1. EthIcal Issues assocIated wIth organ transplantatIon
Assist.Prof.Dr. Mehmet KARATAS
Dept. of History of Medicine & Ethics

2. Definition of Death
Irreversible loss of consciousness, loss of spontaneous breathing with the loss of heartbeat
The death or loss of brain cells are necessary for the determination of death in medical terms
Brain death occurs in every death

3. Possible Reasons for Brain Death
Acute myocardial infarction, bradycardia, tachyarrhythmia, hypothermia, hyperthermia, anaphylaxis, cerebral attacks, anesthesia, trauma, electric shock, lightning strike, drowning in water, electrolyte disturbances, renal failure, toxic causes
Elderness
Chronic diseases etc.

4. Determination of Death
Anaesthetist
Neurologist or Brain Surgeon

5. Legal Basis International Documents Medical Ethics Charter
Patients’ Rights Directive
Organ and Tissue Transplantation, Storing and Law (1979)
Organ and Tissue Transplantation Services Regulations (2000)
Turkish Medical Association Code of Professional Ethics in Medicine

6. Law No. 2238
Must be above 18
Consent in the presence of physician and two witnesses
Donors life should not be endangered
Buying/selling is forbidden
Advertisement is forbidden
The donor should not be mentally deranged
Donor’s spouse needs to be informed
The names of the Receiver and Donor should be kept hidden

7. Law No. 2238, and Ethical Dilemmas
Unless otherwise noted, corneas can be taken without permission
In accidents or natural disasters organs can be taken without consent
Unclaimed bodies can be used in educational institutions after 6 months of kepting

8. Directive
The regulation, which entered into force in 2000, governs the principles and procedures with regard to the opening, running and surveillance of Tissue Typing Units and Organ and Tissue Transplantation Centres which perform the transplantation and the principles and procedures to be complied with by the public and private organizations to which they are affiliated to

9. Organ Transplant Service Execution
The National Coordination Committee
Scientific Advisory Boards (6 member per board)
Board of Coordinators (5 member)
National Organ and Tissue Transplantation Services Co-ordination Centre (Ministry of Health)
Organ and Tissue Transplantation Data Processing Center
Organ and Tissue Transplantation Regional Coordination Centers (Istanbul, Ankara, Izmir)

10. The National Coordination Committee
Undersecretary of the Ministry, Medical Services General Manager, Heads of the Scientific Advisory Boards of Heart-Lung-Heart Valve, Liver, Kidney, Cornea, Bone Marrow Transplantation, Immunology, Dialysis, Intensive Care Coordinators Chairmen and Chairman of the Scientific Advisory Boards

11. The National Coordination Committee
In order to bring the organ and tissue donation services to a modern, the Department of Organ and Tissue Transplantation Services and the Organ Transplantation Services Unit were established within the General Directorate of Curative Services of our Ministry.
The objective of the system is to ensure that, with a fair allocation and in conformity with the scientific rules and medical ethics, organs and tissues from cadavers are delivered to the most suitable patients and transplantation centres in the shortest time possible and that they are transplanted the most suitable patients.
The committee works on to improve national coordination system and follows the developments in the world

12. Scientific Advisory Boards
Heart-Lung-Heart Valve
Liver
Kidney
Cornea
Bone marrow
Immunology
Intensive Care

13. Scientific Advisory Boards
When applying to open up a organ and tissue transplant center the board evaluates applications. Two members of the Scientific Advisory Board members will attend on behalf of the General Directorate of Treatment Services by three people, including a member of organ and tissue transplantation centers prepare for inspection on site inspection report and the National Coordination present to the Board
Monitor the work of organ and tissue transplantation centers
Determines strategies in organ and tissue transplants in the country to determine the measures to be taken, suggest plans and programs for the development of the service

14. Board of Coordinators
Coordinators working with Organ and Tissue Transplant and Centers for Organ and Tissue Resource Centers elect five members and form the Board of Ministry. The Committee shall elect a chairperson from among its members.
Coordinators of the Board direct organ transplant services, and carry out studies in order to find a solution to the problems encountered and to provide communication between the coordinators.

15. References
F. Başak ÇAKMAK/Bilal GÜNENÇ, İnönü Üniversitesi Tıp Fakültesi, translation
Tolga GÜVEN, Marmara Üniversitesi Tıp Tarihi ve Etik AD ders notları
Gürkan SERT, Hasta Hakları
Robert M VEATCH, Medical Ethics
Emine ATABEK, Mebrure DEĞER, Tıbbi Deontoloji Konuları
Hasta Hakları Yönetmeliği, 1998
Klinik Araştırmalar Hakkında Yönetmelik, 2011
Çağlar Boyu Tıp, Roche Yayınları