecting the dignity, integrity and equality of human beings, fairness, and the common good.

Ethical Issues Regarding the Donor

From the Deceased (Kantian ethics and principle of totality) Such a donation can greatly benefit others and cannot

harm the donor who is dead. Not to offer such a donation can be a sign of indifference to the welfare of others. To donate, however, is not considered obligatory. Transplantation is against some people's consciences for religious or other reasons. In any case proper respect should always be shown human cadavers. Although they are by no means on par with a living human body/person, they once bore the presence of a living person. The probably dying potential donor should be provided the usual care that should be given to any critically ill or dying person. "deprived of life or of the essential integrity of their bodily functions.... No organs may be removed until the donor's death has been authenticated by a competent authority other than the recipient's

The Catholic Health Association of Canada (CHAC) considers transplantations of brain cells (presuming irreversible cessation of all brain functions of the donor) in order to restore functions lost through disease as permissible "as long as the unique personal identity and abilities of the recipient are not compromised in any way."The German Bishops' Conference and the Council of the German Evangelical Church consider the transplant of "reproductive glands" as unethical, "since it intervenes in the genetic individuality of the human being."(374) This does not seem to exclude transplanting all sexual body parts, but the gonads. Any child that resulted following an ovary or testicle transplant would have the dead donor and not the living recipient as its biological mother or father. This would violate the rights of the child

From Living Persons (Adults, Mentally Disabled, Minors) Transplants between living persons raise the

question whether it can ever be ethical to mutilate one living person to benefit another. Before transplants of organs such as kidneys were performed, many Catholic theologians considered this unethical between living persons. They thought it violated the Principle of Totality, which allowed the sacrifice of one part or function of the body to preserve the person's own health or life (i.e. a part could be sacrificed for the sake of the whole body), but did not allow one person to be related to another as a means to an end.

Gerald Kelly (1956) argued that the Principle of Fraternal Love could justify such donations, which have as their purpose of helping others, or Charity provided there was only limited harm to the donor.

Basic to medical ethics is the Principle of Free and Informed Consent. To be properly informed the potential living donor should be given the best available knowledge regarding risks to him/herself, the likelihood of success/failure of the transplant and of any alternative.When a living person donates an organ as a result of a personal decision, then the organ's transplant is to be carried out with due attention, and post-operative medical care of the donors as well as the recipients must be provided. Further, consideration must be given so that no problems develop in the relationship between the donor and the recipients (dependence, excessive gratitude, guilt

From Anencephalic Infants Anencephalic infants are born with a major

portion of the brain absent. If born alive they die within a few days, although in rare cases some survive for weeks or months. According to the widely accepted criteria of death as irreversible cessation of all brain functions, they are living human beings/persons. To increase the likelihood of procuring viable organs from them, some would like to redefine death in terms of partial brain death so that they could be considered dead or for them to be exempt from the total brain death criteria, or to consider them non-persons. Although extraordinary means of prolonging the

From Human Fetuses Some argue that transplanting fetal brain tissue

would require the fetus to be still alive, that is, the tissue would not be good for transplant purposes after the fetus has experienced total brain death.

Ethical Issues Regarding the Recipient

Another moral issue involving the recipient is free

and informed consent. A competent person who could possibly benefit from receiving a transplant should be adequately informed regarding the expected benefits, risks, burdens and costs of the transplant and aftercare, and of other possible alternatives. Guardians should respect the wishes, if known and reasonable, of incompetent persons in their care. No unfair influence should be put on someone to be a transplant recipient.

Ethical Issues Regarding Allocation of Limited Resources

Criteria for Selection a "first come, first serve" basis, where there is

equal chance, is fair provided that the need and benefit are approximately the same among potential recipients. Some argue in favor of using criteria such as social worth, and merit or demerit, to select or prioritize potential recipients. Many, however, criticize these and other criteria such as ability to pay, race, religion, gender, and age, as involving unfair discrimination. They are said to violate the equal dignity of all human beings.

Using Animals The use of some animal parts such as insulin

extracted from animal pancreases, catgut as absorbable sutures, and pig heart valves, are already "accepted" medical treatments. Various animal rights groups have protested the sacrifice of animals involved in this and other research, which uses them as "mere means" to human welfare.

Artificial Substitutes for Tissues and Organs Artificial replacement technologies are generally

very costly to develop. The recipient of some artificial parts may need to make certain psychological adjustments.

High Costs, Universality and Justice The development and use of technology related

to organ and tissue transplants or artificial substitutes is expensive. Could the large sums of money (or some of it) that is spent on developing and using transplant technology and artificial substitutes be better used to improve the health and quality of life of more people if spent in other ways (e.g. providing better access to primary health care, improving education and preventative health programs, improving the environment by further reducing pollutants, etc.)?

Ethical Issues Regarding Procurement of Organs and Tissues

Buying and Selling Human Organs and Tissues Some argue in favor of allowing human organs

and tissues to be bought and sold to increase the supply and to respect people's autonomy. Others argue against such saying that to treat the human body and its parts as commodities violates human dignity. Paying for organs can constitute unjust moral pressure on the donor. It could invalidate any free consent or a contract. Equity would be violated with ability to pay rather than medical need determining the distribution of organs

Media Publicity Sometimes an organ or tissue is procured for a

person by publicizing their need through the media. This could bypass the regular transplant channels and their selecting recipients for an available organ on the basis of greatest need and greatest likelihood of benefit, and first come first serve

Expressed, Family, Presumed, Required Request, Routine Inquiry) Voluntary or expressed consent involves a person

making known their free offer to donate one or more of their organs and/or bodily tissue, after they have died or while alive. Many potential organs and tissues for transplantation (e.g. of brain-dead accident victims) are lost because the person did not previously express voluntary consent and their families were not approached about donating. Required request or routine inquiry has been widely endorsed in the United States as a preferred public policy option when compared to a free or regulated market of organ and tissue

Fears, Confusion and the Need for Education Many people are not well informed of the needs,

the shortage of organs and tissues, and the great potential benefit of many people for transplants. Many have unfounded fears or reservations or are confused about some of the issues of being a donor. The alternative is between an organ decomposing or serving to keep another human being alive. Some health care professionals also need to learn that properly respecting the dead human body is a requirement of our humanness.

On the positive note: Organ donation, carried out under proper

conditions, is a beautiful and modern expression of Christian charity: it gives dignity to the person who in death becomes a life-support for another; it shows noble concern for the respect of the life of others; and it implies a sense of communion with humanity.