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PubMed1997

The ethics of organ donation.

As organ transplantation is physically possible within a tension between common biological properties and individual immunities, so it is ethically possible within a tension between individual personality in full integrity and the human community of which each member, social by nature, is an organic part. Ethical donation is by consent, explicit or presumed, spontaneously offered or procured by request. Altruism or commercial dealing is now a live issue in organ procurement, whether cadaveric or by live donation, related or unrelated. Attention is given to children in transplantation, and to new developments with fetal organs, neural tissue, bone marrow and xenografts. Given all that medical science and skill can now offer, patients are still free to decline.

Bone Marrow Transplantation↗

PubMed2005

Organ trafficking: scope and ethical dilemma.

The Israeli experience discloses the relationship between the traditional altruistic basis of organ donation and the new alternatives based on a utilitarian conception of unrelated compensated donation. Although organ trafficking in Israel was dramatically intensified, cadaveric and living-related donations decreased. Reforms in living donations, such as evaluation committees for unrelated directed donors, were insignificant in terms of meeting the demand of patients and reducing the volume of trafficking. It is our contention that battling organ trafficking should provide patients with a realistic alternative for kidney donations. Our model of regulated nondirect paid donations is planned to legalize significant compensation for the unrelated donors drawing individuals from falling into the trap of organ traders. This program, together with uncompromised penalties, would hopefully eradicate organ trafficking.

Altruism↗

PubMed2006

Outcomes of commercial renal transplantation: a Canadian experience.

BACKGROUND: Financial compensation in exchange for live kidney donation is prohibited in Canada. However, patients in Canada with end-stage renal disease and without a suitable biologically or emotionally related live donor face substantial waiting times on lists for deceased donor kidneys, and so may therefore choose to acquire organs from a live donor in a procedure performed outside Canada as part of a commercial transaction. METHODS: We describe the clinical outcomes in such patients transplanted between 1998 and 2005, managed after their surgery at a single Canadian transplant center. RESULTS: Patient and graft survival at three years were significantly worse in this group compared to recipients of live biologically related (P<0.0001) and emotionally related transplants (P<0.01) performed in Canada during this period. A number of different surgical and infectious complications were seen, requiring frequent and often lengthy hospitalization. CONCLUSION: Patients considering this method of acquiring live-donated kidneys should be counseled of the inherent risks and possible adverse outcomes including diminished dialysis-free survival.

Adult↗

PubMed1996

Directed blood donation: a matter of public trust.

Trust is the key issue in blood treatment with respect to public policy. Public trust in the blood system in Canada continues to be exceedingly low. According to the February, 1996 Gallup poll conducted by Janssen-Ortho Inc., 89% of those surveyed chose alternatives to the Red Cross (volunteer) blood. Strategies directed at improving the safety of the blood system will fall short of this goal unless public knowledge and consumer participation are considered. Consumers need to participate in decision making for themselves with the physicians, as well as in the decision making process at the level of public policy. Consumer involvement would contribute to an overall plan of rebuilding public trust. Canadian health care consumers have been significantly affected by the blood tragedy of the 1980s. Public perception of blood safety has been characterized by misunderstanding and fear. The search for alternate methods of transfusion, such as directed donation, are based on a lack of trust of the current blood system. As introducing a program of directed blood donation would not increase safety or decrease the expense of blood transfusions, such a program should not be introduced in Ontario at this time.

Blood Banks↗

PubMed1996

Organ donation consanguinity or universality.

1. Neither the "Diseased Persons" nor the "Genetic Relations" provide an answer to "trading" in human body parts. 2. Live human body constitutes a vital source of supply of organs and tissues and the possibilities of optimum utilisation should be explored. 3. There is no scope for dogmatic postures and open-mindedness should be the approach while dealing with the issue of Organ Transplantation. 4. Society owes a duty to save the file of a dying man and in the event of failure to do so, it is absolutely immoral to interfere with his own arrangements by making unrealistic laws. No immorality is involved if an individual disposes of his spare body parts for a valid consideration to a needy person. 5. The scarcity needs to be urgently overcome otherwise unwarranted trade and crime are liable to thrive. 6. Families are not unconnected or antagonistic fragments of humanity. After thousands of years of continuous efforts the individuals on this earth have attained the stage of organic and functional integration. Atomisation of society on the basis of consanguineous proximities amounts to reversing this holistic trend. Organ transplantation is a functional expression of a highly evolved pursuit with inherent and intimate interaction in the form of organic exchange at the individual level, independent of consanguineous inducements or motivations. As such there is absolutely no scope for restricting organ donations by strangers. 7. Commercialisation should be curbed by making the enforcement agencies more efficient and not by depriving a needy person of his genuine requirements. Legislative craftsmanship lies in providing an answer without curtailing the freedom of the people.

Adult↗

PubMedDate not supplied

Incest, gamete donation by siblings and the importance of the genetic link.

Recently, several requests have emerged in which women wished to be impregnated with donor eggs fertilized with spermatozoa of their brother. An important argument advanced against such applications is that it is a kind of incest. Four definitions of incest are reviewed in this article to evaluate the acceptability of these demands. The first three (sexual intercourse, reproduction with gametes of first-degree relatives and symbolic incest) do not apply to the cases. However, when the sister and her brother intend to raise the child as social mother and father, these requests should be considered as "intentional incest". If the brother only functions as an uncle, the request of the woman resembles the currently accepted practice of oocyte donation from sister to sister. In that case, the wish to receive gametes from a first-degree relative is motivated by the wish to establish as far as possible a genetic link with the child.

Consanguinity↗

PubMed2005

Altruistic living kidney donation challenges psychosocial research and policy: a response to previous articles.

BACKGROUND: Policies with respect to altruistic living kidney donation to strangers (both nondirected and directed donation) should, in addition to medical criteria, preferably be based on valid attitude research data. However, deciding on what data are relevant is a normative issue. The challenge for both research and policy making is to bring together empirical and normative issues. METHODS: By comparing two recent surveys, the authors shed light on the complex methodologic and ethical questions surrounding altruistic living kidney donation. RESULTS: The authors found that the main methodologic issues were the distinction between the willingness to donate and the acceptability of the offer, the difference between public attitudes observed in surveys ("facts") and well-considered moral judgments ("norms"), and biases caused by a misperception of central moral concepts (e.g., discrimination and injustice). The authors argue that transplantation centers have a good case for applying or initiating altruistic living donation programs. Centers should seek to influence public attitudes if these attitudes are shown to be biased by prejudice and misunderstanding. CONCLUSIONS: The authors advocate an interaction between research and policy making. Social research can best influence transplantation policies in altruistic living donation by in-depth interviews into the complicated background beliefs underlying personal preferences. In addition, the public should be encouraged to judge the immanent issues in a morally responsible way. In the end, a fair balance should be established between the impartial requirements of social justice and the partial motivations of individuals involved in altruistic living donation. Although discriminatory acts should be rejected categorically, donation policies should be willing to consider, support, and accept motivations based on personal loyalties.

Altruism↗

PubMed1992

Psycholegal issues in sibling bone marrow donation.

The only hope of survival for children with a number of life-threatening illnesses is a successful bone marrow transplant (BMT). Unlike the treatment source for most therapies, the raw material for transplant therapy comes from a human being. Although many BMTs are autologous, utilizing the patient's own bone marrow, a large percentage of childhood BMTs rely on bone marrow from children or adolescents who are biological siblings to the sick child. Medical and legal systems are confronted with a dilemma when healthy children are needed to undergo minimally risky, yet somewhat painful, procedures for the benefit of their critically ill siblings. This article reviews legal issues involved in sibling bone marrow donation and psychological research that is relevant to those issues. The article concludes with proposed directions for future psycholegal research and a discussion of ethical issues that are not amenable to empirical investigation.

Adolescent↗

PubMed2006

Incompatible kidney donor candidates' willingness to participate in donor-exchange and non-directed donation.

Although paired donation, list donation and non-directed donation allow more recipients to receive living donor transplants, policy makers do not know how willing incompatible potential donors are to participate. We surveyed 174 potential donors ruled out for ABO-incompatibility or positive cross-match about their participation willingness. They were more willing to participate in paired donation as compared to list donation where the recipient receives the next deceased donor kidney (63.8% vs. 37.9%, p < 0.001) or non-directed donation (63.8% vs. 12.1%, p < 0.001). Their list donation willingness was greater when their intended recipients moved to the top versus the top 20% of the waiting list (37.9% vs. 19.0%, p < 0.001). Multivariate logistic regression modeling revealed that potential donors' empathy, education level, relationship with their intended recipient and the length of time their intended recipient was on dialysis also affected willingness. For paired donation, close family members of their intended recipient (odds ratio (OR) = 3.01, confidence intervals (CI) = 1.29, 7.02), with high levels of empathy (OR = 2.68, CI = 1.16, 6.21) and less than a college education (OR = 2.67, CI = 1.08, 6.61) were more willing to participate compared to other donors. Extrapolating these levels of willingness nationally, a 1-11% increase in living donation rates yearly (84-711 more transplants) may be possible if donor-exchange programs were available nationwide.

Adult↗

PubMed2006

The ethical limits in expanding living donor transplantation.

The past decade has witnessed the emergence of novel methods to increase the number of living donors. Although such programs are not likely to yield high volumes of organs, some transplant centers have gone to great lengths to establish one or more of them. I discuss some of the ethical and policy issues raised by five such programs: (1) living-paired and cascade exchanges; (2) unbalanced living-paired exchanges; (3) list-paired exchanges; (4) nondirected donors; and (5) nondirected donors catalyzing cascade exchanges. I argue that living-paired and cascade exchanges are ethically sound, but will lead to only a few additional transplants. Unbalanced exchanges and list-paired exchanges raise ethical issues that should limit their permissibility. Nondirected donations can be ethically sound with adherence to strict eligibility criteria and fair allocation procedures. Nondirected donors catalyzing cascade exchanges can be ethically sound provided that individuals with blood types O and B are not made worse off.

Blood Group Incompatibility↗

PubMed2003

What's not wrong with conditional organ donation?

In a well known British case, the relatives of a dead man consented to the use of his organs for transplant on the condition that they were transplanted only into white people. The British government condemned the acceptance of racist offers and the panel they set up to report on the case condemned all conditional offers of donation. The panel appealed to a principle of altruism and meeting the greatest need. This paper criticises their reasoning. The panel's argument does not show that conditional donation is always wrong and anyway overlooks a crucial distinction between making an offer and accepting it. But even the most charitable reinterpretation of the panel's argument does not reject selective acceptance of conditional offers. The panel's reasoning has no merit.

Altruism↗

PubMed2006

Attitudes of patients, healthcare professionals and ethicists towards embryonic stem cell research and donation of gametes and embryos in Germany.

Due to the Embryo Protection Act, creation of supernumerary embryos, as well as egg and embryo donation, is prohibited in Germany. Human stem cell research is regulated through the Act on stem cells that came into force in 2002. A cross-sectional survey of 101 IVF couples (n=202) in two fertility centres, and representative samples of healthcare professionals and ethicists (n=879), was carried out, and their attitudes towards embryonic stem cell research and donation of gametes and embryos compared. A clear majority of IVF couples favoured legalization of egg and embryo donation and embryonic stem cell research for various purposes. The willingness of couples to donate was related to purpose and to other independent influences. The majority of physicians voted for legalization of embryonic stem cell production from surplus embryos. Most human geneticists and obstetricians approved egg, but not embryo, donation to other couples. Ethicists and midwives were opposed to every kind of donation and research on surplus embryos. The IVF couples surveyed have positive attitudes towards donation and research using surplus embryos, whereas the healthcare professionals and ethicists are predominantly sceptical about most research activities destroying human embryos. This difference should be considered carefully in legal and ethical discussions on reprogenetics.

Attitude of Health Personnel↗

PubMed1988

Improving the quality and quantity of whole blood supply: limits to voluntary arrangements.

The inadvertent transmission of AIDS virus through contaminated whole blood has shaken the viability of the American voluntary blood supply system. For the first time since the voluntary donor system replaced the commercial blood system, there are widespread doubts about the ability of blood suppliers to meet the nation's increasing health care demands. This paper presents a framework for analyzing blood collection. First, we critique the existing literature on blood collection, arguing that its focus on donor motivation is difficult to integrate with policy analysis. We then present a specific model of the individual's decision to donate blood as a comparison of the costs and benefits of donating. The current system of collecting whole blood relies on donors receiving only altruistic benefits. We explore the limits of this approach to dealing with the quantity and quality problems presented by the AIDS virus. Alternative approaches....

Acquired Immunodeficiency Syndrome↗

PubMed2000

Vaccination and other altruistic medical treatments: should autonomy or communitarianism prevail?

The publication of a report into a case where an organ donor's constraints on the race of potential recipients raises questions about whether respect for autonomy or communitiarianism should prevail in altruistic medical procedures. This article briefly reviews how autonomy and communitarianism are balanced in cadaveric and live organ donation, bone marrow donation, gamete donation, blood donation and vaccination. It criticizes vaccination policy for ostensibly respecting patient autonomy yet in practice compromising that autonomy in various ways. Vaccination is properly viewed as an altruistic medical procedure because some vaccines are of more good to society than to the vaccinee, who runs associated health risks. The conclusion is that there is a spectrum of attitudes to the value of autonomy, depending principally upon the invasiveness of the procedure. In most cases the autonomy-communitarianism balance is satisfactory, but this is not so in respect of cadaveric organ donation and vaccination. The article proposes that cadaveric organ donation should be governed by the communitarian law of well-publicised presumed consent. It proposes two alternatives for vaccination: that vaccination should be compulsory or, preferably, that procedures be modified so that parents have real autonomy in their decisions whether to vaccinate their children.

Adult↗

PubMed2005

Assessment of the willingness of potential live related kidney donors.

Even in the case of live related kidney donation, coercion within families is applied on the most vulnerable amongst them. This vulnerability could be financial, social or psychological In this paper we discuss how to assess the willingness or unwillingness of a kidney donor and discover if any coercion has been applied on him/her be it direct or indirect.

Altruism↗

PubMed2006

Anesthetic management of a pregnant living related liver donor.

Pregnancy is often considered a contraindication to living related liver donation. There are serious medical and ethical considerations if a pregnant woman insists on undergoing partial hepatectomy to save her sick child. Herein we report a case of living related liver donation from a pregnant woman at 18 weeks of gestation to her 1-year-old child with decompensated cirrhosis due to biliary atresia. The left lateral segment of the liver was harvested for donation. Meticulous surgical technique and anesthetic management were mandatory in assuring a successful outcome. While this isolated case demonstrated that living related liver donation can be performed successfully with a pregnant donor, it should be undertaken only when there is absolutely no other donor and the recipient is in urgent need.

Adult↗

PubMed2001

It's only love? Some pitfalls in emotionally related organ donation.

Transplanting organs from emotionally related donors has become a fairly routine procedure in many countries. However, donors have to be chosen carefully in order to avoid not just medically, but also morally, questionable outcomes. This paper draws attention to vulnerabilities that may affect the voluntariness of the donor's decision. Suggestions are made as to how to approach the evaluation and selection of potential donors.

Adult↗

PubMed1990

Organ transplantation: the Latin American legislative response.

As medical barriers to human organ transplants have fallen, serious legal and ethical obstacles have emerged. This article provides an overview of those obstacles, taking into account the relevant legislation in force in 16 Latin American countries in 1989. The author proceeds by considering postmortem and inter-vivos organ donations separately and examining the principal ethical and legal issues relating to each kind. In the case of postmortem donation these deal mainly with donor consent, recipient selection, funding of transplant costs, and possible conflict of interest. In the case of inter-vivos donation they relate again to donor consent and funding as well as to certain other matters-notably donor compensation, commerce in organs, and international sharing of organs. On the whole it is concluded that the countries of Latin America, together with the nations of the world in general, urgently need to develop more comprehensive legislation on organ procurement and transplantation.

Brain Death↗