Ethical Concerns of Organ Donation & Transplantation

IN NEWS:

• Recently, a Kerala court initiated a case against Kochi-based hospital and seven of its doctors following a complaint that it harvested organs from an accident victim who had been declared brain dead in violation of norms.

ORGAN DONATION & TRANSPLANTATION:

• Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient).
• Transplantation is necessary because the recipient's organ has failed or has been damaged by disease or injury.
• Organ transplantation has been part of medical technology for over forty years, beginning in the 1950s with the first consistent successes in kidney transplantation.
• India is the world's third-largest country in terms of the number of transplants performed.
• In 2022, the total number of organ transplants (including both deceased and living donors) stood at 15,561. Of this, organs from deceased donors accounted for almost 17.8%.The number of total organ transplants in the country has substantially increased from less than 5000 in the year 2013 to more than 15000 in the year 2022.
• Organ donation and transplantation undoubtedly save lives or improve the quality of life for patients with end-stage organ failure, but they also raise several ethical issues and concerns.

ETHICAL CONCERNS/ISSUES ASSOCIATED WITH ORGAN DONATION AND TRANSPLANTATION:

• Ethical issues associated with the donor:
  • One of the most important ethical issues associated with organ donation is that of consent, which is whether the donor expressed their consent or refusal for organ donation.
  • Also, in the case of a deceased donor, the person who would make decisions on behalf of the donor also creates ethical complexities. The same issues exist for minors and legally incompetent people.
  • The following ethical principles help to determine whether the transplantation would be within the bounds of ethics in instances of living donor transplantation.
    • The removal of the tissue or organ does not impair the health or functional integrity of the donor.
    • The donation should be altruistic and given without any coercion or other form of external pressure.
    • The donor must be fully informed of the nature of the procedure and the possible, even rare, complications. This entails the need for future follow-up on the donor’s health.
    • The views of close relatives, such as the spouse or adult children, are taken into account.
    • There must be no element of commercialization or exploitation in the donation
• Medical integrity and ethics:
  • Patients and the public must be able to trust their doctors not to sacrifice their interests for those of others. Individuals may make that sacrifice, but not their doctors.
  • Also, issues like the recent one in Kerala, where doctors who are supposed to protect life declared the donor brain dead in violation of norms to collect organs, are against medical ethics.
• Ethical issues associated with the recipient:
  • Ethical issues associated with recipients include the question of whether individuals who have abused their bodies through smoking, drinking, or diet should receive new organs, or should organs only be given to those whose organs were damaged by illness.
• Ethical issues associated with the allocation of limited resources:
  • One of the primary ethical dilemmas surrounding organ transplantation arises from the shortage of available organs and the resulting challenges to equal access and fair allocation of limited resources.
  • In the absence of proper government regulation, it is always possible for the rich to take advantage of organ transplantation because they can exploit the donors, who are always poor.
  • The shortage of organs has attracted a black market in the organ trade, and several ethical issues have also surfaced.
  • For instance, kidnapping, trafficking of humans for transplantation, and preying on the poor to sell their organs for money while disguising the transactions as altruistic.
• Religious and moral questions:
  • The transplantation of organs from one human being to another would throw up complex religious and moral questions. For example, will the removal of organs in any way affect the process of ‘rebirth’ or resurrection?

WAY FORWARD:

• Principles of biomedical ethics:
  • The framework for organ donation and transplantation must follow four principles of biomedical ethics, which are autonomy, non-maleficence, beneficence, and justice.

• Awareness generation:
  • Awareness generation about organ donation and transplantation among the public could be helpful to avoid exploitation of the poor and check unethical practises.
  • Superstitions among people should be fought by way of religious injunctions. For instance, Hindu and Vedic scholars accept the concept of brain death. The concept of giving, or daan, is ingrained in Hindu thought.
• Need for government regulations:
  • The government should create the necessary legislation and regulations for an efficient, transparent, and ethically sound organ donation and allocation system in the country that ensures upholding ethical principles, protecting the rights of donors and recipients, and maintaining public trust.
• WHO Guiding Principles:
  • Following the WHO Guiding Principles on Human Cell, Tissue, and Organ Transplantation would provide an orderly, ethical, and acceptable framework for the acquisition and transplantation of human cells, tissues, and organs for therapeutic purposes.
• Incentives to the donors:
  • The government could consider giving incentives to the donors, which could be in the form of health insurance for the donor and his family. The practise has been adopted in several countries.

PRACTICE QUESTION:

Q. Discuss the ethical issues involved in organ transplantation and donation.