There is a discrepancy between the large number of vital organ failure, the need for organ transplantation, and the low supply of organs. It is a touchy subject where each person should have total autonomy over what happens to their body and organs. Therefore, it is acceptable for not everyone to be an organ donor. However, it is also important for people who are in need of organs to receive the donation they need. Therefore, it is important for the public to be educated about the need and merit of organ donations for informed decisions to be made. Moreover, it is important that healthcare practitioners use cadaver organs and tissues with respect and work to deliver care with conscious thought of the altruistic act that the donor has provided. In doing so, the public will be more trusting of practitioners.
The US operates on an opt in consent system where people can opt in to be an organ donor. However, it has been proposed that the US should follow the system of presumed consent that some nations have in place. Presumed consent is where every adult that dies is a potential donor unless they’ve indicated otherwise during their lifetime. Countries with this system in place see higher rates of organ donation than countries that don’t. Although there are merits, it is not completely ethical. There are elements of coercion to presumed consent in that there is an assumption of consent.
It is also important in how organs are allocated. In the US, there are three criterions on how organs are allocated. The first criterion is the preference of donors and recipients who are in geographical proximity. The second criterion is the blood group compatibility and histocompatibility. The third criterion is a number of things such as time of waiting, medical urgency, and age where pediatrics have higher priority. Although not a criterion, allocation also hinges on the basis of humanistic need rather than social, financial, political status, religion, or ethnic origin.
Unfortunately, there is a large international trade in human organs in developing countries and countries with large wealth disparities. It’s ethically wrong and it’s foundation lay on the coercion of the poor and they sadly don’t have a choice in some situations. As science and technology innovates, it is hopeful that the use of stem cells and animal organ and tissue implantation can further help those in need.
Abouna GM. Ethical issues in organ and tissue transplantation. Exp Clin Transplant. 2003 Dec;1(2):125-38. PMID: 15859919.
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Hi Ken,
ReplyDeleteThank you for writing about such an important topic!
While I read your account of the importance of organ donation and the ethics behind it, I was curious about the factors that might influence an individual's decision to become an organ donor (via the opt in system). In my search to find the factors that influenced such an important decision, I stumbled upon a system review of multiple quantitative studies that all explored communal attitudes towards organ donation (Irving, et al., 2012).
The study found eight main themes that influenced the decision to become an organ donor. These themes are relational ties (many are willing to donate to someone close to them), religious beliefs, cultural beliefs, body integrity, the health care system, and knowledge about donation (Irving, et al., 2012).
Interestingly, the study also discovered that individuals were more willing to give organs to close family members or friends while they were alive yet were often hesitant when asked to donate after death (Irving, et al., 2012). The study did not give an interpretation as to why but this might be an interesting topic to discuss in medical settings.
of the factors mentioned above, one of the more significant findings what how health care and fear of health care systems impacted the willingness to donate such that individuals who had had a negative experience (or knew someone who had a negative experience) with medical professionals, were less likely to donate. Thus as future medical professionals (or simply individuals in the world) it is important to acknowledge how the fear of health care (or a negative experience) can affect more than one individual and can even help lead to the organ shortage we are experiencing now.
References:
Irving, M. J., Tong, A., Jan, S., Cass, A., Rose, J., Chadban, S., Allen, R. D., Craig, J. C., Wong, G., & Howard, K. (2012). Factors that influence the decision to be an organ donor: a systematic review of the qualitative literature. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 27(6), 2526–2533. https://doi.org/10.1093/ndt/gfr683