Bioethics of Organ Donors and Transplant Trade

Introduction / Background

In the recent period, the science of transplantation has become a unique treatment approach for the potential life threatening complications. As it involves the surgical replacement of body parts with the functionally superior ones, the major task since the past decade has been to procure significant number of organ donors. This simultaneously contributed to the emergence of social and cultural resistances that gradually hindered the progress of organ donations [1].The ultimate consequences have prompted the medical communities to connect the surgical procedures to the social values that are adequately potent to reduce the disparities between the traditional concepts of personhood and those consistent with the transplantation [1].

However, with the ever changing modern world, an increase in the supply of transplantable organs has become one of the significant health issues in the light of the controversies having ethical background.

Earlier, proposals for uniform required request have been made with the objective of meeting the increased demand for organs and tissues [2]. This has also received open acceptance.

But donating a live organ to a patient may require a mandatory adoption procedure by state and federal legislation, as well as by new hospital standards. Further, moral, clinical, and legal issues need to be addressed prior to any beneficial assurances or adverse consequences [2].

Therefore, the required request laws may have influential role to assess the conflicts of interest at the clinical, psychological, and social/economic levels that may produce considerable negative impact on the organ donation [2]. This donation process could also turn problematic with the intervention of religious rights or some external involuntary force which make the individuals donate for the convenience of trade. So, there is a need to review the ethical issues that might hamper the success of organ donation where the role of individual rights, altruists and others are anticipated to play influential role.

Earlier workers described that the poor availability of donor organs had increased the number of patients on waiting list. This gradually led to the death of patients registered for heart and liver transplantations [3]. Cultural and psychological barriers, deaths of potential young donors were considered as the main factors associated with the problem of organ shortage [3].

So, this crisis needs to be resolved soon to prevent the incidence of donation failure led mortalities.

Further, it was mentioned that ethical organ transplantation could be possible within a tension between the honest individuals and the human community where each member by nature constitutes an organic part [4]. This would strengthen the organ donation procedure on ethical grounds where a true donation would be only made through consent, approval and sincere offer or request [4]. This is in contrast to altruism where an organ is procured on a commercial basis irrespective of the source such as cadavers or by live donation related or unrelated [4].

Hence, the decision of donors may play central role in facilitating smooth organ transplantation.

The controversies surrounding the organ donation have prompted the government authorities to impose stringent regulations. Proposals for kidney sales have incited U.S National Organ Transplant Act to make organ sales a law in US [5]. This subsequently enabled the development of global consensus to keep away the monetary compensation for transplantable organs, either from living or deceased persons [5]. But this act interfered with the lives of many patients who died because of a sudden reduction in the altruistic supply of organs. It was thought that some financial incentives or social benefits to organ sources might enhance the number of cadaveric or living organ donations [5].

The Organ Transplant act has addressed an earlier problematic situation where financial burdens experienced by many living donors were at the peak stages Although, these individuals could initially withstand most of the donor-related medical costs, they later become susceptible to huge expenses that result due to lack of reimbursement policies [6]. It was revealed that an obvious doctor detailing about the costs which would be incurred by the patient for surgery, recovery, and any other potential complication might influence the donor’s financial situation. The root cause of this problem was supposed to be the shortage of cadaveric organs due to an enhanced utility of living organ donors [6].

The shortage of donor organs had also prompted New York State to pass regulations on transplantation programs and appoint an Independent Donor Advocacy Team that could evaluate, educate, and provide consent to all potential living liver donors [7]. Since ethical issues were governed by the specific team members who could play crucial role in the organ transplantation process, questions have been raised to determine whether the donors were able to provide a genuine informed consent in the case of family troubles. The solution for such controversies was to effectively evaluate and educate potential living liver donors and improve the practice such that a safe organ donation is ensured [7].

Further, as the kidney transplantations from the living donors constitute 30% of all transplantations in the United States, it was revealed that nearly 20% of the living donors do not share genetic relationship with their recipients [8]. This problem was identified as another ethical aspect.

Hence, it may indicate that failures in organ donation may be associated with the improper screening of genetic information between the donor and recipient.

In addition, the failure problem could also initiate when the recipient fails to adhere to the treatment which could lead to a graft loss. This failure burden becomes equally applicable to the donor and the treatment team. Hence, donating organs to an unyielding patient from a cadaver or a living donor may raise issues of patient autonomy, justice, paternalism, and benevolence versus nonmaleficence [8].

Next, moral assumptions in the intensive care unit may also become significant issues and get strengthened on ethical grounds with regard to the organ donation [9]. Some of the identified elements in this context were “the problem is organ shortage”, “moral or social duty or responsibility to donate”, “moral responsibility to advocate for donation”, “requesting organs” or “asking for organs”, “trained requesters”, “pro-donation support persons”, “persuasion” and defining “maximizing donor numbers” [9]. These assumptions become the main objectives to accuse the moral validity of nonrational family objections to organ donation [9]. Hence, a morally neutral position has the role to influence organ donation to enable societal acceptability and this could reflect the optimum beneficial role of hospital care during transplantation [9].

Further, the trade of human organs from agents serving as live vendors was previously identified as a moral issue [9]. Such acts were considered outrageous, intolerable in any developed and literate society as they involve a gross exploitation of the poor [9]. This had necessitated the drive to prevent the organ sales when the hatred arguments of opponents initiated the debate and worked out in favor of the people in need of protection [9]. This had finally contributed to the development of new strategies that could expedite the availability of organs for transplantation [10].Here, the objective was to provide a life saving therapy to a large number of patients in need of organs. Hence, the disparity between the organ supply and the demand may play influential role in the utility of living donor organs and the development of the expanded donor concept [10].

Investigation of the Issue

In view of the above information, there is a need to evaluate the pros and cons surrounding the ethical aspects of organ donations. It was obvious that the cultural barriers have interfered with the availability of organ donors [3]. Although it was a much earlier issue, there may be similar instances currently prevailing in the society with a negative impact. But they may also prove beneficial when they regulate the delivery of organ donors through the educational counseling. Hence, creating awareness among the donors may help to overcome the problems associated with the cultural barriers. Further, there were disparities against the practice of paid organ donation as it could interfere with the lives of individuals [12]. However, they may enhance the value of organs by preventing their misuse. Therefore, ethical conflicts should be studied to determine whether greater harm or good would be achieved [12]. Hence, this argument could be supported on both sides and has implications to decide the viability of organ donors.

The financial costs incurred by the donors especially during kidney donation may be very high and this may lead to severe economic consequences [13]. Hence, attempts should be made to assess the direct and indirect costs incurred by the living kidney donors through a review of the strengths and limitations of the existing literature. It was revealed that the informed consent and the reimbursement policies could improve the economic status of donors [13]. So, this proposal may have the potential to avoid the extravagance concerned with the organ donation. But its outcome may be affected when there is a failure in meeting the right professionals. Hence, it is reasonable to mention that this approach may have both good and bad implications in view of the existing concerns. This may suggest the assistance of authorities familiar with the organ donation. There is a need to act promptly with regard to the trade of organs. This is because, although there is a growing need of organs in the recent period, the available number of donor individuals has remained relatively constant [14].

The intervention of altruists had resulted in the motivation of general public and accelerated the mechanisms for obtaining organs like kidneys. This may increase the chances of organ misuse. Therefore, the researchers’ belief may play important role in resolving the controversial situation like by developing the different programs to increase the organ donation, by outlining the scope of the problem and adopting the current legislation governing the procurement of transplantable organs or tissues [14]. This report has shed light on the donation of kidneys as it was believed to be less problematic on the safety and ethical grounds. But as the role of recipients was considered crucial during the transplantation process, there is also a need to evaluate their contribution towards the success before concluding that the donation of kidneys carries a minimum risk. This could be because in the earlier part of description it was obvious that a non adherence to the treatment by recipients could enhance the risk of rejection [8]. Hence, while evaluating the problems concerned with the organ rejection, a plethora of reasons need to be significantly considered with special emphasis on recipients. Further, the role of altruists was described to raise a number of ethical questions with regard to the unrelated living kidney donation [15]. They could easily derive the benefit while assuming their autonomous role. Hence, there is a need to pressurize teams who could better evaluate the altruistic activity and provide optimum care to the potential donors and recipients such that they could avoid compromising the donor screening process [15].

This could enable the potential donors satisfy the medical and psychosocial criteria for donation. But it is difficult to determine whether such donations are intended for recipients with specific characteristics [15]. Hence, this report seems to be inadequate in providing information on recipient’s characteristics, although it provided insightful information on the activity of altruists. On the whole, organ donation and transplant trade appear to survive on a common bioethical platform that is largely influenced by cultural, religious and financial aspects, poor awareness, recipient’s characteristics and altruist’s activity.

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