Organ Donation: Who, How,Why and also What are the Ethics? (5)

There is a source of organs for transplant that represents one of the highest forms of humanistic altruism and that is an organ donation from a living donor. But there are real ethical and psychologic concerns about this action and it is on this topic that I would like to conclude my series on organ donation.
You first need to read the article in Virtual Mentor in which reporter Chris Fusco wrote about his series of articles in the Chicago Sun-Times where he describes his experiences as a living donor of part of his liver. In Virtual Mentor there is a link to the Sun-Times where you can access these articles. The following is a brief excerpt from the start of the Virtual Mentor article which sets the beginning of his journalistic endeavor.

When journalists have opportunities to escape their newsrooms and report stories first hand—to spend days, weeks, or even months with their subjects—they usually chomp at the bit to take them. In most cases, I would, too. But this story was personal. It was August 17, 2000, when my childhood friend Mark Mucha told me that he had liver cancer and might need a living-donor transplant to save his life. Four of my friends and I ended up on the short list to be Mark’s liver donor, and, after nearly 4 months of waiting, I was selected. Adding to the drama was that Mark was a new dad, and that my wife Jennifer was 8 months pregnant with our first child when Mark and I went into surgery on December 12, 2000. We were both 28. … The problem was that this story did not have a happy ending. Mark died on March 25, 2001, after a series of complications that included my liver failing him and a second transplant not working, either

The problem with living donors compared with dead donors is that both parties are alive and aware of the gift and the donor and the recipient may each have their own good feelings of what has happened but each may also have their own uncertainties about it too. If both parties remain separated and anonymous to each other some of the psychologic issues of the transplant will be moot but even if they had not met, there may be a drive in both to finally meet and express their feelings to each other. Some of the feelings that have been discussed by those studying living donor transplants have to do with a feeling of duty by the recipient to, in some way, pay back the sacrifice of the donor. Remember, no money has changed hands or is legal as part of the transplant. Even, though initially the donation represented an altruistic gesture, the donor may eventually expect something back from the recipient. But what is the “something”? This may lead to an unhealthy relationship developing between these two individuals and even their families unless these hidden feelings are brought out. Would it be ethically more beneficent to both parties if the transaction was handled as a sale of a commodity? Yet this idea of selling organs brings up a host of other ethical issues regarding issues as simple as whether the human body parts can be considered commodities. Also what impact selling organs would have on from where the organs would be coming? For example, would this lead to those people who were financially poor to be the more likely population to take the physical risks of surgery and loss of an organ or tissue rather than those financially well off? And would this be just? Would selling organs stimulate a “black market” of organs and be associated with criminal behavior?

What about the situation as described in the story by Chris? The liver tissue that Chris donated “failed” Mark. Think of what a donor might consider if this should happen. Was it the donor’s failure or was the recipient not compliant in some way and caused this to happen? And what about a perhaps unrealistic guilt a recipient might have about this failure.

Another issue about living donors is the greater possibility that the donor will be aware of the specific recipient and that the chances for a directed donation would be more likely depriving those in need on a waiting list for that organ.

These are just some of the issues along with those in my previous posts that have been of concern regarding organ donation. And now for the "Why" regarding the continued dependence on organ donation. At present there is no simple and more permanent way to substitute organ function. Ideally, the answer to the problem of providing life supportive treatment to those whose vital organs have failed them is to eliminate organ transplantation entirely. After all this procedure is only available to a small fraction of those in need. The preservation of a transplanted organ may require a lifetime of compliant complex medical management. What would be best if we can’t prevent even premature organ failure by specific approaches would be to study and try to develop organ repair and regrowth with the use of human stem cells based on their suspected potential value. If this was possible, organ donation along with its limitations and ethical concerns would become an extinct procedure. ..Maurice.