Subject: Med Ethics

Topic: Organ Transplantation and

Donation
Shifting /Date: August 15, 2008
Trans group: Paolo Paraiso

Introduction Types of Human Transplantation

The Department of Health AO 2008-0004 Revised National 1. Autotransplantation – the donor and the recipient of are one and
Policy on Living Non-Related Organ Donors and Transplantation and the same individual
Its Implementing Structures set “the general guidelines and ethical
principles whereby the act of donation and the conduct of 2. Heterologous transplantation – the donor and the recipient of
transplantation using NON-RELATED donors shall be managed and transplantation are 2 different individuals.
regulated”.
 Animal to human transplantation
DEFINITIONS
Organ donation - giving of tissue/organ/body by a person to another
person or to an institution  Human to human transplantation (cadaver-donor; living-
donor)
Donor - giver who maybe a cadaver, or a living person . A donor who
exchanges the organ for money is a vendor Ethical Consideration

Recipient - receiver who may receive directly from the donor or from 1. Donor (deceased or living)
an institution. A recipient who pays for the organ is a buyer
 Deceased (Cadaver) Donor
Organ transplant - transfer of tissue/organ from donor to recipient
 The act of donating one’s body or its part after
Attending physician - doctor caring for the patient death for the purpose of aiding the sick and
relieving their suffering either directly or indirectly
Transplant team - healthcare providers performing the actual transfer is an act of worthy praise.
of the tissue/organ
 Never obligatory
Transplant Committee - group created to ensure that the donation
process follows professional and ethical standards  When a dying patient is a probable donor of organs
direct care should not involve the transplant team
Organ sale - trading of an organ in exchange of money or similar
material. The person or institution who arranges for the trade  Deceased (Cadaver) Donor
between buyer and vendor is the middleman. Organ
trafficking is trading for profit
 No body organs may be removed until the donor’s
death has been confirmed by a competent medical
Gratuity - action/of remuneration received by the donor that
authority
constitutes an act of gratitude for the organ given

Xenotransplantation - transfer of animal organs to human beings.  Organs: kidneys, liver, heart, lungs and cornea

ETHICAL ISSUES IN HUMAN TRANSPLANTATION  Ethically repelling when as a result of the

procedure, the personal identity and abilities of the
recipient are compromised
Is it ethical to mutilate one’s self or allow one’s self to be
mutilated so that the body part surgically “harvested’ can be  Ethical aversion is shown to transplantation of the
transplanted to relieve someone of pain, to restore someone to normal reproductive organs as this violates the genetic
body functioning, or to prolong someone’s life? individuality of the recipient

Transplantation  Living Donor –the following should be observed:

Is a surgical procedure whereby an organ or a tissue, is transferred from  There is a proportionate benefit to the recipient, as
one part of the body to another or from one organism to another a result of the transplant procedure
organism

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI

 The donor is not exposed to greater risks of life or
deprived completely of an important body function
or functional integrity
Types of Body Parts for Human Transplantation
 Body parts that can regenerate
 Unethical when a part of the liver from a living
adult donor is transplanted into a child-recipient à
adult donor’s liver regenerates within a a
reasonable time and the child’s new partial liver
develops as the child grows
 Bone marrow transplant and blood transfusion are
ethical
 Body parts that are paired
 Non-generating human body parts may be
transplanted provided they are paired (kidney)
 Ethical as long as there are proportionately
justifying reasons, the functional integrity of the
body is maintained, and harm to the donor as a
result of the transplant is only limited
 Cornea cannot be justified à functional integrity
would be seriously impaired
2. Recipient
 Not ethical
 Exert pressure in any manner
 Prioritized others, when the rights of other potential
recipients are disregarded at the same time
 Monetary consideration
 Organs for transplant should not be commodities à
manipulation, exploitation and unfair competition easily bred
Observations to consider when making judgment as to who
receives a donated organ or tissue:
 Access to health care should be the privilege of the few
 Post-transplant rehabilitation possibilities
 Post-transplant benefits to the recipient
 The ‘social worth’ of the recipient after transplantation
Subject: Med Ethics
Topic: Organ
Transplantation and Donation
Page 2 of 5
 ‘First come, first served’
3. Procurement of Organs/Tissues
 Practice should be ethical also as long as respect for patient
autonomy is observed provided that those who intend to put
one of their paired or regenerating organs on the market be
provided with sufficient information – health risks, financial
costs, post-surgery rehabilitation
 Regardless of the good intention of either the seller or the
buyer à treatment of the human body and its parts as
commodities is an affront to human dignity
4. The principle of free and informed consent
5. Competency of the donor
6. Role of parents and guardians in transplantation
7. Use of human fetus in transplantation
Animals as Source
 Opposed by the advocates of animal rights who doubt the
human therapeutic benefits of transplant procedures that use
animal-donor
 Ape’s heart to human infant or pig’s liver to a dying
human being
 Use of insulin extracted from animal pancreas or of cat gut as
absorbable sutures is not appreciated at all
 Common view:
 Animals are for the use of man, and their use for
the benefit of man is welcomed, provided that the
manner of using them is human and respects
human sensitivity
THE ORGAN DONOR
 Principles of stewardship and nonmaleficience: “Man must
take care of his body and do it no harm”
 Cadaver donor
 harvesting organ will do no harm
 Living donor

 taking away a healthy organ is not taking care of
one’s body: no life is saved, no health is restored
 Just and proportionate reasons may overrule the violation of
stewardship and nonmaleficence
 Solidarity, love of neighbor, beneficence and
charity
 Donation is praiseworthy act of sharing life in
keeping with what it means to belong to a human
society and to contribute to it, with the goals of
medicine and with one’s duty as a Christian
Ethical Requirements
 Harm and risk of harm must be minimal and proportionate to
the benefits to be derived
 Drive to maximize organs may lead to an unseemly
haste à organ procurers willing to declare
someone dead (dying cannot be killed)
 For healthy: organ removed must not be necessary
for life or for personal and procreational identity
(not brain or gonads), or must be easily regenerated
(blood, bone marrow, hair)
 Donor must be cared for before, during and after the donation
 Proper screening, standard healthcare,
reimbursement for medical expenses, disability and
livelihood lost, prevention of discrimination job
opportunity, insurance, HMO, community
acceptance
 Intrinsic worth and dignity of the donor must be respected
 Free and informed consent must be given
 Necessary information should be given: process of
matching, chance of success of transplant and
permission to refuse
 Reasons for donations: moral duties, religious
beliefs, external pressures, guilt from the past
relationships, identification with the recipient
 Marginalized vulnerable to exploitation: financial
needs and ignorance
 Considerations for the family of cadaver donors:
 Consent for the donation must be obtained
Subject: Med Ethics
Topic: Organ
Transplantation and Donation
Page 3 of 5
 Opportunity to say goodbye and receive comfort in
their grief
THE ORGAN RECIPIENT
 Stewardship dictates that in serious illness, Man has the right
and the obligation to take the necessary measures to preserve
life and health
 A new organ preserves life
 To the extent it is available; one has a right to and obligation
to get it
Ethical Requirements:
 Harm and risk of harm must be minimal and proportionate to
the benefits to be derived
 Not everyone with end-stage kidney disease must
have a transplant
 For a particular patient a transplant may not be
good, even if the patient wants
 Recipient must be protected against exploitation
because of one’s vulnerable state
 Respect for autonomy must allow the recipient to choose how
to get an organ
 Requires free and informed consent
 There must be just allocation
 Justice would dictate equal benefits for everyone in
need
 When a number of candidates equal based on
medical criteria, need and chance of success then
the choice of recipient should be on a first come
first saved basis
THE PHYSICIAN
 Has the positive obligation to provide the best possible care
to the patient: either donor or recipient
SOCIETY
 The obligation of the society
 To provide for the common good and necessitates
that it make organs and transplantation available

 To be just in the allocation of resources
 Policy against uncontrolled trading in an
open market which would allow
exploitation or those with more to jump
to the cue
 Ethical standards must be ensured to
avoid “transplant tourism”
KIDNEY SALES
 Until there are enough organs for all who need them and for
as long as some are willing to pay while others are willing
top sell, kidneys will be sold, regardless of it being illegal or
prohibited
Issues
 What is the motive of the vendor selling a kidney?
 Related and directed à from ties of love and
connectedness
 Non-related donors with no material exchange à
altruistic act
 Sales à altruism? Sustain basic needs?
Educational needs of children?
 Need of a poor man may be related to
responsibility, charity or altruism
 What harm can selling kidneys do?
 Excluding sold organs may reduce the number of
available organs
 Allowing a poor man to sell his organs maybe to
his best interest by opening a chance to improve his
life
 A poor vendor may conceal high risk exposure/
behaviors to be acceptable
 Selling human organs may change the way vendor
and buyer view themselves as possessors of
property rather than stewards
 Associating the transplant ream to money making
may undermine the confidence of the public in the
medical profession
 What be the right price for a kidney?
 A reasonable price based on the average donors
expenses and the economic capacity of the recipient
and not on the outcome of the transplant or the
Subject: Med Ethics
Topic: Organ
Transplantation and Donation
Page 4 of 5
market, not so low as to exploit the vendor, not so
high as to coerce the vendor or exploit the
recipient, with a ceiling price can be determine
Conclusion
 Organ donation and transplantation is a good with one man
helping his fellowmen.
 It should always be done in the context of sharing,
compassion and love
POLICY STATEMENT
These guidelines promote the principles and values underlying AO
2008-004
1. Common Good and Solidarity
 Organ donation and transplantation is a way of caring for the
other
 It is a manifestation of generosity and love
 It should be done first and foremost , to save and improve the
quality of life of another
 Both donor and recipient should benefit from the process
2. Non-maleficence
 A living non-related donor (LNRD) shall be considered only
after neither a deceases donor nor a living related donor is
available 3 months after the potential recipient is enrolled in
the registry
 The removal of the organ, its transplantation and all related
procedures shall be done only in hospitals accredited by the
Bureau of Health Facilities and Services, DOH and by the
PhilHealth
 Both the donor and recipient shall receive appropriate health
care, before, during and after the transplantation
 There shall be no conflict of interest
 There shall be no exploitation of donor or recipient
3. Respect for Person
 Subject: Med Ethics
Topic: Organ
Transplantation and Donation

Page 5 of 5
 Organ sale is not allowed  Composition:

 Free and Informed Consent shall be obtained from the donor  Physician, social worker, chaplain, lay person,
and if married, from the spouse and the recipient. bioethicist and lawyer

 No deception in the information given, no coercion
in obtaining of consent, and volunteerism on the
part of the donor and recipient
 Functions:
 Special efforts shall be exerted to protect the vulnerable and
those with diminished autonomy
 A substitute decision maker cannot authorize the donation of
an organ from another living person, but can authorize the
donation of an organ from a deceased person
 Should be familiar with issues related to organ
transplantation and donation
 Develop and publicize programs to enhance
deceased organ donations, prevent conditions
leading to the need for organs and prevent abuses in
organ transplantation
 Evaluate and approved/disapproved every proposed
donation and transplantation

4. Justice and Equity  Protect donor and recipient

 Monitor ethical issues which arise from organ

 Non-directed donated organs shall be allocated equitably
among patients with priority based on the objective criteria
for medical need and probability of success as specified by
the Donation Allocation Guidelines
donation and transplantation
 Recommend sanctions for violations of guidelines
to the Hospital administration and records action

 “First come, first served” basis

 A donor shall be reimbursed for the expenses related to the

donation and transplantation (medical, loss of income,
inconvenience), but not for the organ itself

 Benefits and burdens must be equally distributed

 A gratuity should be given to the donor

 There shall be transparency in the whole process

5. Beneficence

 There shall be a review of these guidelines every year as

more information and experience become available

 Revisions shall be proposed as needed

IMPLEMENTING MECHANISMS

1. Hospital Transplant Ethics Committee

 Every hospital should establish a Hospital Transplant Ethics

Committee or task an existing Hospital Ethics Committee
(HEC) to implement this guidelines