Advances in transplantation: why ethics matters
The Ethics of Global Organ Acquisition: Moral Arguments about Transplantation
By Trevor Stammers. Bloomsbury. 2023. 272 pages.
Organ transplantation is undoubtedly one of the most significant medical advances of the twentieth century and is often in the headlines. The very first human heart transplant performed in South Africa by Dr Christiaan Barnard in 1967 rapidly made him a household name across the world. As one journalist commented at the time, the story had ‘everything a reporter could wish for’ and it became ‘the operation that took medicine into the media age’.
Transplants have been in the headlines again this month with the announcement of the first-ever UK womb transplant, carried out by Professor Richard Smith and his team at Oxford, though as noted by at least one UK legal scholar, there was very little media comment about the ethics of the procedure.
The European Society for Organ Transplantation has also just concluded its 2023 Congress at which a number of new significant advances were announced which could in future increase the number of organs available for transplant from deceased donors.
The most significant of these was a report from the US which found that of 21,000 neonates who died in 2020, more than 12,000 were potential organ donors. Very few countries permit donations from neonates, but in those that do, the transplanted kidneys from neonates show catch-up growth and were reported to function better than those from living donors.
Professor Gabriel Oniscu, the incoming President of ESOT, acknowledged the ‘highly emotive nature’ of the issues involved in approaching parents about deceased donation from their newborn infants, but considered it ‘imperative that every European country has dedicated paediatric donation protocols in place that encompass neonatal organ donation procedures.’
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Having such a protocol in place may well save many lives, but this depends on whether the application of it in practice is ethically sensitive to parents’ wishes and understanding. This is just the most recent of many examples where the completely understandable need to optimise organ donation procedures can so easily tip into the territory of putting undue pressure on the relatives of potential infant donors.
A closer look
An ethical analysis of similar tipping points forms the basis of my new book on the ethics of organ donation. It aims to increase public confidence in transplantation by increasing understanding of the complex issues involved and enabling readers to know what questions to ask when they or their loved one are faced with either the need for a transplant, or are considering becoming a living donor, or making a decision about donation after death.
The book explores issues such as: does consent always needs to be voluntary; the pros and cons of opt-out versus opt-in systems of consent, donations from children, including those with anencephaly; whether donors need to be dead or ‘as good as dead’ in order to have their organs removed for transplant; whether paying for donations is a way to increase the numbers; whether we should take organs from those requesting euthanasia, or indeed to euthanise them by taking their vital organs; why organ trafficking remains such a prevalent issue worldwide – the first successful prosecution for it occurred in the UK this year – and finally, whether organs from animals or bioengineering may offer effective alternatives to both living and deceased donations.
Each one of us is far more likely to be in need of a transplant than we are to become a living donor, so we all have good cause to be aware of the issues involved and talk with our loved ones about our wishes in regard to deceased donation.
Dr Trevor Stammers is a former associate professor of medical ethics and author of The Ethics of Global Organ Donation: Moral Arguments About Transplantation (Bloomsbury).
Many people react with horror to the thought of using newborns as a source of organs. Others say that it's not a big problem. What do you think? Tell us in the comments box below.
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