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Organ donation

Argument for and Against

To get things started, Webster's Dictionary Defines “Organ donation” as, the taking away of tissue from one person's body to permit the transplantation of that tissue into another person's body. Vital organs for example; the lungs, liver and heart, kidneys and pancreas can be donated, also parts of tissue such as heart valves, corneas, tendons and skin can be given. Organs and tissue can generally be removed from people who have recently died. In fact, since organs for transplantation need to be taken out right after death, only a small number of people die in a way that allows them to donate organs. Nonetheless, kidneys and parts of the liver and pancreas can also be taken out for transplantation from living donors. In Australia, the removal of organs and tissue is a process that generally happens in a hospital operating unit. The transplantation of organs is now a highly recognized practice for those at risk of organ failure or suffering from diseases which limits their life relentlessly.

Duty-based ethics grasp the notion that the consequences of an action do not in total decide whether the action is right or wrong. For that reason, decision making must reflect on the principles of beneficence, non-maleficence, autonomy, and justice. By basing health care choices on these main beliefs, it avoids compromising the patient's or staff member's integrity. The clinician's responsibility does not lie completely with the organ receiver but also with; the organ donor, the value put on organs offered for transplantation, and the social system that gave funding and skills training.

The Organ Donor Register of Australia (ODRA), which is managed by Medicare Australia, is currently the major register of consent in Australia. It is a register of consent or approval for donated organs to be used for transplantation reasons only, and not for scientific reasons. The ODRA was created in 2001 as a national register of people's aim to donate. Subsequent to a review in 2003–04, the Australian Health Ministers Conference (AHMC) declared that the ODRA would be altered from a register of intent to a register of consent. The declared intend of this change was ‘to make sure that the acknowledged desires of the deceased, whether compliant or objecting, are valued and acknowledged.[16] Nevertheless, as shown above and discussed further later in this essay, to register consent is not to create a lawfully-binding decree.

At this time, it is feasible to sign up for consent, intention to consent or for against donation. Registrations of consent or objection to organ donation are only feasible for people who are above the age of 18, through signing the right papers and forms. Registrations of intent can be completed online by any person over the age of 16 with a Medicare. Also, a registration of a protest to organ donation by the individual concerned is recognised by the majority of the jurisdictions in Australia, and will overrule any other conclusion made by a family member. Although, based on subjective evidence, the National Clinical Taskforce has stated that, in some jurisdictions, donation can still happen if the next of kin has prearranged their permission, even with a registered objection by the deceased. ( according to)

Legal issues

Legal guidelines of organ donation are the responsibility of the states and territories under the federal legal system of Australia. Each state and territory has different legislation to do with organ donation and transplantation, including laws on consent for organ donation. Not only is there not a Commonwealth legislation to do with organ donation, but there is as well no national coordinating body or agency with legislated authorities. As a consequence, legislation and regulation of Australia's organ donation and transplantation division, which covers a wide range of actions and procedures, vary across the country. While there is not any Commonwealth legislation concerning organ donation, there are a few general guidelines and protocols that are appropriate to every state.

State and territory legislative frameworks in relation to transplantation are majorly based on the concept of informed consent. In the occasion of their death, people can decide to have consent for their organs to be taken. Where individuals provide their consent for their organs to be used for transplantation use, this consent is then documented and recorded. This consent is now a type of legal agreement that their organs can be used, if required, for transplantation. Though, registration of consent is not a lawfully binding decree. Under different state and territory laws, consent can be shown in a variety of different ways. For example, in New South Wales (NSW) and Queensland (QLD), donation may only continue where the deceased has beforehand given written consent. In Victoria, approval and consent can be given in writing or verbally at some point in the last stages of infirmity of the deceased.

In addition, whenever there is no legal consent registered, the next of kin or close family members are able to provide consent or approval for organs of the departed to be donated. Where the deceased person's family members cannot get in touched with, the states and territories vary with regard to the question of whether or not they permit donation to continue. In NSW, Western Australia (WA) and Tasmania (TAS), where no consent was registered by the deceased and a next of kin cannot be contacted, donation cannot continue. In Victoria (VIC), South Australia (SA), Northern Territory (NT) and the Australian Capital Territory (ACT), where efforts have been made to contact the next of kin or close family member and there is no grounds to think that either the family or the deceased would disagree to the deceased's organs getting donated, then donation can legally carry on. (according to XXx) Although, whether or not an individual has shown their consent for donation, family members are at all times consulted.[accoridn tto)Donation will cannot happen where family members firmly disagree to such a procedure, even when the deceased individual's consent has been registered.

Ethical issues

Ethical guidelines

Subsequent to the modifications made to the AODR in 2004, the Australian Health Ministers Advisory Committee (AHMAC) has charged the National Health and Medical Research Committee (NHMRC) with taking on an evaluation of its procedure, Recommendations for the Donation of Cadaveric Organs and Tissues for Transplantation (1997). This evaluation also reflects on background documents from the Australian Health Ethics Committee and performed sessions and conferences with the appropriate groups and stakeholders. The new NHMRC plans, Organ and Tissue Donation after Death, For Transplantation, offer a guide to ethical standards in relation to organ donation for health professionals. The guidelines are founded on the beliefs that:

  • The donation of bodily organs and tissues is a just act of unselfishness and human cohesion.

  • organs and tissues for transplantation should be acquired in ways that:

    o Show respect for all aspects of human dignity

    o Respect and acknowledge the wishes, where known, of the deceased

    o Give priority to the desires of the potential donor and the family over the benefits of organ procurement

    o Protect all recipients from harm and

    o Recognise the desires of all those directly involved, which take account of the donor, recipient, families, carers, friends and health experts.

  • organ and tissues must be allocated according to just and transparent procedures
  • The decision not to donate must be respected and the family shown understanding for the choice.[19]
  • The guidelines, in addition gives advice as to how authorisation of donation ought to be resolute to where there is no next of kin available, as well as providing ways to make sure that family members make an knowledgeable decision in regards to the donation of the deceased's organs.

    Ethical

    xx

    There are three types in relation to the donation of organs by living individuals to their recipients. They are, directed donation to a loved one or friend; non-directed donation, in which the donor gives an organ to the wide-ranging pool to be transplanted into the recipient at the top of the waiting list; and directed donation to a stranger, whereby donors decide to give to a particular individual with whom they have no preceding emotional relationship with.

    Although, each form of donation presents its own individual ethical concerns. With directed donation to loved ones or friends, uncertainties occur about the extreme pressure that can be put on people to donate, leading those who are unwilling to do so to feel forced. In these cases, transplantation programs are usually prepared to identify a plausible medical excuse, so that the individual can bow out gracefully.1 Equally significant, however, are situations in which people feel obliged to donate regardless of the consequences to themselves. For example, both parents of a child who was dying of respiratory failure insisted on donating lobes of their lungs in a desperate but vain attempt to save her life.2 Such a sense of pressure is not unusual. In cases like these, merely obtaining the informed consent of the relative is not enough; physicians are obliged to stop people from making potentially life-threatening sacrifices unless the likelihood of success is large.

    Non directed donation creates different ethical concerns. The essential unselfishness that encourages an individual to make a potentially life-threatening sacrifice for a stranger calls for careful inspection. A recent case involved a male who appeared pathologically obsessed with giving away everything, from his money to his organs, saying that doing so was "as much a obligation as food, water, and air."3 After donating one kidney to a stranger, he speculated how he might give away all his other organs in a dramatic suicide. Other psychologically suspect motivations must be ruled out as well. Is the individual trying to compensate for depression or low self-esteem, seeking media attention, or harboring hopes of becoming involved in the life of the recipient? Transplantation teams have the responsibility to evaluate possible donors in all these dimensions and forbid donations that provoke serious concern.1

    Directed donation to a stranger creates analogous ethical questions with a few extra notions. This kind of donation generally takes place when a patient advertises for an organ openly in public, on television or newspapers or over the Internet. Such advertising is not against the law, but it has been strongly discouraged by the transplantation society. Two major objections are that the practice is unjust and that it intimidates the view that an organ is a "gift of life," not a product to be bought and sold.

    Even when the reasons for choosing a recipient may be unethical, nonetheless, there may be motives for allowing the donation to carry on. For example, a case that was discussed at a recent public forum hosted by Harvard Medical School's Division of Medical Ethics: a Jewish man in New York learned of a Jewish child in Los Angeles who needed a kidney transplant. The man wanted to help someone of his own race and resolute that he was willing to donate a kidney to aid this child. Regardless of his discriminatory preference, one may analyse the donation as acceptable, since at least several patients would benefit (the child would be given a kidney, and those under her on the waiting list would move up one) and no one would be harmed (those above the girl on the waiting list would not get the kidney under any conditions, because the man would not give it to them). Whether directed donation to strangers violates values of equality is thus controversial. But if it is acceptable, it will be very hard to disallow discriminatory preferences, since donors can just specify that the organ must go to a particular individual, without saying why.

    Refer to 2 theoretical perspectives

    Deontological ethics is too inflexible in its importance on duties, utilitarian ethics too keen to overrule fundamental human rights. Deontology and utilitarianism are both types of ethics referring to how one responds in a certain situation. Deontology is based on following a set of duties and sticking to these duties no matter what the consequences whereas utilitarianism is based on choosing the best outcome over a short term and long term even if it means depriving people of basic human rights. According to a deontologist ones actions must be determined by a set of duties regardless of whether the long term consequences are good or bad.

    A deontologist believes in human morals and that every human has certain rights and these morals and rights should not be betrayed no matter what the cost for example, taking organs from an individual without their consent, even to save one hundred lives would be unacceptable to the deontologist even though the fact the consequences would be better on the whole. The biggest problem with deontology is knowing which set of duties to pursue; there could be a huge variation in systems between people from different backgrounds, different social classes, different religions and people from different cultures. This produces the question as to how do we tell which obligation is the most important and which is the least? If the consequences of each are to be considered then this would make it a consequentialist view and not a deontological one. Single duty conflicts cause just as many problems such as two individuals imminently need a heart transplant but only one organ is available, a deontologist has a duty to save lives but on this occasion only one out of the two can be saved.

    Some modern bioethicists disagree on the moral status of organ donation and transplantation. Certain groups like the Roma are against organ donation on a religious basis, but most of the world's religions support donation as a charitable act of great benefit to the community. Issues surrounding patient autonomy, living wills, and guardianship make it nearly impossible for involuntary organ donation to occur. In issues relating to public health, it is possible that a compelling state interest overrules any patient right to autonomy.

    From a philosophical standpoint, the main issues surrounding the morality of organ donation are semantically in nature. The discussion over the definition of life, death, human, and body is enduring. For instance, whether or not a brain dead patient ought to be kept artificially animate in order to preserve organs for procurement is an ongoing problem in clinical bioethics.

    xxx

    Utilitarianism is a theory that promotes the best welfare and the greatest good for the greatest number. To attain this objective, society's resources are shared so that the maximum number of individuals benefit. In the context of organ transplantation, patients' desires are compared so that the greatest results can be obtained and the greatest use of a scarce resource can be made. Our use of organs from patients who initially are judged to be medically unsuitable as donors supports the utilitarian approach of expanding the pool of potential donor organs and providing benefits to a greater number of patients. The ending result, however beneficial, does not justify the use of unethical means. Medical utilitarianism is therefore subjected to principles that reflect deontological theory.

    xxx

    The “Karlovian” transplant case is a staple of anti-utilitarian theory. In this imaginary case, a doctor must decide whether to kill one of his patients in order to save five other patients with the victim's transplanted organs. I refer to this charming example as the “Karlovian” transplant case because I can imagine Boris Karloff playing the role of doctor (“What I do is for the greatest benefit of humanity. Come, Igor!”).  Possibly as a result of over-exposure to the Karlovian transplant case, I have never liked the term “organ donor,” when used to describe people who elect to pass their organs on to others after they are dead. “Donor” to me suggests a gift given while the giver is alive. There really should be a term that makes it clear that the organs will not be taken until after death has occurred (and that death will occur for reasons unrelated to removal of the organs). Hence, my suggestion: “organ legator.” This term may be unfamiliar, but it does bring to mind the word “legacy”, which has a generally positive connotation. The term “organ legator” would be especially useful in light of the increasing number of live-donor transplants (e.g., of one kidney). People tend to be possessive about their organs; they may be put off when the same term is used to describe those who give up an organ while alive and those who give up organs after they are dead.

    The principle of beneficence and non-maleficence supports the organ donor management program and protocol that are use at Papworth Hospital. The success of the program demonstrates that patients who receive "treated" organs are not at increased risks for complications or early death. As more patients are able to undergo organ transplantation, the list of waiting patients is reduced.

    xxx

    Not only would this present an accurate foundation for Australia's organ donation and transplantation scheme, but it would also allow for the widest variety of motivations for organ donation while not compromising people's capacity to make ethical choices in donation. At the same time, preparation Australia's organ donation and transplantation scheme on the idea of a rational, autonomous decision-maker could allow a number of changes to this scheme, the final result of which may be an increased amount of organs obtainable for transplantation and more Australian and New Zealand lives saved.