ORGAN DONATION AND ALLOTRANSPLANTATION

HEALTH LAW AND BIOETICS

Helena Pereira de Melo

23 April, 2014

Szilvia Szabó - 003903

ORGAN DONATION AND ALLOTRANSPLANTATIONIntroduction

• Organs and tissues for donation

- heart, kidneys, liver, lungs,

- pancreas, intestine, thymus

- Bones, cornea, skin, heart valves

- Nerves and veins …

Most of kidneys > liver > heart

• Culture in relation to transplant

• Human rights in relation

• Justice rights

• Benefice rights

ORGAN DONATION AND ALLOTRANSPLANTATIONIntroduction – Human rights

• Mr. George Olds is a 76-year-old nonsmoking retired business executive with end-stage heart failure. He has good pulmonary and renal function and is not diabetic;thus he is medically a good candidate for a heart transplant. His life expectancy without a transplant is 1 mouth. He has a loving family, with the resources to pay the $100,000 cost of procedure.

• Mr. Matt Younger is a 46-year-old divorced man who is unemployed, having lost his job as an auto worker 3 years ago. He has a history of smoking and alcohol use. He suffers a heart attack, develops intractable heart failure, and will die within 1 mouth without a heart transplant. He has good pulmonary and renal function and is not diabetic, making him a good candidate for the procedure.

Who should receive it?

1984 National Organ Transplaltation Act designed the United Network for Organ Sharing (UNOS)

ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – before modern society

ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 19 century

• 1818 first human – to – human blood transfusion• 1831 Mary Shelley publishes Frankenstein • 1878 first successful human – to – human bone transplant• 1881 first reported use of skin graft• 1896 first attempts at bone marrow transplant

ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 20 century

• 1900-1902 blood groups discovered

• 1902-1908 Carrel Develops Technique for connecting blood

• 1905 first successful cornea transplant

• 1908 first transplant of a knee

• 1909 first recorded kidney transplant, animal to human

• 1913 researches create the first artificial kidney

ORGAN DONATION AND ALLOTRANSPLANTATIONHistory – 21 century

2000-2002

• Population of kidney failure patiens grows

• Tissue and blood banks respond to terror attack

• Number of living donors passes cadaveric donors

• Patients living with organ and tissue transplants numbers in the Millions

2003

• Eighteen people die each day on the waiting list

2004

• 50th anniversary of the first kidney transplant

2004 and beyond

• The future of transplantation

Death by medical sience

1. Clinical death:

The circulation, breathing and brain function temporarily suspended. Reversible!

2. Biological death:

The body’s viability is irreversibly terminated.

3. Brain death:

The brain – including the brainstem – complete and irreversible cessation. The same as the traditional sense of invidual’s death

Legal Death – A statutory definition of death?The Criminal Law Revision Committee (1980): acknowledge the existence of the brain death. To take place in a statue would be too restrictive.

In the other side would promote distrust.

Main questions: What is human death? How can we determine that is has occured?

1. The current mainstream view – the whole-brain approach (irreversible cecassion of brain and brain stream)

2. The progressive alternative – the higher-brain approach (irreversible cecassion of consciousness)

2.1. essence of human persons

2.2. personal identity

2.3. the definition of death is a moral issue

Brain death

Death or alive? The case of anencephalic newborns

95 % of which die within the first postnatal week

‚Organs obtained from these anencephalic newborns could make a substantial contribution to the supply of infant organs’

‚They would provide a significant proportion of transplantable organs’

US Uniform Determination of Death Act (1980) also requires that anencephalics like all organ donors meet estabilished criteria for brain death, icluding cessation of brainstem activity, before they are used as donors.

Transplantation’s interspecies

1. Allotransplantation is the transplantation of cells, tissues, or organs to a recipient from a genetically non-identical donor on the same species.

2. Autotransplantation is the transplantation of organs, tissues or proteins from one part of the body to an other in the same invidual.

3. Xenotransplantation is the transplantation of living cells, tissues or organs from one species to another (pigs – human)

4. Isograft is a graft of tissue between two inviduals who are genetically identical. (i.e. Monozygotic twins where the transplant rejection never occur)

Transplantation

1. Live donor transplants

2. Cadaver transplantation

3. Foetal Tissue Transplantation

2.1 Opting/Contracting in countries: USA, UK, Canada, Germany, The Netherlands, Switzerland, New Zeland, Australia, Japan, South Korea, Thailand, Ireland, South-America, and in most Arab countries

2.2 Opting/Contracting out countries: Austria, Czeh Republic, Poland, Denmark, Portugal, Finland. Some countries can choose to give opportunity to ask the family (France, Italy, Spain)

Transplantation from Live Donors• Whole organs (kidneys)

• Organ materials (liver or bone marrow)

2 cases

• Parents conceived a child in the hope that the baby’s bone marrow cells would save the life of a teenage daughter dying of leukemia.

• 3 years old one of twin’s bone marrow requestd by the father of their half-brother in the face of their mother’s objection

‚the law alone cannot provide all of the answers to matters of human relation’ (Curran 1991)

Foetal Tissue Transplantation• From aborted foetus (may be infected or defective)

• ‚second patient’

• ?Independent from the woman?

Usefulness:

• It seems to have the greatest therapeutic potential such as

- Parkinsonism,

- Treatment of diabetes and

- immunodeficiency disorders,

- Anaemia patients,

- Immune system research.

In the US research sould continue, on political grounds too (=win the anti-abortion movement). Modification: allow research on spontaneously aborted foetuses and embryos, and will probably be overturned in time.

Foetal Tissue Transplantation

The Council of Europe (1986)

‚even when dead the embryo

of foetus retains its human

character and … respect for

human dignity requires that

any commercial or industrial

use must be prohibited’

Benefice Rights in Foetal Transactions (US National Organ Transplant Act 1983; United States niform Anatomical Gift Act 1983)

Foetal Tissue Transplantation

• How to provide equitable acess to these scare tissues?

• How to protect the right of couples or women to produce foetal tissue to help loved ones?

• How to avoid the possible exploitation of poor woman?

https://www.youtube.com/watch?v=uXulTMrNI4M

Organ theft in Kosovo