Organ donation and transplantation is one of the health care issues raising serious ethical questions, especially considering the benefits concerning the risks. Over the years, the demand for organs has far exceeded those available from deceased donors; hence, the need to turn to live donors as a way of meeting the high demand. However, this introduces a wide array of ethical concerns although organ donation may be of value towards saving lives. Most of these concerns revolve around whether organ donors have been given all information allowing them to make a well-informed decision. Additionally, this also creates the perception that consideration of living donors goes against the traditional first rule of medicine, which is primum non nocere (translating to “above all, do no harm”) (Katz, 2017). The focus of this report is to examine medical ethical issues surrounding organ donation and transplantation to determine some of the ethical considerations.
Organ donation and transplantation have become a key business point for hospitals across the world connecting recipients to donors. The primary goal of organ donation and transplantation is to save lives with the expectation being that an organ donor will allow a recipient to lead a healthy life (Abbasi, Kiani, Ahmadi, & Salehi, 2018). The kidney is the most commonly donated organ of the human body with hospitals and health facilities around the world offering this organ at high costs. In trying to regulate organ donation and transplantation, the United States Department of Health and Human Services (DHHS) set up an Advisory Committee on Transplantation (ACOT) mandated with conducting a review of all requests for donation and transplantation of solid organs. In some cases, a recipient will pay up to $260,000 in typical costs for a kidney in the United States (Abbasi, Kiani, Ahmadi, & Salehi, 2018). That raises the question of how the low-income population in such countries would afford kidney transplants considering the high cost of care.
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Organ donation and transplantation must occur in a well-regulated environment. The public policy debate around organ donation and transplantation reflects the need to establish clear-cut guidelines that would help prevent the occurrence of ethical issues. The debate focuses on the question of whether it is ethical to consider organ donation from living donors as a way of substituting the depleted supply from deceased donors. The Health Resources and Services Administration (HRSA) has been at the forefront in highlighting the need for the establishment of an appropriate mechanism to evaluate organ donation and transplantation. HRSA focuses much of its debate around the need to consider that the organs donated are from living donors, who must also be provided with an opportunity to live a healthy life after they have donated an organ (Abbasi, Kiani, Ahmadi, & Salehi, 2018). The mechanisms put in place must be reflective of the idea of protecting patients from possible exposure to harm likely to impact on the quality of their health.
Another key aspect to note in the debate is the need to promote informed consent for the patients involved, which would mean that donors decide to donate an organ based on the availability of information. Before embarking on the organ donation process, donors must be educated on the risks associated with such processes including both short- and long-term risks (Katz, 2017). It is from this perspective that a donor will be able to make an informed decision of whether to move ahead with the organ donation while considering the underlying risks noted. In cases where donors are not provided with such information beforehand, the organ donation can be considered as unethical regardless of whether the donor may have given his/her consent. The issue is that the donors were not accorded the right information that would help them make an informed decision on whether to move ahead with the organ donation.
Organ donation and transplantation offer great benefits to recipients but equally expose donors to risks. The ethical justification around organ donation and transplantation while considering living donors focuses on the risk-benefit ratios. The ratios consider the potential benefits that the organ donation process is likely to have on a recipient compared to the risks that a donor is likely to encounter to determine the viability of donation (MacKay & Robinson, 2016). Health facilities involved in organ donation and transplantation are expected to create models of probability and the magnitude of harm likely to result directly from the decision to move ahead with organ donation. The model will be compared to the potential benefits to help create a middle group, which would guide the decision that a living donor would make while considering all possible aspects. That will give donors a clear sense of understanding of what they expect if they move ahead with their decision to donate an organ.
The main precondition for a living organ donation reflects on an acceptable risk-benefit ratio that would be supported by the model created. The unavailability of a risk-benefit ratio means that the entire idea around organ donation does not reflect on the best possible ethical considerations. Health professionals have a key role in ensuring that they help patients interpret their risk-benefit ratios to determine the likelihood that they would be exposed to any form of health challenge after they decide to donate an organ. Another ethical justification for living organ donation is presupposed on voluntary consent from the donor (MacKay & Robinson, 2016). The high demand for organs across the world has helped fuel black market trade for organs, especially those in high demands. Criminal enterprises are forcing people to donate their organs, which are then sold for millions of dollars in other parts of the world. Therefore, this raises ethical concerns around voluntary consent for living organ donors.
Living donors must be allowed to make their decision on whether or not to engage in organ donation. The idea around forcing a living donor to give his or her body organ goes against the ideals of one’s human rights because it exposes an individual to more harm than good (Bollen et al., 2016). When individuals are forced to decide to donate an organ, they do not understand the risks that such procedures may portend, which is the case considering that these procedures require intrusive surgeries. In some cases, hospitals find themselves facing serious dilemmas because a living donor decides to donate an organ solely on the relationship that they have with the recipient (Bollen et al., 2016). The dilemma results in cases where some of these donors face serious risks of permanent damage or even death. That reflects on the idea that people decide to donate an organ without having to consider the implications that this may have on their health.
In summary, organ donation and transplantation are key issues raising serious ethical questions and concerns in the health care industry today. These concerns result from the fact that the demand for organs far outweighs the supply from deceased donors, which means that the health industry is turning to live donors. The consideration of these ethical issues reflects on the need to ensure that those involved in organ donation understand the risks around such procedures as opposed to only considering the potential benefits. In my view, organ donation and transplantation are some of the medical advancements that have helped give millions of people hope for a much healthier life. Therefore, health professionals and facilities involved in such procedures should come up with effective ways of ensuring that they protect donors and recipients as they proceed with transplantation. I believe in the idea of allowing donors to decide to donate without pushing them towards such decisions.
References
Abbasi, M., Kiani, M., Ahmadi, M., & Salehi, B. (2018). Knowledge and ethical issues in organ transplantation and organ donation: Perspectives from Iranian health personnel. Annals of transplantation , 23 , 292.
Bollen, J., De Jongh, W., Hagenaars, J., van Dijk, G., Ten Hoopen, R., Ysebaert, D., ... & van Mook, W. (2016). Organ donation after euthanasia: a Dutch practical manual. American Journal of Transplantation , 16 (7), 1967-1972.
Katz, A. L. (2017). Ethical Considerations for Organ Transplantation. In Anesthesia and Perioperative Care for Organ Transplantation (pp. 3-9). Springer, New York, NY.
MacKay, D., & Robinson, A. (2016). The ethics of organ donor registration policies: Nudges and respect for autonomy. The American Journal of Bioethics , 16 (11), 3-12.
