More Discussion On Organ Donation

From the August 2009 issue of The American Journal of Bioethics

Why Consent May Not Be Needed For Organ Procurement
by James Delaney, David B. Hershenov
AJOB 2009; 9(8):3
ABSTRACT |FULL TEXT

Open Peer Commentary

Pardon My Asking: What's New?
by D. Micah Hester, Toby Schonfeld
AJOB 2009; 9(8):11
FULL TEXT

The Organ Conscription Trolley Problem
by Adam Kolber
AJOB 2009; 9(8):13
FULL TEXT

Hypotheticals, Analogies, Death's Harms, and Organ Procurement
by James L. Nelson
AJOB 2009; 9(8):14
FULL TEXT

Survivors' Interest in Human Remains
by Norman L. Cantor
AJOB 2009; 9(8):16
FULL TEXT

Why Intuitions and Metaphysics Are the Wrong Approach for Health Law: A Commentary on Delaney and Hershenov
by Christopher Robertson
AJOB 2009; 9(8):18
FULL TEXT

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Controversies in Defining Death

Controversies in the Determination of Death: A White Paper by the President's Council on Bioethics The President's Council on Bioethics Washington, D.C., January 2009

• Full Document (PDF)

Controversies in Defining Death

Controversies in the Determination of Death: A White Paper by the President's Council on Bioethics The President's Council on Bioethics Washington, D.C., January 2009

• Full Document (PDF)

A New Definition of Death

From WIRED

Bioethicists Save Organ Donation by Tweaking the Definition of Death

By Brandon Keim January 13, 2009 | 7:38:12 PMCategories: Bioethics

In response to an emerging moral controversy over whether most vital organs used in transplants are technically taken from living people, the President's Council on Bioethics issued a new report that defines brain death as the cessation of engagement with the world.

The report overturns the current neurological death standard's reliance on an outdated notion of the brain as the body's control center for physiological processes.

The Council's definition of life as a process of engagement, which might sound like so much philosophical mumbo-jumbo, could keep the number of organ transplants from plummeting.

"One is faced with a choice of saying that the notion of brain death doesn't work, and since you're not supposed to take organs from a donor until they're dead, we have to stop doing a lot of transplantation — or you can find a better explanation for why total brain failure constitutes the death of an organism," said Gilbert Meilaender, a Valparaiso University bioethicist and Council member. "We offer a better philosophical explanation."

read more

Image: Flickr/Rodrigo Basaure

See Also:

• Social Networking Speeds Organ Donation
• All Your Organ Are Belong to Us: UK Considers Opt-Out Organ Donation
  
• Televised Kidney Competition a Hoax
• China Needs to Rein in Out-of-Control Organ Market
• Organ 'Printing' Creates Beating Heart Cells
  
• Gene Therapy and the History of Organ Transplantation

A New Definition of Death

From WIRED

Bioethicists Save Organ Donation by Tweaking the Definition of Death

By Brandon Keim January 13, 2009 | 7:38:12 PMCategories: Bioethics

In response to an emerging moral controversy over whether most vital organs used in transplants are technically taken from living people, the President's Council on Bioethics issued a new report that defines brain death as the cessation of engagement with the world.

The report overturns the current neurological death standard's reliance on an outdated notion of the brain as the body's control center for physiological processes.

The Council's definition of life as a process of engagement, which might sound like so much philosophical mumbo-jumbo, could keep the number of organ transplants from plummeting.

"One is faced with a choice of saying that the notion of brain death doesn't work, and since you're not supposed to take organs from a donor until they're dead, we have to stop doing a lot of transplantation — or you can find a better explanation for why total brain failure constitutes the death of an organism," said Gilbert Meilaender, a Valparaiso University bioethicist and Council member. "We offer a better philosophical explanation."

read more

Image: Flickr/Rodrigo Basaure

See Also:

• Social Networking Speeds Organ Donation
• All Your Organ Are Belong to Us: UK Considers Opt-Out Organ Donation
  
• Televised Kidney Competition a Hoax
• China Needs to Rein in Out-of-Control Organ Market
• Organ 'Printing' Creates Beating Heart Cells
  
• Gene Therapy and the History of Organ Transplantation

Human Organs for Sale

Organ donation has always been regarded as an altruistic act. Thus all government, professional societies and ethics committees regard it as unethical to allow for sales of kidney. Altruism is implied that a person donates an organ (usually a kidney) without coercion and receiving any compensation including financial ones. Their only reward is satisfaction in their self-sacrificial action. Unfortunately there are not many altruistic persons around. Most organs for transplants come from brain dead or dead donors (cadaveric organ transplants). Very few living persons come forward as donors. The result is a scarcity of organs for transplants which results in thousands of deaths for want of organs.

By not allowing sales of organs, these organisations have unwittingly created a black market for organs sales. Unscrupulous middlemen have arisen to take advantage of the needs of organs. In countries where the laws were not so stringent, a commercial transplantation trade of transplant tourism has arisen where one may buy a kidney if one is willing to pay and not ask too many questions. There is no protection for donors. Horror stories abound of people being kidnapped and their kidneys removed, the poor exploited or prisoners forced to donate their kidneys. The middlemen reaped large amount while the donors were given pittance. In a recent court case in Singapore, the donor received $23,700 for his kidney out of the $300,000, magnate Tang Wee Sung paid the middleman. This is the unregulated free market!

In an effect to address the scarcity of organs for transplantation, the Singapore government has taken the bold step of legalising the monetary ‘compensation’ for kidney donors (The Straits Times, Nov 1, 2008). The amount which may be in five or six figures will compensate the donors for their kidneys. It is also suggested that all transplants be regulated through an independent organisation to ensure that the donors will not be taken advantage of. Singapore sidestepped the ethical issue by allowing monetary compensation rather than sales. This is the semi-regulated approach to organ donations.

A third alternative is the Iranian model which the fully regulated model. In Iran, all organs transplants are done through a state-sponsored body which regulate organ transplant in a transparent, non-commercial, and middle-man free process. Donors are paid by this government sponsored agency. It has worked well so far and in Iran there is no waiting list; all patients (rich, poor, educated, uneducated) have receive their transplants. Iran has a government sponsored healthcare system so the model may not work in other countries.

Is there a difference between a sale and compensation? A sale is a business transaction while a compensation is something given for something lost or given. However when it comes to human organ, it is a thin line between the two. It is interesting to note that while it is unethical to sell one’s kidney, however it is acceptable to sell one’s sperms or eggs or in some countries, blood. The moral ethical basis that lies behind the forbidding of sale of human organs come from the group of moral theories called virtue-based theories. The virtue-based theories are based on the premise that human beings are basically good and altruistic. Reality has however shown how far that is from the truth. It may be time for us to review the ethics of human organ sales.

picture credit

Human Organs for Sale

Organ donation has always been regarded as an altruistic act. Thus all government, professional societies and ethics committees regard it as unethical to allow for sales of kidney. Altruism is implied that a person donates an organ (usually a kidney) without coercion and receiving any compensation including financial ones. Their only reward is satisfaction in their self-sacrificial action. Unfortunately there are not many altruistic persons around. Most organs for transplants come from brain dead or dead donors (cadaveric organ transplants). Very few living persons come forward as donors. The result is a scarcity of organs for transplants which results in thousands of deaths for want of organs.

By not allowing sales of organs, these organisations have unwittingly created a black market for organs sales. Unscrupulous middlemen have arisen to take advantage of the needs of organs. In countries where the laws were not so stringent, a commercial transplantation trade of transplant tourism has arisen where one may buy a kidney if one is willing to pay and not ask too many questions. There is no protection for donors. Horror stories abound of people being kidnapped and their kidneys removed, the poor exploited or prisoners forced to donate their kidneys. The middlemen reaped large amount while the donors were given pittance. In a recent court case in Singapore, the donor received $23,700 for his kidney out of the $300,000, magnate Tang Wee Sung paid the middleman. This is the unregulated free market!

In an effect to address the scarcity of organs for transplantation, the Singapore government has taken the bold step of legalising the monetary ‘compensation’ for kidney donors (The Straits Times, Nov 1, 2008). The amount which may be in five or six figures will compensate the donors for their kidneys. It is also suggested that all transplants be regulated through an independent organisation to ensure that the donors will not be taken advantage of. Singapore sidestepped the ethical issue by allowing monetary compensation rather than sales. This is the semi-regulated approach to organ donations.

A third alternative is the Iranian model which the fully regulated model. In Iran, all organs transplants are done through a state-sponsored body which regulate organ transplant in a transparent, non-commercial, and middle-man free process. Donors are paid by this government sponsored agency. It has worked well so far and in Iran there is no waiting list; all patients (rich, poor, educated, uneducated) have receive their transplants. Iran has a government sponsored healthcare system so the model may not work in other countries.

Is there a difference between a sale and compensation? A sale is a business transaction while a compensation is something given for something lost or given. However when it comes to human organ, it is a thin line between the two. It is interesting to note that while it is unethical to sell one’s kidney, however it is acceptable to sell one’s sperms or eggs or in some countries, blood. The moral ethical basis that lies behind the forbidding of sale of human organs come from the group of moral theories called virtue-based theories. The virtue-based theories are based on the premise that human beings are basically good and altruistic. Reality has however shown how far that is from the truth. It may be time for us to review the ethics of human organ sales.

picture credit

You Can't Take It With You

The first thing that come to mind when someone says, “You can’t take it with you” are our jewelleries, companies, fame and fortune. Very few of us think of our bodies, those vessels which have embodied our souls for so many years. Our bodies are being discarded as our souls move into the hereafter. Like discarding a dirty shirt for a clean one, we exchange our mortal bodies for immortal ones.

How many of us ever think of the mortal bodies we leave behind except to think of its disposal-cremation or burial? Yet our mortal left-behind bodies may still be of use to others. Yes, I am talking about organ donation.

Every year thousands of people are in need of organs for transplantation. They are quite happy to receive the organs from dead bodies (cadaveric organ donors). These organs can save their lives. People with kidney failure and on dialysis can tell you about their ordeals. A person with kidney failure will need to be dialysed on the average 2-3 times a week. Each session last 4-6 hours and incur financial cost. In between dialysis, they are tired and lethargic. They may be alive but there is no quality to their lives. They need kidneys.

There is such an acute shortage of organs for transplant that a black market exists to supply this need. People are going to countries like China, India, Turkey and other poorer countries to buy kidneys.

Personally I believe all Christians should be organ donors. After all we are going to get a new body! At least let the discarded one be of use; our final legacy to this world. Even better will be if we are to donate one of our kidney when we are alive. After all God gave us two kidneys and the body function equally well with only one. That will be truly self-sacrificing love.

photo credit

You Can't Take It With You

The first thing that come to mind when someone says, “You can’t take it with you” are our jewelleries, companies, fame and fortune. Very few of us think of our bodies, those vessels which have embodied our souls for so many years. Our bodies are being discarded as our souls move into the hereafter. Like discarding a dirty shirt for a clean one, we exchange our mortal bodies for immortal ones.

How many of us ever think of the mortal bodies we leave behind except to think of its disposal-cremation or burial? Yet our mortal left-behind bodies may still be of use to others. Yes, I am talking about organ donation.

Every year thousands of people are in need of organs for transplantation. They are quite happy to receive the organs from dead bodies (cadaveric organ donors). These organs can save their lives. People with kidney failure and on dialysis can tell you about their ordeals. A person with kidney failure will need to be dialysed on the average 2-3 times a week. Each session last 4-6 hours and incur financial cost. In between dialysis, they are tired and lethargic. They may be alive but there is no quality to their lives. They need kidneys.

There is such an acute shortage of organs for transplant that a black market exists to supply this need. People are going to countries like China, India, Turkey and other poorer countries to buy kidneys.

Personally I believe all Christians should be organ donors. After all we are going to get a new body! At least let the discarded one be of use; our final legacy to this world. Even better will be if we are to donate one of our kidney when we are alive. After all God gave us two kidneys and the body function equally well with only one. That will be truly self-sacrificing love.

photo credit

More on Harvesting Human Organs

I have posted harvesting organs when brain functions is still present. Maurice has an interesting blog named Bioethics Discussion Blog in which he wrote a response to my comments.

The moment of death for legal purposes has always been pronounced by a person who has the legal responsibility and capacity to pronounce death. It should be the same (and is the same) whether organs are to be procured or not. The pronouncement of death of a patient in whom no attempt will be made for cardio-vascular-pulmonary resuscitation should occur when it is known by clinical experience that full return of non-assisted cardio-vacular-pulmonary system function spontaneously is unlikely or if it should occur the period of anoxia of the brain would be long enough to cause brain function to meet brain death criteria. The pronouncement of death can also be made in a patient who may still have cardio-vascular system function but meets the clinical criteria for brain death. The pronouncement of death, if not by neurologic criteria, was made not because the heart was "dead" but because of the permanent pathophysiologic failure of the cardio-vascular-pulmonary system, no longer providing oxygen or other substances to the brain and the other body organs and with no intention to attempt artificial resusitation. I believe it should be clarified that The Dead Donor Rule (that the patient should be dead at the time the organs are removed) is satisfied by a legal pronouncement of death, There is no other way to define death since it is known that the cells throughout the human body don't all die at the same instant. There is nothing inconsistent with the Dead Donor Rule that the donated heart has resumed beating in the recipient. This event is not pertinent to the pronouncement of death of the donor since it was the entire cardio-vascular-pulmonary physiologic system that "died" and not the heart..

Patients have the ethical and legal right to voluntarily withdraw unwanted life support and the legal right to give permission for their organs to be removed for donation when the patient is pronounced dead. I would disagree that "doctors are allowing patients to die so that organ harvesting can take place" since the physicians, supported by the law and ethics, are following the requests of the patient. As long as society maintains strict attention regarding the validity of these patient permissions, the act of organ procurement for transplant is an ethical and humanistic procedure. ..Maurice.

Please see here for further comments and discussion.

In addition, he has included the following link to the New England Journal of Medicine Video Round Table discussion of the issue regarding organ donation after cardiac death with Atul Gawande as moderator and discussants, ethicists George Annas, Arthur Caplan and Robert Truog.

.

More on Harvesting Human Organs

I have posted harvesting organs when brain functions is still present. Maurice has an interesting blog named Bioethics Discussion Blog in which he wrote a response to my comments.

The moment of death for legal purposes has always been pronounced by a person who has the legal responsibility and capacity to pronounce death. It should be the same (and is the same) whether organs are to be procured or not. The pronouncement of death of a patient in whom no attempt will be made for cardio-vascular-pulmonary resuscitation should occur when it is known by clinical experience that full return of non-assisted cardio-vacular-pulmonary system function spontaneously is unlikely or if it should occur the period of anoxia of the brain would be long enough to cause brain function to meet brain death criteria. The pronouncement of death can also be made in a patient who may still have cardio-vascular system function but meets the clinical criteria for brain death. The pronouncement of death, if not by neurologic criteria, was made not because the heart was "dead" but because of the permanent pathophysiologic failure of the cardio-vascular-pulmonary system, no longer providing oxygen or other substances to the brain and the other body organs and with no intention to attempt artificial resusitation. I believe it should be clarified that The Dead Donor Rule (that the patient should be dead at the time the organs are removed) is satisfied by a legal pronouncement of death, There is no other way to define death since it is known that the cells throughout the human body don't all die at the same instant. There is nothing inconsistent with the Dead Donor Rule that the donated heart has resumed beating in the recipient. This event is not pertinent to the pronouncement of death of the donor since it was the entire cardio-vascular-pulmonary physiologic system that "died" and not the heart..

Patients have the ethical and legal right to voluntarily withdraw unwanted life support and the legal right to give permission for their organs to be removed for donation when the patient is pronounced dead. I would disagree that "doctors are allowing patients to die so that organ harvesting can take place" since the physicians, supported by the law and ethics, are following the requests of the patient. As long as society maintains strict attention regarding the validity of these patient permissions, the act of organ procurement for transplant is an ethical and humanistic procedure. ..Maurice.

Please see here for further comments and discussion.

In addition, he has included the following link to the New England Journal of Medicine Video Round Table discussion of the issue regarding organ donation after cardiac death with Atul Gawande as moderator and discussants, ethicists George Annas, Arthur Caplan and Robert Truog.

.

Harvesting Organs When Brain Function is Still Present

The normal procedure for organ harvesting is from patients who has been certified brain death. In the United States, the Uniform Determination of Death Act (UDDA) set two criteria for death; (1) sustained irreversible of circulatory and respiratory function, and (2) all function of the brain including the brain stem is considered non-existent.

In recent years, there is a movement to harvest organs when the heart stops but brain function is still present. This is usually in patients that are severely ill and are going to die. This is termed "Non-Heart-Beating" or "Cardiac Death" organ donation. The University of Pittsburgh Medical Centre allocated 2 minutes after the heart stops before organ harvesting can begin. There is some uncertainty about this and the Institute of Medicine (IOM) extended the time to 5 minutes. However there have been documented cases of "autoresuscitation" i.e. the heart restarts after 10 minutes of no heart beats. The University of Zurich allows 10 minutes. This is a scary development because doctors are allowing patients to die so that organ harvesting can take place. read more

Dr Mark M Boucek reported the first heart transplants in three children after cardiac failure rather than brain death in August 14, 2008 issue of the New England Journal of Medicine. The transplants were done in Denver's Children Hospital in Denver. The time between the heart stops and organ harvesting is...75 seconds! read more

This is a scary development because the ends has justified the means. While it cannot be denied that there is a need for human organs, these organs must be harvested from patients who are already brain dead, not those allowed to die.

What do you think?

Harvesting Organs When Brain Function is Still Present

The normal procedure for organ harvesting is from patients who has been certified brain death. In the United States, the Uniform Determination of Death Act (UDDA) set two criteria for death; (1) sustained irreversible of circulatory and respiratory function, and (2) all function of the brain including the brain stem is considered non-existent.

In recent years, there is a movement to harvest organs when the heart stops but brain function is still present. This is usually in patients that are severely ill and are going to die. This is termed "Non-Heart-Beating" or "Cardiac Death" organ donation. The University of Pittsburgh Medical Centre allocated 2 minutes after the heart stops before organ harvesting can begin. There is some uncertainty about this and the Institute of Medicine (IOM) extended the time to 5 minutes. However there have been documented cases of "autoresuscitation" i.e. the heart restarts after 10 minutes of no heart beats. The University of Zurich allows 10 minutes. This is a scary development because doctors are allowing patients to die so that organ harvesting can take place. read more

Dr Mark M Boucek reported the first heart transplants in three children after cardiac failure rather than brain death in August 14, 2008 issue of the New England Journal of Medicine. The transplants were done in Denver's Children Hospital in Denver. The time between the heart stops and organ harvesting is...75 seconds! read more

This is a scary development because the ends has justified the means. While it cannot be denied that there is a need for human organs, these organs must be harvested from patients who are already brain dead, not those allowed to die.

What do you think?