Transplantation is a surgical technique that involves removing an organ from one body and transplanting it into the body of another to substitute a missing or damaged tissue. Autografts are transplanted organs from the same person’s body while allografts are transplantation conducted between two individuals of a species. Living or cadaveric allografts are available. Kidneys, heart, liver, pancreas, lungs, intestine, uterus, and thymus have all been successfully transplanted (Rogers et al., 2019). The most often transplanted tissues are corneas and orthopedic grafts, which exceed organ transplants by much more than threefold.
Due to the various technological consequences as well as new horizons to be explored while seeking for new treatment possibilities that go well beyond conventional judgments, organ transplantation is among the top forms of treatment operations. While professional expertise were established first, transplantation gained a broader scope only when the immunological response to donor organs was known and management of genetic factors was obtained (Rogers et al., 2019). This is not without bias or distortion as a human multifunctional endeavor. Despite the fact that organ transplantation has historically been done out of need, there is a need to shift away from it since it violates patient autonomy, ethics of justice, and the concept of non-maleficence.
Organ Transplantation Violates Patient Autonomy
Since organ transplantation was first rendered viable and safe some decades ago, the scarcity of donor organs for transplantation has been a major and persistent global concern. Different tactics have been used by countries throughout the world to try to solve the problem, with varied degrees of success. It is important to note at this point that the principles of altruism underpins organ donation. The moral worth of an individual’s acts is seen as “Altruistic” when the value of the person’s behavior is centered primarily on the good influence on other persons, without concern for the individual’s own implications. There are two sorts of altruism: compulsory and supererogatory (Berry et al., 2019). The term “obligatory altruism” refers to a moral obligation to aid others. Going “well beyond” one’s responsibility is characterized as supererogatory benevolence, which is ethically beneficial but not morally essential.
Ideally, organ procurement should be based on an explicit consent approach. The statement implies that until someone expressly declares otherwise, they will not be an organ donor. The willingness to be a donor is usually documented on in an official document, on a driver’s license, or by a proxy with judgement call authority. However, so far the expressed-consent strategy has not really been demonstrated to be successful in boosting organ supply to a level close that of need while respecting the autonomy of donors.
As it stands, many nations procure organs using a form of implied (rather than stated) permission. According to the concept, people are believed to desire to donate their organs at clinical death until they have directly protested (Prabhu, 2019). For example, the law requiring the potential organ donor to be pronounced dead on neurobiological criteria by three doctors was approved in Spain in 1979, and anyone who has not formally expressed their disagreement to a possible donor is deemed a prospective donor once death has been proclaimed (Fernández‐Ruiz et al., 2020). Additionally, the Caillavet Law, approved in December 1976 in France, permits a third person to indicate whether a donor has any objections, even though the donor has not declared them explicitly (Chavot & Masseran, 2018). Lastly, according to a Columbian statute, if an individual has abstained from using his right to object to the extraction from his body of anatomical organs during his lifetime, there shall be a legal presumption of donation (Berry et al., 2019). From the above three examples, it follows that every nation has its own policy, however, permission can only be assumed in all variants of the model if people are fully informed about the strategy and given a choice to opt out from donating. This violates patient autonomy.
Advocates of implied consent use a utilitarian logic to justify the policy’s implementation. They argue that implied consent is the best option for the most individuals since it harms no one while helping many. They go on to say that the onus of conveying and expressing preferences should lie on individuals who oppose donation, not those who favor it, because transplantation is a socially desired aim. Advocates of implied consent are oblivious to the fact that for more than a decade, Spain has had the world’s finest donation rate, and does not have a system of implied consent (Prabhu, 2019).
Additionally, while others may argue that presumptive consent system for organ procurement affords greater autonomy than stated agreement since it permits the donor, rather than his or her family and friends, to make the final call, the apparent lack of respect for autonomy is wrong on so many levels. For one, it is unethical to enter someone’s body without their consent, and also that “total regard for the deceased’s will” is paramount (Truog & Miller, 2010). Moreover, the government is already too engaged in our affairs and that “additional intrusion into our business by claiming custody of our bodily parts…would be a move far off.”
Secondly, presumptive consent violates the 5th Amendment’s ban on seizing personal property without permission and reasonable remuneration. Despite the fact that presumptive consent eliminates the need to request a relative for a beloved one’s organs during a period of significant loss, which is harsh and needless, and thus relieves the family’s concern over the decision, presumptive consent also lead to the prospect of “false – positive results,” or assuming somebody authorized organ removal when, in reality, he or she did not want to donate, had not read the required papers, did not even know the important facts, or was somehow unable to engage in the organ donation discussion.
To sum up this chain of logic, proponents of presumed consent make the argument that all errors in trying to interpret a donor’s preferences have the very same moral value; it really is no worse, they argue, to presume that somebody decided to donate, take his or her body parts, and then discover that he or she raised objections, than to incorrectly presume that somebody does not want to donate and thus forego prospective organs (Truog & Miller, 2010). In actuality, these two sorts of errors are not morally equivalent; erroneous removals are fundamentally worse off than erroneous nonremovals. Morally, an action that causes injury or death is worse than no action at all, and thus presumed consent organ transplantations should be stopped. The principle of autonomy acknowledges people’s control over their bodies, and the right to be free of unwelcome physical intrusions is part of human dignity. If one does not explicitly consent to transplant, it is an ethical justifications to deny organ transplantation.
Organ Transplantation Violates Non-maleficence
The Dead Donor Rule is the cornerstone of modern organ transplant legislation (Cummins & Nicoli, 2018). It is not a formal legislation, but rather a generally held view that killing one individual to save another life is immoral. An organ donor has to be deceased before essential parts are taken on such grounds. As a result, the dead donor rule is a moral code: essential organs may be taken once the person has died. The majority of donors are considered to be dead based on neurologic standards, which include the permanent loss of all brain activities. Due to a scarcity of “brain dead” donations, essential organs are now frequently being obtained from donors who have been certified dead based on circulatory standards or living donors (Truog & Miller, 2010).
There are significant reasons to put into doubt present transplantation methods’ conformity with the dead donor rule, which necessitates reconsidering the morality of organ donation. “Irrevocable loss of respiratory and circulatory functions” is the first condition for finding death. Can we be certain that these processes are unchangeable a short time after the heart stops beating? The fact that perfusion has stopped for 3-4 minutes does not suggest that it has stopped for good. To meet the requirement of “irreversibility” in its common sense, it should be impossible to reverse perfusion using existing medicine.
Recognize the causative impact of withholding life support, particularly artificial breathing, to legitimize essential organ donation without the dead donation rule. According to popular belief, removing respiratory support only permits the patient to die, not that it causes death. Death is caused by the person’s underlying illness. This viewpoint, on the other hand, is untrustworthy and cannot survive investigation.
Even though decisions are made not to use chest compressions after the removal of life-sustaining therapies in cases of donation after circulatory death, it is possible that if it is used, it will be effective in re – establishing blood flow. As a consequence, individuals who donate after circulatory death are not identified to be deceased at the time of organ removal. The irreversible stoppage of perfusion, according to some critics, is able to support the dead donor criterion. The terms “permanent” and “irreversible” are not synonymous. If the stoppage of circulation is irreversible, it also is permanent; however, the opposite is not always true. There are even stronger arguments to be made that the dead donor rule is habitually broken in the event of “brain dead” donations. “Brain dead” people can retain a broad range of biological activities for up to 6 months with artificial ventilation, including perfusion, respiration, tissue repair, disease combating, temperature management, hormone production, and even fetal gestation (Cummins & Nicoli, 2018). They are not, in the biological sense of the word, dead. They have life, and removing organs from them kills them. This violates Non-maleficence. Furthermore, if physicians should not cause their patients’ death for whatever reason, then deferring life-sustaining therapy even at the request of the patient is unethical. Lastly, doctors are ethically obligated to follow medicine’s particular moral responsibilities, and Primum non nocere, or “first, do no harm,” is a vital medical ethical tenet (Truog & Miller, 2010). The Hippocratic Oath for doctors clearly embodies this notion.
Organ Transplantation Violates Ethics of Justice
An ethical choice, according to the justice system to ethics, is one that distributes advantages and liabilities among parties in a just, equal, or unbiased manner. Organ donation fails this test. It is comparable to asking a healthy guy to risk his life by leaping into the water to save a drowning man. As mentioned before, dead donor rule requires one to die to save another, and a living donor suffers the more or less the same consequences. For instance, a living kidney donor loses 30% to 40% of their kidney functionality after donation. Evidently, even if it is consensual is unfair (Kates et al., 2021).
Additionally, many donors- while previously healthy- are in excruciating agony and are unable to work for some time after the procedure. Also, in living donor surgeries, the probability of medical complications is 6 percent to 15%, and the chance of mortality is 1 percent to 2 %. Living donation comes with both short and long-term hazards. Blood clots, pneumonia, pain, blood loss, infections, allergic responses to anesthesia, harm to surrounding tissue, and even death are all possible surgical consequences (Truog & Miller, 2010). It is unjust considering the procedure carries a minimal risk for the organ recipient because it is a potentially lifesaving treatment whereas donating an organ exposes a healthy individual to the danger of major surgery and the recovery time associated with it.
Organ Transplantation Violates Beneficence
A doctor owes a responsibility of beneficence to their patients, which entails putting the patient’s interests ahead of their own. As a result, the lowest variants of the donor damage criterion may be supported by citing a concomitant of the donor rule in deceased organ donors. The rule states that “a person has to be deceased before life-prolonging organs can be acquired for transplant or other uses.” It is frequently based on the belief that the intentional death of innocent individuals is not ever permitted (Kates et al., 2021). It is provided as an ethical justifications to deny organ transplantation.
Thus, even if an event of organ donation is both independent and going to occur in a net benefit, instances of donations when donor death is definite will always be judged unlawful under the method as it violates beneficence. In many instances, it happens to be the most common scenario due to the dead donor rule. Thus, organ donation should be altruistic but only to a certain extent. Consequently, individuals should be able to have directed donation within families. While advocates of organ transplant may argue that it does save lives, and that when one arrive at the hospital, a medical professional’s primary priority is to save live, one cannot rule out the possibility that being an organ donor would jeopardize physicians’ and nurses’ dedication to saving lives which violates beneficence.
In conclusion, the mountain of data points to the necessity for drastic efforts in the medical industry to move away from organ transplantation. Organ donation not only violates patient autonomy to a large extent, but transplant surgery is also unjust as it carries a risk for the recipient since it exposes the recipient to the danger of unneeded multiple surgeries and the recovery period. Additionally, transplantation for compensation is ethically unjustifiable as there would be less emotional satisfaction for the donor family, less regard for humanity and the sanctity of the body, and a loss of the special relationship that exists presently in the altruistic donation procedure, organ transplantation for remuneration is immoral and unjustifiable. It is also possible that an affluent vs. poor divide will emerge from organ transplantation for remuneration.
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Fernández‐Ruiz, M., Andrés, A., Loinaz, C., Delgado, J. F., López‐Medrano, F., San Juan, R., … & Aguado, J. M. (2020). COVID‐19 in solid organ transplant recipients: a single‐center case series from Spain. American journal of transplantation, 20(7), 1849-1858.
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