The problem of organ donation and transplantation in adults and children cannot be viewed unambiguously. On the one hand, it has a highly moral goal of saving human life. On the other hand, this boon always comes at the expense of another person. As a result, opinions on this matter are also quite different. In particular, arguments against organ donation include the inevitable harm it causes to a living donor, a high level of risk, which is manifested in the lack of a guarantee that the transplanted organ will not be rejected by the patient’s organism, the problem of a statement of death of a donor, and the recent trend of commercialization of medicine, which results in the perception of a human body and organs as objects of purchase and sale, without taking into account age of a donor. However, in case of a serious or irreversible damage to internal organs, organ donation is often the only way of saving the patient’s life. Moreover, from the bioethical point of view, a voluntary donation is an expression of high morality, love, and compassion. Finally, a strict governmental control (a need for the presence of a documented consent of a donor and issuing donor cards) provides that no organs will be retrieved illegally, as well as ensures voluntariness of the donation process. Thus, despite all moral and ethical issues surrounding it, organ donation was and still is a necessity as it is an important and often only way of saving human life. However, in order to avoid new ethical and moral issues, namely violation of the right to life and the principles of voluntariness and freedom of choice, this process must be not only regulated by the government, but also governed by a set of bioethical rules.
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Aspects of bioethics suggest that modern scientific and technological revolution, namely in the healthcare industry, should not be a barrier between a doctor and a patient, forcing the latter to lose his/her individuality. Emergence of new medical technologies has intensified a series of moral, ethical, and legal issues that can be solved only from the perspective of bioethics. The most vivid examples of such problems are donation and transplantation of human organs and tissues. In the late XX – early XXI century, this branch of medicine has concentrated the latest achievements of surgery, anesthesiology, critical care medicine, immunology, pharmacology, and other life sciences (Veatch & Ross, 2015). Nowadays, it is an area of high biomedical technologies that are used in case of pathological changes of organs and tissues, which would inevitably lead to the death of the patient. The process of donation and transplantation of organs is a treatment of a great social importance for severely ill patients since it does not only prolong life, but also ensures a higher level of its quality. However, despite these humane goals, organ donation is also associated with various ethical issues, namely the problem of retrieval of organs and tissues, a statement of death of a donor (e.g. death of his/her brain), and commercialization of this branch of the healthcare industry. Therefore, the following research is dedicated to the analysis of the mentioned issues in order to define arguments in favor of and against organ donation and develop a final argument on this matter.
As mentioned before, organ donation presents a variety of ethical and moral issues, which has lead to its negative perception by the society. First of all, retrieval of an organ from a living donor is always associated with damage to his/her health. Thus, upholding the ethical principle of doing no harm, which is the basis of the medical ethics, is practically impossible. The doctor faces a contradiction between the principle of doing no harm and helping the patient (Lo, 2009). On the one hand, transplantation of an organ (e.g. kidney) means saving the life of a person (the recipient), i.e. it is a boon for him/her. On the other hand, the health of the living organ donor becomes severely impaired, i.e. inflicted damage violates the principle of doing no harm.
Another serious argument against organ donation and transplantation is high labor intensity, extreme complexity of transplant operations, and a considerable risk of adverse effects. Some of these surgeries require improvement (e.g. heart transplant), while others are still in the experimental stage. As a result, rejection of the donor tissue is quite common, which can lead to the death of a patient. For example, in 1968, Denton A. Cooley, an American surgeon, performed the first heart transplantation in medical practice (Jensen, 2011). Subsequently, in the first eight months after this operation, other fifteen heart transplantations were performed. However, out of all patients only three survived, with six people dying shortly after surgery and the rest dying some time later (Jensen, 2011).
The next refutation is associated with a source of material for transplant operations. As mentioned before, some organs and tissues (e.g. kidney or bone marrow) can be taken from a living person, which contradicts the primary ethical principle of medicine, but ensures that the donor will live on. However, donation of vital organs requires that the donor is clinically dead. Thus, there is a moral requirement: a vital organ such as heart can be transplanted without ethical issues only from a person that is clearly dead. In case this condition is not met, surgery turns into murder. This problem is quite complex because it involves ascertaining death, which still lacks unambiguous criteria. The modern medicine uses the following criteria of the state of death: heart, respiration, pulse, reflexes, and brain activity, with the last of them being a source of many debates. In particular, some scientists characterize the end of life as death of the cerebral cortex, but there is also an opinion that it can be described as death of the brain as a whole. The lack of a single opinion on this matter may result in mistakes during the ascertaining of death of a donor, leading to the abovementioned case of murder. The problem is further exacerbated by the fact that it is almost impossible to define the precise time of brain death (Novitzky & Cooper, 2013).
The final argument against organ donation is a risk of abuse in connection with commercialization of the modern medicine. Despite unacceptability of the creation of a market of organs and tissues and profit from their trade, this process continues to develop in order to satisfy the growing need for them. Moreover, it is well-known that, in accordance with the economic law of demand creating the supply, there is a black market of organs and tissues. Sellers, in this case, are people who decide to sell one of their organs for various reasons, namely the material ones. Moreover, organs are often retrieved from defenseless people like residents of underdeveloped countries, homeless and mentally ill people, and children despite the illegality and immorality of such practice. Therefore, commercialization contradicts the highest humanist idea of organ donation: sacrifice for the sake of life, thus being one of the primary reasons of a negative attitude towards this procedure (Veatch & Ross, 2015).
Despite a variety of ethical and moral issues, organ donation and transplantation have many positive aspects. First and foremost, it ensures the right of every person to life. This fact is especially significant in terms of its moral value as the idea of life and health protection gets a high moral sanction. Moreover, transplantation is recognized to be an efficient treatment of irreversible diseases and injuries of human organs. This thesis is supported by many doctors in the world, whose goal is to serve the human by protecting life and health. In particular, organ donation is now firmly entrenched as an alternative method for treatment of vital organs such as kidneys and heart. The argument in favor of organ donation rests on an appeal to those situations when this method is the only one possible. In particular, it is efficient when all other types of treatment are not acceptable and the patient has no choice between life and death. In such a desperate situation, organ donation and transplantation are the only solution (Veatch & Ross, 2015).
Another argument in favor of organ donation is based on high moral grounds of this procedure. In particular, its success is possible only in conditions of its justification and recognition of moral values during all of its stages. Among unconditional humanistic values to be recognized during organ donation, it is possible to highlight the following three: voluntariness, altruism, and independence. Thus, the concept of organ donation as an anatomical gift has a special place in bioethics. By stressing gratuitousness of such a gift, liberal bioethics tries to overcome and eliminate possible economic motives for this action. The primary reason for that is not only unacceptability of a human body being regarded as an object of purchase and sale, but also the fact that presence of any form of material interest means a loss of a moral status of donation. As a result, this process can be considered as a noble deed, a sacrifice for the sake of saving one’s life, which is highly valued not only from the ethical, but also from the religious point of view. In particular, the concept of self-sacrifice has an important place in Christianity (Bramstedt & Down, 2011).
The final argument in favor of organ donation is the fact that this process is under control of both government and healthcare specialists, namely the ones working in transplantation centers. It is clear that transplantation of organs without consent of a person is a forcible transformation into a donor. Such action is a violation of a basic ethical principle of the relationships between people relating to the will and consent of the person to be engaged in such a relationship. Therefore, in the United States the law ensures that, without the legal consent of a person, the doctor is not entitled to retrieve his/her organs and/or tissues for further transplantation, notwithstanding the situation. A specificity of the ethical vector in organ donation is manifested in the presence of the following triangular relationship: recipient – donor – surgeon (Wilkinson, 2011). Thus, it is necessary to have consent for transplantation not only from the recipient, but also from a donor that gave a permission to use his/her body for such purpose after death. In the U.S., this practice also includes granting donors with personal cards that confirm their voluntary consent to donate their organs or tissues. In turn, such measures eliminate ethical issues that accompany a decision to retrieve an organ from a dead person as such donation is made of the person’s free will, which is manifested in the form of a document (Wilkinson, 2011).
By taking into account all the above mentioned arguments in favor of and against organ donation, it is possible to formulate the final argument on this matter by addressing the most pressing issues. The first of them is the question of justification of such practice when there is a possibility to substitute human organs with those of animals or the ones grown artificially. Unfortunately, transplantation of organs from one person to another is not a fad, but a necessity due to the current state of medical science and practice. Animal organs cannot substitute the human ones and their use does not exclude infection with zoonotic diseases (including hemorrhagic diseases caused by the Ebola virus), which contradicts the ethical principle of doing no harm to the patient. At the same time, creation of artificial organs is one of the most promising research directions, but it is yet to be implemented. Meanwhile, patients that die waiting for donor organs are in need of them now (Siegel & Alvaro, 2010).
Another issue is the opinion that transplantation of organs from one person to another always leads to violation of the rights of the donor in favor of the recipient. Thus, one may assume that it is irrational and unethical to assist a seriously ill person at the expense of the donor’s health. However, it should be noted that any civil society is built on the principle of protection of the weak by the strong. No person is safe from the disease, which can lead to the need for donor organs and it can happen to any person (Siegel & Alvaro, 2010). Moreover, the state is obliged to provide guarantees to citizens in this case. In addition, infringement of the rights of donors does not take place in countries with a clearly debugged system of donation, namely in the U.S. As mentioned before, donor’s organs can be retrieved only if he/she has agreed to such a procedure. One may think that such an approach is immoral as in case the person has not managed to file the agreement prior to his/her death, his/her organs and tissues are to remain intact instead of being used to save another life. However, such an approach considers the ethical principle of voluntariness, as well as makes the entire process easier to control, thus preventing illegal organ trade (Wilkinson, 2011).
Finally, there is a problem relating to the statement of brain death, which is a necessary condition for the retrieval of vital organs. Many people still perceive it as a death sentence to a living person, a refusal to fight for the patient’s life to the end, euthanasia, and the abandonment of resuscitation. However, it must be clearly understood that a statement of brain death is not a refusal from the treatment of the patient, but a scientific and legally valid recognition of the fact that he/she has already died. The very fact that the patient has reached the state of brain death without dying earlier from cardiac arrest is the proof that doctors did everything possible to save him/her. Moreover, possibilities of modern medicine are limited and restoring the dead brain is not yet possible (Miller & Truog, 2012).
Thus, it is possible to summarize the abovementioned argument in the following way: despite all moral and ethical issues surrounding the issue, organ donation was and still is a necessity. As mentioned before, it upholds one’s right to life. However, in order to avoid violation of other ethical and moral principles and rights, including the right to life and the principle of voluntariness, this process must be strictly monitored and regulated both by the government and healthcare specialists.
Donation and transplantation of human organs remain a necessary part of the modern healthcare. However, in order for it to exist further, it must be governed by a set of basic ethical principles. First of all, the human body cannot be regarded as an object of purchase and sale. A transplant from a living donor can only be based on a voluntary self-sacrifice for the sake of saving the life of another person. In this case, consent to organ removal becomes a manifestation of love and compassion. However, a potential donor should be fully informed of possible consequences of a surgery for his/her health. In addition, since removal of organs from bodies of newly deceased people is the most common practice, ambiguity in the definition of the moment of death should be eliminated. Namely, conditions of an ethically correct diagnosis of brain death include compliance with the following principles: the principle of a unified approach and the principle of financial and organizational independence of the team. Finally, it is ethically and morally unacceptable to use the most vulnerable groups of people as donors, namely the homeless, psychiatric patients, children, and residents of economically underdeveloped countries. By strictly following these rules, it will be possible to reduce the number of moral and ethical issues that currently accompany the process of organ donation.
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