Ethical Issues in Organ Transplants

Ethical Issues in Organ Transplants
Lim, Pio Lim, Vanessa Limtin, Olivia Linchangco, Eric Lindain, Kristina Llana, Mia Lleva, Jan Michael Lo, Virgilio Locsin, Nichole Lopez,John Michael Lopez, Robe Lozano, Ivan Lu, Wryan Lua, Jardine Lubaton, Christian Angelo

Ethical Principles: Organ Transplants

Two types of transplants
Involving an organ or tissue taken from a dead person and given to a living person Involving an organ taken from one living person and given to another living person Lozano, Ivan Lopez, John Michael

Transplant involving an organ or tissue from a dead person to a living person
Lozano, Ivan Lopez, John Michael

Transplanting an organ or tissue from a dead person to a living person presents no ethical problem. With few exceptions, religious groups as well as humanistic ethicists have recognized the worth and ethical validity of such transplants. If a serious question arises concerning this type of transplant, it stems from factors other than the transplant itself. Lozano, Ivan Lopez, John Michael

The Gospel of Life, Pope John Paul II – echoing the Pope Pius XII – summed up Catholic teaching on transplants involving human organs: The Gospel of Life is celebrated above all else in the daily living of life which should be filled with self giving for others….A particular praiseworthy example of such gestures is the donation of organs performed in an ethically acceptable manner with a view toward offering health and even life itself to the sick who sometimes have no other hope. (John Paul II, 1995, n.86)

At first, some theologians sought to justify transplants between human beings by reason of the principle of totality. But close examination of this principle indicated that a person cannot endanger his or her own life to assist another by reason of this principle. Lozano, Ivan Lopez, John Michael

Because the body and the organs exist principally for the good of the individual, the power to give organs to another living person is limited. The principle that justifies donors to sacrifice an organ for transplantation is not that of totality, because the actual donor is mutilated, but the principle of common good or charity, the supreme commandment of the love of neighbor. Lozano, Ivan Lopez, John Michael

The command “to love your neighbor as yourself,” donors cannot injure their own bodies or seriously risk their own lives for another when this risk may in fact do little good. One can donate an organ only when it is probable that one’s own health will be preserved and the recipient will receive a proportionate benefit. Lozano, Ivan Lopez, John Michael

Such a donation is not one of justice but a free act of charity, it is possible for donors to refuse to make such a free gift, nor should others pressure them into doing so or condemn them for not doing so. Lozano, Ivan Lopez, John Michael

Transplants involving an organ taken from one living person and given to another living person

Refers to the material or physical integrity of the human body
Anatomical integrity Can be sacrificed Refers to the material or physical integrity of the human body Functional Integrity Cannot be sacrificed Refers to the systematic efficiency of the human body Ex. if one kidney were missing from a person’s body, there would be a lack of anatomical integrity, but if one healthy kidney were present and working, there would be functional integrity because one healthy kidney is more than able to provide systemic efficiency Lozano, Ivan Lopez, John Michael

Anatomic/Functional integrity
Skin grafts Blood transfusions Elective appendectomy Lozano, Ivan Lopez, John Michael

Dolentium Hominum by Pope John Paul II
Transplantation presupposes a prior, explicit, free and conscious decision It is a decision to offer without monetary reward, a part of one’s own body for the health and well being of a person Medical action of transplantation makes possible the donor’s act of self-giving, that sincere gift of self which expresses our constitutive calling to love and communion Lozano, Ivan Lopez, John Michael

Therefore... Organ transplants between two living persons are licit if the donor’s functional integrity is maintained Great care should be taken in weighing the merely potential benefit against the actual risks No consent if there is a high chance for rejection Brief prolongation of recipient’s life vs. risk to donor Lozano, Ivan Lopez, John Michael

Organs for sale OBJECTIONABLE
It is contrary to the dignity of the human body and is depersonalizing. All those who need such a gift should receive it, rather than only those who can pay. Lozano, Ivan Lopez, John Michael

Conclusion 1. The functional integrity of the donor as a human person should not be impaired, even though anatomical integrity may suffer. 2. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. 3. The donor’s consent is free and informed. 4. The recipients for the scarce organs are selected justly. Lozano, Ivan Lopez, John Michael

Live vs. Cadaveric Organ Transplants

Live Organ Transplant Involves an organ or tissue taken from one living person & given to another living person Unique ethical dilemma Physicians must risk the life of a healthy person to save or improve the life of a patient As surgical techniques and outcomes have improved, however, this practice has slowly expanded. Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

3 types of live organ donation
Directed - to a loved one or friend Non-directed - donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list Directed donation to a stranger - donors choose to give to a specific person with whom they have no prior emotional connection

Theologians Initial Justification
Using the Principle of Totality A person cannot endanger his/her own life to assist another by reason of this principle. The body & its organs exist principally for the good of the individual, thus, the power to give organs to another living person is limited. Actual donor is mutilated Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Theologians Justification
Using the Principle of Common Good or Charity The supreme commandment : “to love your neighbor as yourself” however, donors cannot injure their own bodies or seriously risk their own lives for another when this risk may in fact do little good Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Using the Principle of Common Good or Charity one can donate an organ ONLY when it is probable that one’s own health will be preserved & the recipient will receive a proportionate benefit Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Using the Principle of Common Good or Charity Because such a donation is not one of justice but a free act of charity, it is possible for donors to refuse to make such a free gift, nor should others pressure them into doing so or condemn them for not doing so Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Integrity Anatomical Functional
Refers to material or physical integrity of the human body Can be sacrificed Refers to systematic efficiency of the human body Cannot be sacrificed Integrity Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Integrity For example:
if one kidney were missing from a person’s body = lack of anatomical integrity But if one healthy kidney were present & working = functional integrity is preserved because it is more than able to provide systemic efficiency Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Integrity associated with the Principle of Totality
Loss of anatomical integrity may occur through loss of blood, skin tissue, or an internal organ, but no loss of functional integrity occurs. Reason why the church approves blood transfusions and skin grafts Reason why theologians approve elective appendectomy if the abdominal cavity is open for another legitimate reason Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Pope John Paul II: The Essence of being an Organ Donor (as quoted in Dolentium Hominum)
Transplantation presupposes a prior, free, & conscious decision on the part of the donor or of someone who legitimately represents the donor, generally the closest relatives. It is a decision to offer without monetary reward, a part of one’s own body for the health & well-being of another person. Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Pope John Paul II: The Essence of being an Organ Donor (as quoted in Dolentium Hominum)
The medical action of transplantation makes possible the donor’s act of self-giving, that sincere gift of self which expresses our constitutive calling to love & communion. - John Paul II 1992, n. 2 Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Live Organ Transplant is licit if…
The functional integrity of the donor as a human person should not be impaired, even though anatomical integrity may suffer. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. The donor’s consent is free & informed. The recipients for the scarce organs are selected justly. Lim, Vanessa Marie T. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Cadaveric Organ Transplants

Cadaveric Transplant Involves the organ or tissue taken from a dead person and given to a living person. Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Cadaveric v.s. Live Transplant
Transplanting an organ or tissue from a dead person to a living person presents no ethical problem. With few exceptions, religious groups as well as humanistic ethicists have recognized the worth and ethical validity of such tranplants. Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Cadaveric v.s. Live Transplant
If a serious question arises concerning this type of transplant, it usually stems from factors other than the transplant itself. Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Cadaveric Transplant Serious factors arising other than the Transplant are: In heart transplants, most of it either arises from the great expense of money. Personnel involved in a medical procedure. Fear that in some cases the organ donor had not actually died. Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

These factors have been somewhat dispelled as a result of:
better survival rates in recipients of heart tranplants a greater ability to ascertain the criteria for total brain death. Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

In The Gospel of Life, Pope John Paul II –echoing Pope Pius XII – summed up Catholic teaching on transplants involving human organs. The Gospel of Life is celebrated above all else in the daily living of life which should be filled with self giving for others...A particular praiseworthy example of such gestures is the donation of organs performed in an ethically acceptable manner with a view toward offering health and even life itself to the sick who sometimes have no other hope. (John Paul II 1995, n. 86) Lim, Pio Rafael R. Ethics of Health Care 3rd ed. by Ashley and O’Rourke 2001

Ethical Issues regarding donor
"In the donation and transplantation of human organs, respect is to be given to the rights of the donor, the recipient and the common good of society.“ (CHAC, 44) Lozano, Ivan Lopez, John Michael

From the Deceased Lozano, Ivan Lopez, John Michael

ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES
From the Deceased In general it is seen as praiseworthy to will one's body or parts of one's body for the benefit of others after one's death. In 1956 Pope Pius XII summed up the Catholic view on this: A person may will to dispose of his [or her] body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it....this decision should not be condemned but positively justified.(quoted from Ashley and O'Rourke 1989, 305) Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased More recently (1985) the Pontifical Academy of Sciences stated: Taking into consideration the important advances made in surgical techniques and in the means to increase tolerance to transplants, this group holds that transplants deserve the support of the medical profession, of the law, and of people in general. The donation of organs should, in all circumstances, respect the last will of the donor, or the consent of the family present.(MacNeil) Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased Such a donation can greatly benefit others and cannot harm the donor who is dead. Not to offer such a donation can be a sign of indifference to the welfare of others. To donate, however, is not considered obligatory. Transplantation is against some people's consciences for religious or other reasons. Consideration for the sensibilities of the survivors may also make some people hesitate to sign over their bodies. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased In any case proper respect should always be shown human cadavers. Although they are by no means on par with a living human body/person, they once bore the presence of a living person. The probably dying potential donor should be provided the usual care that should be given to any critically ill or dying person. Because of a potential conflict of interest, it is widely agreed that the transplant team should be different from the team providing care for the potential donor, who is not to be "deprived of life or of the essential integrity of their bodily functions.... No organs may be removed until the donor's death has been authenticated by a competent authority other than the recipient's physician or the transplant team." Various parts of the human body can often be kept in good condition for transplant purposes after the death, irreversible cessation of all brain functions, of the donor. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased The Catholic Health Association of Canada (CHAC) considers transplantations of brain cells (presuming irreversible cessation of all brain functions of the donor) in order to restore functions lost through disease as permissible "as long as the unique personal identity and abilities of the recipient are not compromised in any way." The German Bishops' Conference and the Council of the German Evangelical Church consider the transplant of "reproductive glands" as unethical, "since it intervenes in the genetic individuality of the human being." This does not seem to exclude transplanting all sexual body parts, but the gonads. Any child that resulted following an ovary or testicle transplant would have the dead donor and not the living recipient as its biological mother or father. This would violate the rights of the child Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased The case of the body of a pregnant woman in Germany, who had been declared brain dead, being kept alive with the hopes of the child coming to term was recently given some media attention. Some criticized this as not giving proper respect to the woman. Can not this effort, however, be seen as similar in some ways to organ donation and, therefore, as commendable? The woman had at least implicitly offered her body for the child's sake before her fatal accident. Her family also requested this.(Associated Press) Cases such as this also raise the question of "ordinary" and "extraordinary" means of saving life Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From the Deceased The use and possible use of cadavers and "neomorts" (brain-dead individuals maintained on life support) for a variety of purposes (transplants, research, training medical students), perhaps even a considerable time after the person's death, has provoked ethical and legal debate. Various concerns include respect for the dead and their wishes, respecting the family's wishes, benefitting others and the common good. In light of this, anyone considering donating their organs and/or body after their death, highly commendable in itself, may wish to specify certain limits. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From Living Persons (Adults, Mentally Disabled, Minors)

Transplants between living persons raise the question whether it can ever be ethical to mutilate one living person to benefit another. Concerning this many distinguish between parts of the body that can regenerate (e.g. blood and bone marrow) and parts that do not regenerate. Regarding the latter some are paired (e.g. kidneys, corneas and lungs), whereas others are not (e.g. heart). Before transplants of organs such as kidneys were performed, many Catholic theologians considered this unethical between living persons. They thought it violated the Principle of Totality which allowed the sacrifice of one part or function of the body to preserve the person's own health or life (i.e. a part could be sacrificed for the sake of the whole body), but did not allow one person to be related to another as a means to an end. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

Gerald Kelly (1956) argued that such donations which have as their purpose helping others could be justified by the Principle of Fraternal Love or Charity provided there was only limited harm to the donor. Some ethicists argued this did not violate the Principle of Totality provided that functional integrity of the body was not destroyed, even though there is some loss to anatomical (physical) integrity. Donating one of one's kidneys could be justified for proportionate reasons, since one can function with one healthy kidney. Donating one of one's functioning eyes, however, can not be justified, since one's ability to see (functional integrity) would be seriously impaired. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

Basic to medical ethics is the Principle of Free and Informed Consent. To be properly informed the potential living donor should be given the best available knowledge regarding risks to him/herself, the likelihood of success/failure of the transplant and of any alternatives. In some cases there is much pressure to donate (e.g. from family members if one is a good match). The courts have rightly refused to compel such donations. Motivated by charity, which includes a properly ordered love for others and oneself, one could decide not to offer an organ. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

The distinction of ordinary and extraordinary means is also applicable to transplants. The Catholic Church teaches that one is obliged to use ordinary means to preserve life, but not extraordinary means, that is, means that are very burdensome (very painful, expensive, inconvenient, risky, or even very psychologically burdensome) or do not offer reasonable hope of benefit, or are disproportionate Some forms of organ and tissue transplant from a living donor, especially those involving invasive surgery, involve considerable burden to the donor. If means are available that do not involve such burdens, such as a matching organ from a deceased donor, these are certainly to be preferred. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

The above principles would allow in some cases such procedures as "transplanting part of the liver from a living adult donor into a child recipient, where after the adult donor's liver regenerates within a month and the child's new partial liver develops as the child grows", or donating one's heart if one were to simultaneously receive a heart and lung transplant . Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

A competent adult can give free and informed consent to be or not to be a living donor, but an incompetent person cannot. Can a guardian ethically consent for a legally incompetent person, such as a severely mentally disabled adult or a minor, to be a living donor? Concerning this issue some distinguish, for example, between a young child and a mature minor's ability to comprehend the implications of donating. Regarding medical decisions an incompetent person's guardian is to act for their benefit or best interests, and, as far as possible, their wishes, if known and reasonable. Some think children and the mentally disabled should never be living donors. They are simply being used with a violation of their bodily integrity, risks to their health and life, and no benefit to themselves. An argument against their being a living donor of an organ such as a kidney, is that an alternative such as renal dialysis is often available until a suitable deceased donor can be found. Others argue that in some cases the psychological benefit to the donor (e.g. a child's sibling lives) could outweigh the risks (e.g. of donating bone marrow). The Catholic Health Association of Canada (CHAC) says that, "Organ or tissue donation by minors may be permitted in certain rare situations.“ Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

Can it be ethical to have another child for transplant purposes (e.g. for a bone marrow transplant)? Conceiving and having a child for this motive alone would involve treating him/her as a mere means to another's benefit. This would violate the great dignity of a person, created in God's image, who should be loved for his/her own sake. Concerning the whole issue of living donors, the German Bishops' Conference and the Council of the German Evangelical Church say: ...No one is obliged to donate tissue or an organ; therefore no one can be forced to do so. The decision to donate one's organs while still alive can only be made by the individual concerned personally. Not even parents are allowed to decide on an organ donation by their child; they are allowed to give their consent only for a donation of tissue (e.g., donation of bone- marrow). The doctor in this case has a special responsibility because no one can control whether a donation is truly voluntary. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

When a living person donates an organ as a result of a personal decision, then the organ's transplant is to be carried out with due attention, and post-operative medical care of the donors as well as the recipients must be provided. Further, consideration must be given so that no problems develop in the relationship between the donor and the recipients (dependence, excessive gratitude, guilt feeling). Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From Anencephalic Infants

From Anencephalic Infants
Anencephalic infants are born with a major portion of the brain absent. If born alive they die within a few days, although in rare cases some survive for weeks or months. According to the widely accepted criteria of death as irreversible cessation of all brain functions, they are living human beings/persons. To increase the likelihood of procuring viable organs from them, some would like to redefine death in terms of partial brain death so that they could be considered dead (although still breathing spontaneously...), or for them to be exempt from the total brain death criteria, or to consider them non-persons. Many others, however, argue that partial brain death criteria are invalid in light of our present knowledge and/or such an arbitrary move would endanger other classes of living human beings and lead many more people to refuse to sign organ donor cards. Although extraordinary means of prolonging the life of anencephalic infants do not need to be used, they should be given the normal care of dying persons Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From Human Fetuses

From Human Fetuses Is it ethical to transplant brain or other tissues from human fetuses to benefit others (e.g. those suffering from Parkinson's Disease)? If the fetus has died of natural causes, the ethical issues would be similar to other transplants from the deceased. When the fetus has died or will die as a result of procured abortion, however, other ethical issues arise. Catholic Church considers direct abortion (the intentional killing of an innocent human being) to be gravely immoral. Some argue that to use tissues from a fetus killed by abortion could be done without approving direct abortion (cf. using tissues or organs from a murder victim). Such use, however, could "justify" abortion (i.e. to benefit others) for many women who otherwise are unsure about having an abortion. A good end though does not justify an evil means . The timing of the abortion may be influenced as well. The widespread usage of electively aborted fetuses would establish an "institutional and economic bond between abortion centers and biomedical science. Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

From Human Fetuses Some argue that transplanting fetal brain tissue would require the fetus to be still alive, that is, the tissue would not be good for transplant purposes after the fetus has experienced total brain death.(cf. Duncan, 16-22) Some say that other means of treating such diseases as Parkinson's can and should be developed.(cf. Dailey) Another issue involves consent. Anyone involved in procured abortion would not qualify as the fetus' guardian since they hardly have his/her best interests at heart. The Catholic Health Association of Canada (CHAC) concludes that, "Transplantations using organs and tissues from deliberately aborted fetuses are ethically objectionable." (45; cf. SCDF 1987, 16-18) Lozano, Ivan Lopez, John Michael ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL ISSUES Paul Flaman

Ethical Issues regarding the Selection of Recipients

Organ Donors Need for informed consent
- individuals should be properly informed about the process involved in order to be in a position to consent or decline in a free and conscientious manner.

Organ Donation Moral certainty of death required for removal of vital organs - complete and irreversible cessation of all brain activity.

Organ Donation Anatomical integrity
- material or physical integrity of the human body. It can be sacrificed for a better cause, as long as the body can still function normally. Functional integrity - systematic efficiency of the human body. The Principle of Totality applies here, pointing out that parts can be taken as long as the function of the whole is not sacrificed.

Organ Donation “ The Gospel of Life is celebrated above all else in the daily living of life which should be filled with self giving for others…A particular praiseworthy examples of such gestures is the donation of organs performed in an ethically acceptable manner with a view toward offering health and even life itself to the sick who sometimes have no other hope.” Pope John Paul II 1995, n. 86

Selection of Recipients
Principle of Justice - promotion of equity of care. The right of each person to basic health care is respected.

Principle of Triage - to pick or sort according to quality. Dangerously wounded are tended first, w/out regard to rank or distinction. Less severly injured must wait until gravely wounded are operated on.

Principle of Triage In applying triage in emergencies, 2 questions must be asked: Who is in greatest need of treatment? Who will benefit most from treatment?

Principle of Triage 3 divisions of patients:
The dying: Need is great, but benefit least from the treatment The wounded who will survive w/out treatment: Need is little and can be left to care for themselves Wounded who will die unless treated: Need is great, and will probably survive with treatment (deserve most attention)

Sometimes it is necessary to use a random principle of selection not based on need or benefit (e.g. lottery, rule of first come first served) Not unfair if the need and benefit are approximately the same for all, or if there is no way of discriminating on a need and benefit basis Principle of subsidiarity: closest to us and whose needs is best known should be cared for first. As long as no one else is treated unjustly.

Summary The functional integrity of the donor as a human person should not be impaired The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient The donor’s consent is free and informed The recipients for the scarce organs are selected justly.

Ethics of Organ Selling/Buying

Definitions Seller: Donor who exchanges organ for money
Buyer: A recipient who pays for the organ Middleman: Person/institution that arranges trade between buyer and vendor Organ sales: Trading of an organ in exchange for money or similar material Organ trafficking: Trading for profit Lozano, Ivan Lopez, John Michael

Ethical & Moral Considerations on Organ Buying & Selling
The buying and selling of human organs has traditionally been considered ethically and morally reprehensible WHO CBCP WMA Transplantation Society Lozano, Ivan Lopez, John Michael

WHO The World Health Organization (WHO) declares the commercialization of human organs to be "a violation of human rights" and "human dignity" Guiding Principle "The human body and its parts cannot be the subject of commercial transactions. Accordingly, giving or receiving payment (including any other compensation or reward) for organs should be prohibited.” Lozano, Ivan Lopez, John Michael

CBCP The Catholic Bishops’ Conference of the Philippines (CBCP) said human organ transplant is viewed by the Church as an: “act of self-giving which expresses our constitutive calling to love and communion,” but becomes “morally unacceptable” when it already involves sale and trade. Lozano, Ivan Lopez, John Michael

WMA Statement – Living Donors
Ensure donation free of coercion Prohibit payment for tissues/organs for donation or transplantation Financial incentive compromises the voluntariness of the choice and the altruistic basis for organ and tissue donation Access to needed medical treatment based on ability to pay is inconsistent with the principles of justice Organs suspected to have been obtained through commercial transactions should not be accepted for transplantation. October 2000, at its 52nd General Assembly in Edinburgh, WMA came up with its most elaborate statement to date on human organ and tissue donation and transplantation. Lozano, Ivan Lopez, John Michael

Transplantation Society (Ethics Committee)
Has consistently opposed paid organ donation Its position being: "organs and tissues should be freely given without commercial or financial profit." Lozano, Ivan Lopez, John Michael

Legalization of kidney sales?
With demand for healthy kidneys for transplantation far outstripping supply: An international debate has arisen on whether traditional ethical and moral values should be put aside The sale of organs legalized Argument: Society has a collective responsibility to save lives and therefore must set aside ethical notions such as altruism and the inviolability of the human body. Lozano, Ivan Lopez, John Michael

Questions Ethicists raised regarding the said Argument:
Can we put aside fundamental and absolute moral principles so that a small percentage of the population can extend their lives by a few years? And more fundamentally, can we justify setting aside morality for non-moral purposes? Lozano, Ivan Lopez, John Michael

Harm of Kidney Sales Do sold organs fill need?
Exploitation of poor by middlemen or profiteering clinics Real chance to improve life of poor seller? Incentives due to organ price (low supply/high demand created) Vendor paid less than right price (and buyer pays more than right price Poor vendor may conceal high risk exposure/behaviors Lozano, Ivan Lopez, John Michael

Harm of Kidney Sales Vendor motive is altruism/responsibility/charity?
Vendor and buyer see themselves as possessors of property rather than stewards "We will be eyeing each other's bodies greedily as a potential source of spare parts with which to extend our lives.“ (T. Awaya) To use organ as item for sale or exchange is contrary to inherent dignity of person (Pope John Paul II) Lozano, Ivan Lopez, John Michael

Harm of Kidney Sales Undermine public confidence in medical profession by associating transplant to money-making Inhibit development of better procurement programs Role of society: educational campaign to increase donors and disseminate info on medical and ethical inssues involved in donation Control “transplant tourism” Lozano, Ivan Lopez, John Michael

Virtues of a Catholic Healthcare Giver

In the encyclical letter Evangelium Vitae, the Holy Father suggested ways "which build up an authentic culture of life." One way "is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope." (86) Lozano, Ivan Lopez, John Michael

THE HIPPOCRATIC OATH ….. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient… …I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous….. Lozano, Ivan Lopez, John Michael

AS THE CATHOLIC HEALTH CARE PROVIDER…
The physician has positive obligation to provide the best possible care to the patient: either donor or recipient Lozano, Ivan Lopez, John Michael

Virtues of a Catholic Health Giver
Prudence Foresight; caution Charity An act or feeling of generosity The giving aid to the poor Fidelity Faithfulness to trust and promise Justice Giving others their due Lozano, Ivan Lopez, John Michael

“It is the physician who offers the final determination of death”
PRUDENCE “It is the physician who offers the final determination of death” Pope Pius XII, 1957 Lozano, Ivan Lopez, John Michael

PRUDENCE Ethical and Religious Directives – Directive 62
The determination of death should be made by the physician or competent medical authority in accordance with responsible and commonly accepted scientific criteria Lozano, Ivan Lopez, John Michael

PRUDENCE Ethical and Religious Directives – Directive 64
Organs should not be removed until it has been medically determined that the patient has died The physician who determines death should not be a member of the transplant team to prevent any conflict of interest Lozano, Ivan Lopez, John Michael

DETERMINATION OF DEATH
Brain death Irreversible cessation of all brain functions, even if cardiac and respiratory functions which would have ceased have been maintained artificially various tests are conducted to determine brain death verified by 2 physicians Lozano, Ivan Lopez, John Michael

DEAD DONOR RULE First, policies aim to ensure that all deceased donors are truly dead; that there are clear criteria for discerning when death has occurred; that these criteria are grounded in the nature of death itself as a biological phenomenon and yet applicable in light of novel technological capacities to sustain various biological functions even after whole-brain death has occurred; Lozano, Ivan Lopez, John Michael

DEAD DONOR RULE and that the desire to procure organs does not invite us to redefine death in general or hasten the death of particular patients in order to expand the organ supply, or tempt us to procure vital organs from those who are severely debilitated or imminently dying but not yet dead. Lozano, Ivan Lopez, John Michael

CHARITY Gifting, Not Selling
Laws prohibit the buying and selling of human organs, the treatment of organs as commodities, and the use of cash payments or other "valuable considerations" as incentives to expand the organ supply Lozano, Ivan Lopez, John Michael

CHARITY Gifting, Not Selling
Our system of organ procurement is rooted in the belief that organ donation should be an act of altruism or gifting, motivated by the desire to do good for a needy patient or the desire to give added meaning to the donor's death, not the desire to profit from the sale of one's body or the sale of a family member's mortal remains. Lozano, Ivan Lopez, John Michael

FIDELITY Directive 65 Use of tissue or organs from an infant may be permitted after death has been determined and with informed consent of the parents or guardians Lozano, Ivan Lopez, John Michael

FIDELITY Directive 30 The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of the prospective donor must be respected, and economic advantages should not accrue to the donor. Lozano, Ivan Lopez, John Michael

JUSTICE Scarce resources should be distributed fairly
Time on the waiting list (first come first serve basis) Medical need Ability to pay Previous transplantation (chance of success) Citizenship Ethnic background Lozano, Ivan Lopez, John Michael

JUSTICE Ethical guidelines are balanced differently for different organs Example: Renal failure: dialysis is an effective alternative to transplantation; higher priority is given weight to HLA matching Liver failure: no alternative to transplantation; priority is given to patients in the most critical condition Lozano, Ivan Lopez, John Michael

ALLOCATION BY JUSTICE AND LOVE
Aim to establish a fair system of allocating organs procured from the deceased, one that takes into account a range of factors. These factors include: the amount of time spent on the waiting list, the physiological compatibility of organ donor and organ recipient, the urgency of a patient's medical condition, the likely benefits to be gained by the patient from receiving an organ transplantation, and the age of the potential recipient. Lozano, Ivan Lopez, John Michael

These allocation criteria do not govern organ donation by living donors to their chosen recipients- such as family members, loved ones, or even strangers who have made a personal appeal via the Internet, billboards, or newspaper ads. Limtin, Olivia S. Lua, Jardine

So while the system of publicly allocating available organs (mostly from deceased donors) aims to be governed by the commitment to justice (with debates about what justice requires), the system of privately arranged donation (mostly from living donors) is governed (mostly) by love. Lozano, Ivan Lopez, John Michael

COMPASSION Give the family an opportunity to say goodbye and receive comfort in their grief. Lozano, Ivan Lopez, John Michael

SOURCE Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition Resolving Ethical Dilemmas: A guide for clinicians. 3rd edition. Bernard Lo E.Cohen, Organ Transplantation: Defining the Ethical and Policy Issues, June 2006 Lozano, Ivan Lopez, John Michael

Ethical Issues in Organ Transplants

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Ethical Issues in Organ Transplants

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