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The need for the organ transplant is increasing in our sector of health care as more and more end stage diseases are being diagnosed. Organ transplantation may be a life-saving option, but they are not without their challenges and risks. The concept of organ transplantation is both miraculous and challenging at the same time. Whether a patient needs a new kidney, liver, heart, or lung, there are multiple issues that the patient and the family need to deal with. They involve decisions before the transplantation and medical issues postoperatively. An organ transplant bill that had been under study with the senate since 1992 was finally approved on 5 September 2007 as "A Transplantation of Human Organs and Tissues Ordinance 2007" by the Government of Pakistan, and many illegal organ donation and transplantation centers were closed down and many senior doctors involved in the act were charged against it. The issue over here is much diversified and complex when we go into the details of the consequences of the act. Firstly, the question arises of what is right and what is permissible? Secondly, the right of making the laws for the right and wrong act is disputed and challenged by mankind, on the basis of his reasoning and self judgment.
The organ transplantation has been long debated and addressed by many scholars from both religious and secular perspective. The major issues concerning the wide permissibility of the act are of bypassing the virtue ethics cardinal features: respect for autonomy, nonmaleficence, beneficence and justice. If we further categorize the ethical dilemmas we can address he organ transplant act under these broad types, which encompass their own challenges when it comes to making a sound and safe decision. These categories are:
Transplant organ from a living person.
Transplant of organ from a dead person
Transplant from a fetus.
If we were not being guided by the supreme law, which has been transedented on us, and let us believe, that man has the power of brains over all other logics and laws of nature. Then trying to find any solution for a given problem, or setting any rules to follow for any system to work would have been very difficult. In other words trying to find analogies for God grounded systems is beyond human competence and reasoning.
Considering moral principles
Considering the issue of organ donation and transplantation, the respect for autonomy is the right to choose for the decision making of certain biomedical ethical dilemma. It not just involves giving respect for the attitude, but also for the action to be performed. From pure secular ethics point, we can relate what Immanuel Kant had recognized from the concept of unconditional worth, stating that each individual has the capacity to determine his or her own moral destiny. To violate a person's autonomy is like treating that person merely as means, without regard to that person's own goals. Example if a person s dead and his organs are taken from his body without his previous advance directives of any such act, then, it's again considered to be using that body as a means. But what if that organ was so precious in saving the life of a living person, who could have benefitted humanity if given a chance to live, e.g. a doctor or a well trained militant, etc. this shows the beneficence over the autonomy and serving the utilitarian ethical principle. If we consider the case of organ taken from a fetus, then again who is the ultimate supreme authority to give consent on behalf of that minor? What makes one decides the ruling of a certain act to be just for an individual? Then here comes the question of, who plays the role of the unquestionable evaluator and who among us is eligible to be devoid of all flaws in reasoning and decision making? Does the living donor has the ultimate right over his body or his relatives who have the right to decide the answer to this if another influential family member is the supposed recipient of the organ? A wife cannot take decision over her own medical issues without her husbands' will and consent? A poor clan member of a certain tribe falls victim to the Jirga rulings. Similarly what happens to the war prisoners? The freedom fighters in occupied areas, who have been mutilated for organ trafficking? Who plays the role of just decision making and for what principle? Is it justified that "Greatest happiness Principle" is fulfilled by the Utilitarian approach? Kantian approach, a duty to save human life? Egalitarian approach, to get equal benefit? Communitarian to serve the community benefits at the cost of one's own necessities and health. The questions remains open ended, if we try to rebut the argument with one ethical principle, then the other might get offended. Does virtue ethics answers every thing?
Promoting Organ transplantation has three basic issues namely social, religious and political. The controversy still goes on whether to openly accept the permissibility of the act or to completely Bann it. Another important debate is on the issue of burial in case of cadaveric transplants. The question is of the sanctity of the deceased maintained at the time of burial if he is stripped off all his organs and a hollow coffin is buried instead; would any of us want such an end of life. Moreover some people are of the view that every individual holds the right to be buried as a whole and taking out his body organs (in cases when he hasn't left a clear will regarding the issue) despite in all good faith sounds unethical. These delicate and intricate details further complicate the allowance of this transplantation and organ donation act in full context in all diversities of cases. But the argument's strength depends upon careful analysis of each of the cases keeping in mind all kinds of harms and benefits ; be it physical, emotional or financial pertaining to the donor, recipient, and / or their families. Argumentative views regarding the retrieval of an organ from a cadaver as being a part of the corpse or not is also an aspect that cannot be overlooked. The controversial role of Advanced Directives has led to two main questions:
1. Does one have legal rights over ones body?
2. If that is the case, then what exactly is wrong with even selling something that belongs to me?
Another view held by many individuals is that, so what it is just an organ? People can sell their organs, which is supposedly their ownership, to gain financial benefits for their families. This again holds the view of providing benefit to many, without doing harm(as the removal of organ is done under anesthesia). But doesn't this promotes the evil of organ trafficking which would harm many poor population and weaker ones in the society. This consequentionalist approach is again challenged here. The chain of this reaction would eventually affect many people, be it a good end or a bad.
The principles of beneficence and nonmaleficence can be advanced in the context of different issues: like the expertise available, the disclosure of all the possible outcomes and complications of the procedure, for the donor and the recipient, both medical and financial. The support that would be needed by the family and the prognosis of such advanced procedures should be looked into detail to benefit the patient and do no harm to the donor and the family members. The professional may have an influential role on the decision making. The autonomy of the patient is usually surrogated by the financial and moral obligation of the social setup.
There is a strong need for a system to keep a check on the medical problems of certain disease transmission through non screened donor organs, the use of unskilled surgeons in removing the organ, organ trafficking and selling, the actual financial damages of the post operative chemotherapy and potential need for the failure of the graft or re-transplantation, the actual life expectancy even after the transplant of individual case etc. Every state's constitution differs in some aspect to their religious and cultural norms, example, what ever is permissible in Germany is not accepted in many Muslim states, so the need for a definite, supreme, sovereign law cannot be denied.
Finding the ultimate law which would be unchallengeable and flawless is yet to be defined by the human nature. The unlimited limits of transedental laws and reasoning begins, where my horizons of imagination and limited reasoning ends. The noble act of organ donation should be encouraged only in the limits drawn by the Shariah' rulings of the contemporary times in view of its divines as an act of saving the humankind and helping those who are suffering. It should be given prime importance that these rulings certainly apply to variations of case selection as well.