Organ Transplantation

1. Ethics and Organ Transplantation

2. Objectives
• Introduction
• History
• Types of organ transplant
• Guiding principles by WHO
• Ethical issues involved
• Allocation of the resources
• Certain Guideline
• Organ Market :Controversy
• Conclusion

3. Transplantation
• It is the act of surgically removing an organ
from one person and placing it into another
person.
• Transplantation occurs because the
recipient’s organ has failed or has been
damaged through illness or injury.

4. Organ Transplant
• The transfer of a whole or partial organ from
one body to another .
• Removal of an organ from:
A deceased donor
 A living human person
• For the purpose of replacing the recipient’s
damaged or failing organ with a working one
from the donor site

5. Which organs can be
transplanted :
• Liver
• Kidney
• Lungs
• Pancreas
• Heart
• Intestine

6. History of Organ Transplant
• 1954 living relating kidney transplant( Dr. Joseph
Murray and Dr. David Hume Boston)
• 1962 cadaveric kidney transplant by (Dr. Joseph Murray
and Dr. David Hume Boston)
• 1963 lung transplant (Dr. James Hardy Mississippi)
• 1967 liver transplant( Dr. Thomas Starzl Colorado) and
heart transplant(Dr. Christiaan Barnard South Africa)
• 1981 heart/lung transplant(Dr. Norman Shumway
California)
• In 1983, the FDA approved cyclosporine for use in
organ transplantation, and the first lung transplant
patient survived more than six years.

7. Types
• Autograft - A transplant of tissue from one to
oneself Skin grafts, vein extraction for CABG,
storing blood in advance of surgery
• Allograft - Transplanted organ or tissue from a
genetically non – identical member of the
same species
• Most human tissue and organ transplant

8. • Isograft -A subset of allografts in which organs or
tissues are transplanted from a donor to a
genetically identical recipient (e.g. identical twin)
• Anatomically identical to allografts, closer to
autografts in terms of the recipient’s immune
response
• Xenograft -Replacement of an individual’s defective
organ with an organ harvested from another species
- Source of organs for human use: primates (genetic
similarities to humans) and pigs (large availability)

9. Increasing Organ Donation
• Limited Resource
• Cadaveric Organs
– Mandated Choice – voluntary donation
– Presumed Consent - a person is presumed to
have consented to organ donation in the case of
their accidental death.
– Incentives
– Prisoners

10. Informed Consent
• Diagnosis
• Nature and purpose of treatment
• Risks and benefits of treatment
• Alternatives
– Risks and benefits
• Risks and benefits of not having treatment

11. Increasing Organ Donation
• Living Donors
– Buying and selling of organs
• Unfair pressure on economically disadvantaged
• Wealthy people have unfair access
• Donor and recipient safety

12. Organ allocation
• “Those who are dangerously wounded must be tended first,
entirely without regard to rank or distinction. Those less
severely injured must wait until the gravely wounded have
been operated upon and dressed. (Hinds 1975, 6)
• Limited resource
• Distributive justice
– How to fairly divide resources
– Equal access
– Maximum benefit

13. Distributive Justice
• Equal Access
– Everyone should be able to access it equally
– Length of Time
– Age of recipient
• Reasons for equal access: exclude individual
worth from equation
– Exclude Medical “worthiness” i.e. smoking
– Exclude Social “worthiness” i.e. prisoners

14. Distributive Justice
• Maximum benefit
– Maximize the number of successful transplants
– Medical need
– Probability of success
• Reasons for maximum benefit: limited
resource and should avoid waste
– Second transplant
– Factor in medical outcome

15. Current Organ Distribution
System
• Medical need
• Probability of Success
• Time on Waiting List

16. WHO Guiding Principle 1
• Autonomy
• Cells, tissues and organs may be removed
from the bodies of deceased persons for the
purpose of transplantation if:
– (a) any consent required by law is obtained, and
– (b) there is no reason to believe that the
deceased person objected to such removal.

17. WHO Guiding Principle 2
• Beneficence
• Physicians determining that a potential donor
has died should not be directly involved in
cell, tissue or organ removal from the donor
or subsequent transplantation procedures;
nor should they be responsible for the care of
any intended recipient of such cells, tissues
and organs.

18. WHO Guiding Principle 3
• Autonomy, Non-maleficence, Justice
• In general living donors should be genetically,
legally or emotionally related to their recipients.
• Informed, voluntary consent
• Professional follow up ensured and organized
• Selection criteria
• Non coercive (by force)

19. WHO Guiding Principle 4
• Non-maleficence
• Minors and legally incompetent people
– No cells, tissues or organs should be removed from
the body of a living minor for the purpose of
transplantation other than narrow exceptions
allowed under national law.
– Specific measures should be in place to protect the
minor and, wherever possible the minor’s assent
should be obtained before donation.

20. WHO Guiding Principle 5, 6, and 8
• Beneficence
• Cells, tissues and organs should only be donated
freely without any monetary payment or reward of
monetary value.
• The prohibition on sale or purchase of cells, tissues
and organs does not preclude reimbursing reasonable
and verifiable expenses incurred by the donor,
including loss of income, or paying the costs of
recovering, processing, preserving and supplying
human cells, tissues or organs for transplantation.

21. WHO Guiding Principle 7
• Non-maleficence
• Physicians and other health professionals should
not engage in transplantation procedures, and
health insurers and other payers should not
cover such procedures, if the cells, tissues or
organs concerned have been obtained through
exploitation or coercion of, or payment to, the
donor or the next of kin of a deceased donor.

22. WHO Guiding Principle 9
• Justice
• The allocation of organs, cells and tissues should
be guided by clinical criteria and ethical norms,
not financial or other considerations.
• Allocation rules, defined by appropriately
constituted committees, should be equitable,
externally justified, and transparent.

23. Ethical issues
• Is the human body a commodity?
• How should decisions be made about who
receives scarce organs?
• Who should pay for transplants?
• Should one person receive several organs or
several persons receive one?

24. • Should one person have a second transplant when
the first one fails or should a different person be
given a first chance at a new organ?
• Should organs be donated to those persons who
have abused their bodies by drinking and smoking or
only to those whose organs are damaged by
disease?
• Should state or federal law makers be involved in
transplantation?

25. Certain Guidelines
• The functional integrity of the donor as a human
person should not be impaired, even though
anatomical integrity may suffer.
• The risk taken by the donor as an act of charity is
proportionate to the good resulting for the recipient.
• The donor’s consent is free and informed.
• The recipients for the scarce organs are selected
justly .

26. Organ Market :Controversy
• The vicious cycle – Needs money , has organ.
- Has money , needs organ.
Main Issues on Organ Trade
It is contrary to the dignity of the human body and
depersonalizing
• Organ sale promotes coercion and exploitation of people,
especially of the poor.
Insufficient screening compromises quality of organ and health
of both donor and recipient
• It promotes poor quality of care as a result of poor standards
of donor selection and inadequate screening for transmissible
disease

27. All those who need such a gift should receive it, rather
than only those who could pay.
• There is favor for those who have the resources to
purchase these “entities” .
• Discrimination
“It makes human organs a commodity for profit and
sale.”

28. Citations
• Informed Consent. American Medical
Association< http://www.ama-
assn.org/ama/pub/physician-resources/legal-
topics/patient-physician-relationship-
topics/informed-consent.shtml>
• WHO Guiding Principles on Human Cell, Tissue
and Organ Transplantation<
http://www.searo.who.int/LinkFiles/BCT_WHO_g
uiding_principles_organ_transplantation.pdf> 26
May 2008.

29. "Sometimes our light goes out but is blown again
into flame by an encounter with another human
being.
Each of us owes the deepest thanks to those who
have rekindled this inner light."
– Albert Schweitzer