Organ donation is one of the sensitive areas that needs to be monitored diligently. Many things need to match or be very close to ensure a successful organ transplant. Blood group, age and weight are all taken into account. For kidneys another important factor is tissue type which is much more complex than blood grouping. The best results can be achieved if a perfect match is found. Tissue is very occasionally matched, eg for size and tissue type, but otherwise is freely available to any patient in need of a transplant. The decision about whether some or all organs or tissue are suitable for transplant is made by a healthcare professional, taking into account the patient’s medical history.
Gloria J in her article ‘Legal & ethical safeguards: protection of society’s most vulnerable participants in a commercialized organ transplantation system‘ on American Journal of Law & Medicine vividly puts the scenario that pushes for legal right to buy and sell body parts on the global market:
“Legal and ethical questions regarding existing organ transplant procurement policies and practices are numerous and unsettling. They arise because transplantable organs are scarce. The scarcity of such organs has been the hue and cry of several medical and legal scholars. (1) For example, the scarcity creates competition among those who wait, necessitating equitable organ allocation procedures and guidelines. (2) Medical obstacles surround the determination of when, how, and on whom such procedures can be performed successfully. Other obstacles range from finding a suitable donor for proper “matching” with the intended donee, to the time constraints involved in preserving excised organs until transplantation, to the donee’s ability to fight off rejection of transplanted organs. (3) There is also the obstacle of locating available organs. As medical technology continues to advance, the number of possible organ sources increases. Currently, these sources have included live human donors, cadavers, mechanical devices, animals, fetuses, anencephalic infants, and “brain-dead” donors.”
Various body parts and form of transplants needed
The human body has approximately thirty transplantable parts. Scientific developments have made it medically possible to replace both structural and cellular human body parts. And with cellular human body parts, there is a major physiological distinction between regenerative and nonregenerative cells. The problem of identifying available donors has been present in both regenerative and nonregenerative human organ and tissue transplants due to the various medical obstacles identified above. Regenerative tissue is more readily transplanted from living donors, whereas nonregenerative organs generally come from cadavers or animals. This distinction is lucidly put in the above Gloria J’s article:
“The primary legal distinction between regenerative and nonregenerative human organs and tissue is the manner of transaction permitted under law in the transfer of such organs or tissue between the donor and donee. Current national and state laws permit both the donation and sale of regenerative tissue such as blood, sperm, ovum, cells, hair, and other such body products. On the other hand, nonregenerative solid body organs such as the heart, lungs, liver, pancreas and kidneys, can only be transferred by participation in the existing volunteer organ donation system. The sale of such nonregenerative organs is strictly prohibited in the United States as well as in many other countries.”
Problems facing the sector
Medical professionals who have fought to successfully transplant human tissue have faced three major threshold obstacles.
- Medical technology required to perform the basic operation.
- Preserving extracted organs long enough to allow a successful transplant.
- Warding off threatening infections in the donee caused by the presence of foreign tissue.
Medical advancements in these three areas have continued to provide options in the field of organ transplants. Scientists, however, remain challenged to overcome the ever-present problem inherent in all three of these obstacles–the problem of identifying readily available organ donors. Although certain scientific medical developments have increased the supply of available organs for human transplants, they have also created legal and ethical issues. There are only two conditions where organ donation is ruled out completely. A person cannot become an organ or tissue donor if they have been diagnosed with HIV or have, or are suspected of having, CJD(Creutzfeldt-Jakob disease) which are transmissible diseases.
Donor organs will be able to survive outside the body from 24 hours to several days. The current medical practice uses immuno–suppressive drugs to decrease the likelihood that newly transplanted would not be rejected by the Immune system straight away. But the use of these kind of drugs would leave patients as immuno-compromised, a condition which would further make people vulnerable to opportunistic infections which could have been easily destroyed by a normally functioning Immune System. And the body still reacts to the transplants, causing them to fail. This results in patients needing another donor organ before the end of life of the donated organ. For instance, transplanted kidneys on average last only 10 years, whereas they could last for almost triple that time. Recent developments in drugs are decreasing the chance of organs being rejected, and future advancements of stem cell research on cloned cells are believed to have a profound effect.
The number of people who are on the waiting list for organ donation far outweigh those who are fortunate to get the transplant treatment. And not a small quantity so often die waiting for an organ. There is a national, computerised list of patients waiting for an organ transplant. The computer will identify the best matched patient for an organ or the transplant unit to which the organ is to be offered. Normally, priority is given to patients who most urgently need a transplant. UK Transplant operates the transplant list and donor organ allocation system. It works round the clock, every day of the year and covers the whole of the UK.
Each of these organ donor sources generates legal and ethical issues. One of the most controversial is whether medical personnel improperly subject brain-dead donors to a prolonged death-like existence until potential donees can be located. Additionally, with respect to euthanasia and the “right to die,” some fear that the value of life of the brain-dead may diminish so as to create prey for organ-hungry opportunists should society eventually reach the bottom of the slippery slope.
The scarcity of human organs for transplant purposes leads the debate in the organ transplant industry. Some argue that the current voluntary system has failed and have proposed several alternate systems. The proposals include the enactment of a presumed consent or compulsory organ donation system, and the partial or full commercialization of human organs and body parts for transplantation purposes.
Options to address the issue
For various religious and psychological reasons, many people feel uncomfortable donating organs to others, even if these organs are removed after their death. To address the problem of organ donation, two approaches are followed.
- Remove the need for transplants of living organs by increasing research to find alternative solutions to using real organs: This involves grow organs on demand (can involve realising stem cell techniques that would also decrease the chance of the new organ, cloned, being rejected by the Immune System), use of animal organs or find alternative cures for diseases
- Increase the number of organs being donated: most realistic and quickest-to-implement option.
Possible Solutions to Increase Donations (as part of the 2nd option)
- Imposing that everyone should be a donor: poses serious ethical dilemmas as patient autonomy and religious opinions would collide
- Financial incentives: Paying for organs is currently illegal in UK because it is open to abuse and would lead to the establishment of the traffic in organs which could have devastating effects on parts of the population. Individuals would also seek to obtain organs from poorer countries to sell them at a profit back at UK. Hence, providing incentives in public services to those who donate and establishing market for options on organs would regulate things.
- Reciprocity plans: already in practice at States, no-give-no-take plans by joining organ donation clubs. The system works on a point system to determine who is entitled to what benefit.
- Regulating the organ transplant industry by pushing for legal right to buy and sell body parts on the global market
The last option is very debatable. Mike Adams, author of Natural Health Solutions and the Conspiracy to Keep You From Knowing About Them condemns the move to address the global shortage of human organs available for transplantation as well as a trend toward “transplant tourism” on The World Health Organization’s second Global Consultation on Transplantation, “The legalization of organ trading on the global market would create a monstrous industry of human misery and suffering, where innocents are labeled criminals and killed for their organs so that organ transplant profiteers can make a fortune while claiming they’re saving lives.” He goes further, “The organ transplant industry claims this move would save more lives, and it may, but it would also coincidentally ensure future revenues of organ transplant surgeons, anti-rejection drug manufacturers and surgical facilities — all of which profit from the trade of body parts.“
It is imperative to address the ethical implications if a commercial organ transplant system becomes legal, including safeguarding society’s most vulnerable individuals who participate as transferors in a legalized commercial organ market. Even if I believe there are potential doors of abuse when we think of legalising organ trading, the contemporary suffering faced by those who desperately need it overrides the move to de-legalise but still with caution. The shortage of organs and the duration an available organ would remain useful also incapacitates the current supply. The scarcity of a donor match dictates the use of immuno-suppressive drugs, which would have the disadvantage of making people susceptible to various opportunistic infections, and eventually run out of supply options. Hence, its benefit from availability at a large scale plays down the argument for the contradictory.
For comprehensive view of the laws that dictate this practice, it is worth having a look at this:
Human Tissue Act 2004 An Act to make provision with respect to activities involving human tissue; to make provision about the transfer of human remains from certain museum collections; and for connected purposes.