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Discuss the Social, Ethical and Legal Issues related to Human Orga

Merlin Joseph
BSc Biomedical Science
BS306 Issues in Biomolecula

Word Limit 3300


Word Count 3038

Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

Organ transplantation has become a vital part of modern medicine. The


ability to replace non-functional organs without it being rejected has
allowed for the improvement in the health and wellbeing of many
recipients. A successful transplantation means that not only is the patient
able to live for longer but their quality of life is also improved.
There are many types of transplantations: Isograft, Autograft, Allograft
and Xenograft. Isograft is the transplantation within identical twins,
Autograft is moving tissue from one point to another in an individuals
body, Allograft is the most commonly used method in which organs from
donors are moved into recipients and Xenograft is the least common
method where organs are transplanted within species.
The idea of transplanting organs has been around from as far as the 5th
Century when an Indian physician and his medical students developed
transplants for reconstruction of noses, earlobes and other small body
parts which were amputated for religious, criminal or military punishments
(The National Kidney Foundation, 2014). His works were published in
in Sushruta Samhita (ca. 500 BC), in his medicosurgical compendium,
which was later translated into English and published in Calcutta
(Sushruta, Bhishagratna Kunja Lal Kaviraj, 1907).
Yet it was in the early 20th century that many developments in
transplantation technology occurred. In 1905 Alexis Carell published a
paper called The Transplantation of Organs: A Preliminary Communication,
in which he stated that From a clinical standpoint, the transplantation of
organs may become important and may open new fields in therapy and
biology (Carell, 1905).
This and his subsequent work on organ
preservation allowed him to receive the Nobel Prize in 1912.
However it took 30 years after Carells paper was published for the first
human to human transplant to be successfully completed by Dr Voronoy in
1936. He transplanted a kidney from a 60 year old man who had died of a
fracture to the skull. The donor had been deceased for 6 hours when the
kidney was removed. The recipient was a 26 year old woman who died
after 48 hours due to her having a different blood group to the donor
(Margreiter, 2016). It was in 1944 that the idea of transplantation became
a form of medical treatment rather than unsuccessful experiments after
British scientist sir Peter Medawar reported that rejection of a transplant is
based on immunologic factors (The National Kidney Foundation, 2014).
Through the lack of sufficient immunosuppressants, there were many
more failed attempts at transplantation. Surgeons such as Dr Christian
Bernard carried out the first heart transplant on his patient, Louis
Washkansky in 1967 who lived for 18 days after the operation (Johnson. A.
R, 2012).

Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

The real success in Organ transplantation came in 1979 after the


introduction of immunosuppressive drug Cyclosporine which when
combined with steroids controlled rejection better than any drug used in
the past (The National Kidney Foundation, 2014).

Transplantation within the scientific community has been a leap in medical


advances to allow for an increase the life expectancy of people. Being
such a diverse community there are social issues which impact the way
people react towards the idea of Organ transplantation and donation.
Religion is a huge part of our lives weather we have a specific faith or not.
No religion forbids the act of organ donation with religions such as
Christianity and Islam regarding it as saving a life. The Holy Quran,
chapter 5, vs. 32 states that Whosoever saves a life, it would be as if he
saved the life of all mankind. With Buddhism, the central belief is a wish
to relive suffering therefore circumstances may occur where donation of
an organ may be seen as an act of generosity. Dr Desmond Biddulph,
Chairman of The Buddhist Society stated that Giving is the greatest of
Buddhist virtues. The Buddha in a previous life gave his body to a starving
tigress who could not feed her cubs. There are many such Jataka tales
some in which he even gave his eyes to someone who wanted them. What
loss do I suffer to give an unwanted organ after my death to give another
person life?
However religions such as Jehovahs witnesses were not allowed to
receive or donate organs until very recently. Their guidance from the
Watchtower in the 1960s stated that Those who submit to such
operations are thus living off the flesh of another human. That is
cannibalistic. God did not grant permission for humans to try to
perpetuate their lives by cannibalistically taking into their bodys human
flesh. This view was however revised in the 1980s and they view the
decision for or against organ transplantation as an individuals choice
(Grundy, 2016).
The more spiritual religious beliefs such as Shinto and Gypsies are against
organ transplantation. Gypsies dont have a formal resolution towards
organ donation but oppose it due to their belief in the afterlife. They
believe that for one year after their death, the soul retraces its steps and
for that, all parts of the body must remain intact. This is because they
believe that the soul maintains a physical shape. The Shinto religion
however, believe that the dead body is impure and dangerous, which
makes it quite powerful. They believe that to injure a dead body is a
serious crime and families do not want to damage the itai, which is the
relationship between the dead and the bereaved (Donorrecovery.org,
2016).
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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

There are many social misconceptions within people about donation of


organs and how it occurs once a person has passed away. This is due to
the lack of education given to people, leading to long waiting times for
transplants to occur. These misconceptions include notions about the way
the body of the donor will be treated after surgery as well as fear that
other organs also being taken without permission. Its not right to say that
these misconceptions are only due to a lack in knowledge, as the fears
that people have about donation have occurred. In China the wait for a
vital organ is only one month, with 10000 organs donated per month.
They have no donating system so where are these organs coming from?
(Stoporganharvesting.org, 2016). Forced donation occurs all around the
world with certain authorities being accused of harvesting organs from
people who they think are undesirable, such as prisoners, without their
consent.
Organisations
such
as
DAFOH
(Doctors
against Forced Organ harvesting) creates awareness for the illegal and
unethical ways in which organs are sometimes harvested without consent.
They believe that it is a crime against humanity as well as a threat to
medical science to obtain organs without consent (DAFOH, 2016).
Occurrences such as these force us to evaluate the ethical values that are
needed to be considered while transplanting organs. There have been
many practices that have occurred within the history of organ
transplantation that has been unethical. It evokes question such as:
whether it is right to transplant an organ that has been obtained illegally.
Or is it wrong to save someone with an organ that cant be traced back to
a donor who gave consent? Or should the main concern be the life of the
recipient?
The main aim in organ transplantation is to save lives but it requires
detailed analysis of the ethical implications that are related to it. The main
ethical dilemma is due to the shortage of donors. This leads to question;
how do you determine who receives a transplant first with the available
organs? There are cases in which recipients abuse their new organ which
leads to ask other important questions such as Should everyone deserve
a transplant? Should younger people get priority? There are many things
to consider and it is of priority to make sure that all the transplants are
done fairly and without anyone getting any unfair advantages.
With organ transplantation, the notion of distributive justice arises. This is
the socially just way to allocate goods in which incidental inequalities in
the outcome do not occur. This theory also states that there is no right
way to distribute organs, rather many ways in which one person can
justify why to give their organ to one individual over another (Lamont and
Favor, 1996). Equal access is a type of distributive justice which could be
used while assigning the available organs. It states that organs that are
allocated for donation should be distributed to patients according to
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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

objective factors, to reduce unfair distribution and bias. The equal access
criteria include (E. Ehtuish, 2011):
o
o
o
o
o

Length of time waiting (i.e. first come, first served)


Age (i.e. younger to younger, older to older or youngest to oldest)
Organ type, blood type and organ size
Distance from the donor to the patient (genetically)
Level of medical urgency

People who believe in the use of the equal access method believe that the
procedure of organ transplantation is incredibly valuable and should only
be offered to those who need it. There are many cases of injustice that
occur in which people with power and influences receive transplants
before those who are in the waiting list. An example of this is the case of
footballer George Best. He convinced his doctors that he was suitable for a
liver transplant in 2002 after suffering alcohol induced cirrhosis. However
after the operation, he resumed to drink against his doctors
recommendation. His surgeon states that urgent measures are needed to
identify those who will abuse their organs after the transplant so that they
can be kicked off the waiting list (Sample, 2005). Further investigations
into this story revealed that the hospital at which he received his
transplant was privately treating Greek and Cypriot patients with organ
transplants, while receiving 85,000 per operation, from which the
doctors fee was deducted (Delgato, 2008).
Another type of distributive justice is maximum benefit. The main aim of
this is to maximise the number of successful transplants. The maximum
benefit criteria include (Paul et al., 2004):
-

Medical need (i.e. the sickest people are given the first opportunity
for a transplantable organ)
Probable success of a transplant (i.e. giving organs to the person
who will be most likely to live the longest)

The supporters of maximum benefit believe that organs should be


distributes so that the greatest benefit is achieved from every organ. This
means that the organs which are so scarce are not wasted. They believe
that to avoid wasting organs, all patients should be ranked according to
the extension of their illness and their chances of survival after the
operation. This method of distributing organs allow for the consideration
of several other issues which the equal access philosophy does not see as
correct e.g. the right to give someone a second transplant factoring in the
probability of a successful result (Paul et al., 2004). Although this seems
fair there are arguments which oppose this method of organ allocation.
First is the measuring of the medical success. How do you measure the
success of a transplant? Is it by the amount of life years gained by the
patient after the transplant? Or is it the amount of time the transplanted
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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

organ was functional? Could it also be the amount of level of rehabilitation


and the quality of life of the patient? These are the type of questions that
the people who allocate the organs have to consider before choosing a
recipient. The second issue with the maximum benefit method is that it
could lead to bias, lying, favouritism and other unfair practices (E. Ehtuish,
2011). Currently Organs are distributed according to: Medical need,
Probability of success and the time spent on the waiting list (Unos.org,
2016). This means that there is no discrimination against age and that all
life is considered equal.
The main way to reduce the ethical issues regarding who to give an organ
first can be solved by an increase of organ donors. However this could
lead to illegal cultivation of organs leading to organ farming as well as
premature declaration of death in order to obtain an organ. One of the
most famous examples of organ harvesting in the UK is that at Alder Hay
childrens hospital in Liverpool. They retained the hearts and organs of
children without the knowledge or permission of the parents. These
organs were taken from babies who died between 1988 and 1996. They
were found out in 2001 almost by accident when the heart specialist
revealed that the hearts were kept at Alder Hay at a different enquiry
(News.bbc.co.uk, 2001). The enquiry also revealed that thymus glands
which are removed to get better access to the heart during surgery were
sold to pharmaceutical companies in exchange for cash donations (Ward
and Boseley, 2001).
Organs can be obtained for a transplant in many different other ways. The
first and most common is by cadaveric donation. This occurs when a
person has died and had previously given their consent to donate their
organs. They would have given consent while they are still alive, but if
they hadnt then their closest relative will decide if the organs can be
donated or not. Secondly organs can be donated by live donors. As the
term suggests its when a living person donates an organ to someone they
know mostly close relatives or loved ones. This means that the recipient
will not have to be on the waiting list to receive the donation. However
there are a few drawbacks to being a living donor which may cause some
people to discourage others from becoming one. These include:
o Health consequences such as pain, discomfort, infection and future
health complications
o Psychological consequences such as family pressure, guilt or
resentment towards the recipient
o No donor advocate to turn to if they need guidance or advice.
o Pressure to donate to a sick member of the family or someone they
love

Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

Organs can also be sourced alternatively. Researchers are developing


bioartificial organs that can keep patients alive for many years. In the U.S
there is a national research program underway to create a small,
surgically implanted, and free-standing bioartificial kidney to treat end
stage renal disease (Pharm.ucsf.edu, 2016). There has also been
development in using stem cells to create organs for transplantation.
Researchers believe that one day stem cells can be used to grow entire
organs or even just specialised cells (Paul et al, 2004). There has also
been recent breakthrough in the study of stem cells to repair a faulty
organ. Scientists were able to perform gene therapy on living mice to
create stem cells in vivo. If the same mechanics can be transferred into
humans then it can be used to generate stem cells at the site of a
diseased organ and eliminate the need for an organ transplant (Connor,
2013).
The World Health Organisation (WHO) has set out 11 guidelines regarding
consent, donations, payment for organs and many more issues that affect
Organ transplantation (www.who.int, 2010). These along with the
legislation that are particular to each country allow for legal donation and
transplantation of organs. In the UK there are three different legislations in
use. England and northern island follow the Human Tissue Act 2004 which
establishes the Human Tissue Authority to regulate the removal, storage,
use and disposal of Organs that have been donated (Transplant, 2016).
The most important aim of this legislation is consent and there are
different requirements for consent for when a person is a living donor and
when they are deceased. It establishes a set of rules which should be
followed in situations such as; trafficking, transplants non-consensual
analysis of DNA and many more (The Human Tissue Act, 2004). Scotland
uses the Human Tissue act (Scotland) 2006 legislation, which is different
to that of England and NI. It states that anyone who is above 12 years of
age is allowed to give consent to donating their organs. There are many
more laws that can be followed similar to the legislation of England and
NI. This system of donation is called opt-in.
In 2015 Wales changed their legislation on organ donation to become
Deemed consent also known as opt-out by allowing The Human
Transplantation (Wales) Act 2013. This means that unless a person who is
living in Wales has expressed that they dont want to donate, it will be
assumed that they have no objections towards donating their organs for
transplantations (Organ Donation Scotland, 2012). This will be good for
the Welsh community as countries that have changed to the opt-out
system such as Belgium experienced that only 1.7% of their 11 million
people refused to give their organs for donation after death. It meant an
86% increase in the number of kidneys retrieved for transplants since they
changed the legislation in 1986 (Wilson, 2012).

Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

The issue with a policy like opt-out is that it completely relies on the
assumption that everyone knows about the organ donation. If this is so
then the organs are being taken without true consent. This can be seen as
a violation of the deceased, which is why the British Medical Association
believes that before any changes occur, there should be a nationwide
campaign to inform everyone about the process (Bma.org.uk, 2016). They
also believe that donations should not occur if there is a family
disagreement that may cause distress.
Legal issues that surround Organ transplantation are mainly based on how
the organs are obtained. The National Organ Transplantation Law 1984
which was amended in 1988 and 1990) outlawed the sale of human
organs. It also authorised the Department of Health and Human Services
to assist qualified Organ Procurement Organisations (OPOs) with their
planning and establishment (Nation Organ transplant Act, 1984).
Organ transplantation is a crucial part of modern medicine. Without which
the death rate of people in every country would be significantly higher.
When conducted fairly, its a just system which focuses on saving lives.
Politics and greed have caused many issues to arise during the past and
many will occur in the future too, but with the new developing
technologies and legislations in place maybe there wouldnt be as many
issues. Educating the public with campaigns and spreading awareness will
allow for more donors and developments to occur in the future allowing
for the lives of many more to be saved.

References
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Association. [online] Available at:

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13-0037.pdf [Accessed 27 Jan. 2016].


Connor, S. (2013). Breakthrough with stem cells could 'end need for
transplants'. [online] The Independent. Available at:
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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

http://www.independent.co.uk/news/science/breakthrough-withstem-cells-could-end-need-for-transplants-8809955.html [Accessed

28 Jan. 2016].
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[Accessed 19 Jan. 2016].


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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

of Minnesota, Department of Bioethics. Available at:


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Merlin Joseph
BSc Biomedical Science (Hons)
BS306 Issues In Biomedical Science

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