Controversy with Public, Churches, and Government
Since the 1954 first successful kidney transplant, organ donation and transplantation have become lifesaving phenomena for several diseases previously regarded as incurable. Organ transplantation is considered one of the most fascinating medical advances of the modern world, providing an approach of gifting life to a patient with incurable failure of a vital organ through the involvement of society and few humans by donating organs from living or deceased persons. However, the gap between people in need of organ transplantation and donors grows. As of November 2021, the US had 45,936 patients aged 50-64 years on the waiting list to receive organ transplants (Chen, Ali, Marrero, Parikh, Lavieri, & Hutton, 2021). The country is experiencing an excessive need for organ donation while supply is low. The shortage of organs has dire impacts as an average of 8,000 patients die every year or about 21 every day or one person per hour waiting for an organ transplant that never materializes. Only 100,900 patients received required organ transplants globally in 2009, representing only 10% of the demand (Gardenier, Rojas, & Ratcliffe, 2020). The whole issue has elicited thoughtful, ethical concerns across the public, religious, and government quotas, and the debate about them rages unabated.
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Ethical Controversies of Organ Donation
Critical ethical issues concerning organ donation and transplantation that necessitate aggressive interference include payment for organs, organ trafficking, and subtle balance in the live donation process between benefits of transplantation to the recipient and potential harm to the donor. There are various types of donations, which have pros and cons and ethical controversies surrounding them.
Types of Organ Donations, Pros and Cons, and Ethical Concerns
Living Organ Donations
Living organ donation is the donation of an organ for transplantation by a living donor. Different classifications of living organ donation exist: (a) Directed living donation, where a donor identifies a loved one or the person to receive the donation. This type of donation occurs between blood relatives such as siblings, children, or parents. It can also happen with close personal relationships, such as spouses. (b) Non-directed living donation is when a donor donates the organ a general pool for transplantation to patients on the waiting list (Bastani, 2020). Each type of organ donation stimulates different ethical and moral concerns. Directed living-related donation of human organ is recognized to be one of the most moral and ethical types of organ donation. It is associated with real emotional and non-specific benefits, particularly when the loved one regains normal health. But there are dire physical consequences (Lamb, 2020) that can harm the donor.
In directed living-related donation, the organ saves the life of the loved one by accepting the associated physical injuries like to donation process. While most related donors belong squarely into this altruistic/philanthropic classification, there are instances where related-organ donors attain financial, emotional, or physical toll from the recipients (Moorlock, Ives, & Draper, 2014). Concerning directed donation to family members, friends, or any category of loved ones, worries emerge regarding the intense direct on people to donate, causing people unwilling to do so to feel forced. In such cases, the organ transplantation programs strive to establish a reasonable medical excuse to save potential related donors unwilling to donate. Equally significant are circumstances where individuals feel forced to donate an organ, notwithstanding their impacts. In such cases, obtaining informed consent of the donor alone may not be adequate. Physicians have the mandate to stop individuals from making possibly life-threatening sacrifices where they feel the chances of success are minimal. The non-directed donation, on the one hand, generates a dissimilar ethical concern. The radical philanthropy/altruism that drives an individual to make a possibly life-threatening sacrifice to people who are not their relatives or loved ones appeals for thoughtful scrutiny (Solanki & Desai, 2021). The transplantation team must evaluate the prospective donor in these scopes and prevent donations from raising serious concerns.
Directed donations can also be done to a stranger and happen when a patient or potential donor advertises organ donation publicly over the internet, billboard, or television. Such donations also raise similar ethical concerns and will additional wrinkles. For instance, advertising an organ is legal but strongly discouraged by transplantation experts and even the government and religious community. There are two main objections concerning advertising an organ: a) the practice is discriminating; b) the practice intimidates the idea that the body organ is a gift of life by the maker and not a product to be purchased or sold. Some sections argue that people have the right to donate whatever they want to charity is the same way an individual should be permitted to select whom to gift their organs. However, this might imply that only individuals with the most persuasive stories and resources to advertise their plight will be the ones to receive the organ instead of those in need (Lamb, 2020). I also agree that organ advertisement is unfair and unethical in that case. Unlike financial gifts, organ transplantation involves social structures and institutions, including hospitals and transplantation teams. Therefore, organ donation is justifiably subject to the societal requirement of fairness. Hence, transplantation teams should not permit the allocation of organs based on any criteria that are not morally relevant. Besides, advertising organ also makes it possible for an individual with organ failure to search for a living donor for organ donation, bypassing the nationwide waiting pool to obtain a cadaveric organ (Bruno & Arora, 2018). Besides the ethical concerns, the living donation also has benefits and drawbacks, highlighted in the following section.
Benefits/Pros of Living Donation
- There are often perfect matches between the organ donor and the recipient since they are genetically related in most cases.
- There are always psychological benefits for the donor and recipient because the donation is lifesaving for someone the donor care about. Seeing a recipient of a loved one live a better and quality life post-organ transplantation is psychologically fulfilling.
- The organs are often in good health due to vigorous medical checkups, part of the organ donation procedure (Bruno & Arora, 2018).
Drawbacks/Pros of Living Organ Donation
- There are adverse health consequences of organ donation, including pain, infections, and possible future health complication.
- There are also psychological consequences, including resentment or guilt and family pressure.
- Family pressure may also force a person to donate if they have sickling loved ones, even if they are unwilling to do so.
- There is also no donor advocate, unlike the patients. Patients often have advocates, including the transplant medical or surgeon team, advising them and working towards the patient’s best interest. Donors do not have advocates and my not have someone to turn to for advice in case they face complications (Bruno & Arora, 2018).
After exploring both sides, ethical concerns, benefits, and drawbacks, my stand is that living donation is unsuitable under any conditions and should not only be discouraged as a medical or surgical procedure but prohibited altogether due to dangers and risks linked to donating organs. For me, an organ is a gift of life and compromising a person’s organ to make another person live raises more ethical concerns than benefits. The living donations also face increasing financial incentives, encouraging the living to donate their organs for money. There are reports of organ sales by business people for financial gains in several parts of the world, exploiting the poor for the benefits of wealthy individuals. To me, buying and selling a living human’s organ is the most disrespectful and immoral practice as it mostly appeals to the less privileged in the society, the uneducated and poor people who are pressured or forced to sell their organs by the promise of financial benefits. Such people may overlook the potential drawbacks linked to organ donation, including future health complications in favor of financial benefits. Besides, as mentioned earlier, donors do not have advocates in case of any eventuality, which may be risky for these poor people.
Deceased/ Cadaveric Organ Donations Ethical Concerns, Pros, and Cons
Cadaveric organ donation is giving an organ for transplantation at the time of the donor’s death. The idea is that you can give life to others at the end of your life. Cadaveric organ donation can only be conducted after all the attempts to save the patient’s life are vain. The ethical questions concerning cadaveric organ donations and transplants are complicated by the debates about the definition of some critical teams, including death, life, body, and human (Chen, Ali, Marrero, Parikh, Lavieri, & Hutton, 2021). Public concerns about the definition of death, worries concerning possible conflicts of interests, and suspicions physicians may compromise end-of-life are some of the potential barriers around organ transplantation (Levitsky, Formica, Bloom, Charlton, Curry, Friedewald, & Volk, 2017). An example of a controversial definition is that of brain death. Under organ donation guidelines, diagnosis and declaration of brain death must meet certain criteria, including a) irreversible coma, b) no self-respiration, and c) absence of brain stem reflexes. Brain death should be assessed for a patient who suffered a massive permanent brain injury with recognizable causes (Anwar & Lee, 2019). However, there have been ethical and moral concerns around brain death due to high public cases of individuals recuperating from comas even after several years of inactivity (Lamb, 2020). There have been cases of people recovering from a coma even after over a decade. For instance, Gary Dockery, an American police officer, woke up after spending seven and half years in a coma following a gunshot that caused injury to his head (Doyle, 2001). The difference between coma and brain death becomes an issue that warrants a clear definition.
Because of the sacred of human life, the church is also against organ donations from after active euthanasia or anencephalic donors. According to Pope John Paul II, the death of an individual is a single event, comprising a total collapse of an integrated and unitary whole, the personal self. The church appears to be against scientific methods of ascertaining death, which have shifted from the customary cardio respiratory sign to neurological criterion. On the one hand, governments worldwide, including the US, are not raising any ethical concern around organ donation of whichever type. Instead, governments strive to create laws, such as the Uniform Anatomical Gift Act (UAGA), to improve organ match processes and address organ donation shortages. The concerns are much on organ shortage than the ethical concern for living and death organ donations. However, the government has tried to protect organ donation from minors and put laws and mechanisms to prevent organ trafficking and other forms of donation against the law (Glover, Shah, Bennett, Wilson, & Barnes, 2020).
Benefits/Pros of Deceased Donation
- One benefit of cadaveric organ donation is that it helps meet the shortage of organ transplantation.
- It can save a patient’s life with a life-threatening disease or an accident victim.
- It helps in the grieving process as family members know that their loved one helps to save a life.
Drawback/Cons of Deceased Donation
- Besides, the term brain dead unfortunately may imply that there are two ways one can die, being ‘brain dead’ and being ‘dead.’ This means that physicians can incorrectly use or misuse the team to imply reduced neurological dysfunction than it strictly implies. Therefore, it is important to ensure that it is correctly used to mean the irreversibility of brain functioning (Makowski, 2015).
- It is also not easier for family or laypeople to understand death based on the brain function principle. A patient satisfying brain function criteria for death may be perceived as sleeping instead of death on casual observation (Makowski, 2015).
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Despite ethical concerns, including the definition of death, I support deceased/ cadaveric organ donations over living donations provide the mechanism to ascertain a donor’s death before the donation is made fully. Deceased organ donation can help save a life for patients with organ failure or accident victims and help the family cope knowing that their loved one saved lives. Practically, if it is ascertained that the patient is dead, there is no need to let the patient’s organs all die if a close family member or another person may be in need, provided their family members and even the deceased consented before their death. However, any family required to donate from their deceased relatives because of brain death must be confident that there is absolutely no hope of recovering.
Overall, inadequate supply of organs, particularly from cadavers, and increased cases of vital organ failures have generated a huge gap between organ demand and available supply, resulting in very long waiting times for one to receive the required organ and more deaths of people in the waiting list. Such events have generated several ethical, societal, and moral issues concerning supply, organ allocation methods, and usage of living donors. The primary concern with living donors is the possible pressure from family members to donate even when they are unwilling, while for the dead donor, the ethical concern surrounds the definition of brain dead, as explored in this paper.