Organ Transplant Ethics

Organ Transplantation

• process of moving a vital organ from one person to another

• kidney, liver, heart, lung, pancreas, intestine

• can come from living or deceased donors

• early attempts failed → organ rejection

• development of cyclosporine and immunosuppressants (1980s) → success

Types

• non-vital organs

• self-transplant

• autologous (self) ovarian transplantation → both non-vital + self-transplant

  • preserve ovarian function of cancer patients w/ systemic treatments

  • tissue removed and stored during treatment period → transplanted back after treatment completed

• vascular composite allografts (VCAs) → hand, face, uterus, etc.

• xenotransplants - organs taken from animals

• 3D transplants - only theoretical currently

Demographic

• 103,00 national waiting list

• 17 die a day waiting for a transplant

• organ shortage

• significant majority in US → kidney transplants

Evaluation Process

• transplant program at an individual hospital decides they are willing to potentially have a transplantation for the patient → approved for national waitlist

• national waitlist → uses algorithm → sends out transplant offers (deceased donor organs) to specific patients

• transplant program + patient accepts/declines organ offer

Allocation

• group level, not individual people

• contrast to most clinical ethics (individual patients are the concern)

• can be listed at multiple hospitals → better for richer people

OPTN identifies several values → balanced against each other

• Utility = net benefit to the group (X sickest regardless of outcome)

• Justice = fair distribution of “benefits and burdens”

• Respect for persons

  • treating people not as mere means

  • persons are the ends themselves (ends justify the means)

  • respect individual right to make own medical decisions

Issues

• three main values often in conflict - example

  • patients can turn down specific organ offers

  • hopes of receiving a better-quality organ

  • reduces overall utility of transplant allocation system

Living Donor

• bypasses allocation system

• donate kidney or part of liver

  • rarely = lobe of lung, part of pancreas, part of intestine

• must complete extensive evaluation → ensure healthy enough to donate

2 types

• directed → organ donated to specified person (majority, ~97%)

• non-directed → organ donated to non-specified person

Paired Donation

• 2+ donor recipient pairs

• donors are biologically incompatible w/ intended recipients

• donors are compatible with another donor’s intended recipient

Coercion

• ongoing debate of permitting financial compensation for organ transplants

  • coercion = major concern + main argument against organ markets

• safeguards placed (particularly for living donation)

  • separate medical teams for donors + recipients

  • teams X conflicted between donor and recipients well-being

  • living donors meet w/ independent living donor advocate (not on transplant team) → assesses motivations/signs of coercion

  • donors can back out at any time → reasons not shared with recipient

Case Analysis

• 37 year old man - Sam admitted to local hospital

• diagnosed → liver failure from drinking alcohol

• in shock → need organ transplant → added to waitlist

• hospital requires alcohol-free 6 months before transplant

• Sam will die if made to wait 6 months