Ethics in organ transplant

What is organ donation? What are the ethical principles involved in organ Transplant? What are the issues related to organ transplants? How to bridge the gap of demand and supply for organs? Read further to know more.

Altruism and compassion are the cornerstones of organ donation. The era of Organ transplant has started despite many challenges and has been widely recognised as a great advancement in medicine and surgery.

But right away, ethical issues were found to be hiding in the miracle.

India performs the second-highest number of transplants worldwide, after the United States, according to the Global Observatory on Donation and Transplantation.

Also read: Xenotransplantation

What is organ donation?

Organ donation is the transfer of biological tissue or an organ from a living or deceased donor to a recipient who is still alive and in need of a transplant.

A transplant is a medical operation in which a healthy person’s organ or tissue is substituted for an unhealthy person’s malfunctioning organ or tissue to restore function.

Ethical principles involved in organ transplant

The ethical foundation of a gift is permission, which is based on the knowledge that has been properly provided, considered, and comprehended and is unforced and unbought. Consent is frequently paired with the adjectival phrase “informed,” yet the word has various connotations.

State governments, which are in charge of providing health care, are expected to make sure that the organs donated voluntarily by the families of brain-dead people are handed to recipients ethically and legally.

The Transplantation of Human Organs and Tissues Rules stipulate that citizens on the State and national waiting lists have priority over foreign nationals. No healthy body should be invaded to obtain an organ for another; this is against a person’s right to bodily integrity.

Patients and the general public must have faith in their doctors to act in their best interests at all times. Basic biology and technology must be sufficiently reliable to offer a case-by-case probability of a favourable outcome.

Altruism is demonstrating care for the welfare of others. When people observe others in difficult situations, they become compassionate and want to lend a hand.
The moral justification for the giving of bodily components is altruism, which continues to be at the centre of ethical considerations regarding organ donation.

Also read: Ethics of Euthanasia

Issues Related to Organ transplant

In India, the organ donation rate is a pitiful 0.65 per million people (PMP), and every year, 5 lakh individuals pass away owing to a lack of organs.

Infrastructure:

• Organ Transplant and Retrieval Centers are quite rare in the nation.
• Only 250 of the 301 hospitals that are capable of doing the transplant procedure are registered with the National Organ and Tissue Transplant Organization (NOTTO).
• There is now only one completely functional hospital for organ transplants serving 43 lakh people.

Trust Deficit in the organ transplant process:

• Organ transplants in this nation have primarily been obtained through charitable donations. However, an erroneous unfavourable perception of private hospitals’ connections to organ transplants has been spreading.
• The precipitous decline in organ donation in Kerala from 76 deceased donors in 2015 to 8 in 2018 is a textbook illustration of this unfavourable publicity.
• In addition to endangering the sacred cause of saving a life, illegal organ sale also puts the life of a healthy person in peril.

Inequality and Accessibility:

• While most organ receivers come from the limited group of people who can afford expensive lifetime medicine after transplant surgery, the bulk of donors come from the lower middle class and lower socioeconomic backgrounds.
• An organ is given to society for free, but the cost of transplanting it ranges from Rs. 5 to Rs. 25 lakhs. This expense makes organ transplantation less affordable for the less fortunate members of society.
• The imbalance is demonstrated by instances where foreign patients have been given preference when receiving hearts and lungs in Tamil Nadu; in 2017, foreign patients received 33% of lung transplants and 25% of heart transplants, respectively.
• The main reason why more than 75% of donated hearts and lungs go unutilized is the financial issue.

Superstitions and Misconceptions regarding organ transplant:

• It is a widespread misunderstanding that organ donation leaves the deceased donor’s body deformed, which discourages individuals from signing up to donate.
• Religion prevents organ donation from the deceased. The life-death-rebirth cycle and being born (or reborn) with a missing organ are two common superstitions.

Wastage of organs:

• Organs (particularly hearts and lungs) were not used because no suitable receiver could be found. Organ waste results from this.
• The high price of transplant operations. Transplant surgery costs are unregulated and out of the grasp of the poor.

Negative propaganda by media about organ transplants:

• Organ rackets and false “scandals” announcements.
• News of unethical methods of organ collection undermines public confidence and hinders the overall organ donation process.
• False claims of scandals involving organ rackets News of unethical methods of organ collection undermines public confidence and hinders the overall organ donation process.

Taking advantage of abducted persons:

• Organ trafficking from kidnapped people is becoming more common, especially among the poor and orphans.

Some of the Best practices in Ethical organ transplant

We are going to talk about two ethical organ transplant models that the entire nation could use.

The Tamil Nadu Model:

• 2008 saw the launch of the Cadaver Transplant Program.
• An agency, the Transplant Authority of Tamil Nadu, efficiently monitors the donation process and organ allocation (TRANSTAN)
• Principal actions:
  • focus on organ donation for the dead.
  • There is a focus on not wasting organs, and there are criteria to make sure that all organs are used, even in facilities that do not perform transplants.
  • Mandatory declaration of brain death.
  • coordinators for transplant training.
  • application of transplantation regulations.
  • waiting lists at one location.
  • Government hospitals offer free transplants.

The Spanish Model:

• The world’s highest rate of organ donation is in Spain.
• Establishment of the National Transplant Organization (ONT), which synchronises transplant regulations throughout Spain.
• The organ donation process has an opt-out option; unless declined, it is automatic.
• Donation is also taken into consideration in cases of circulatory death, which differs from brain death in that it occurs when respiration, heartbeat, and circulation cease.
• To ensure that organ donations are quick and effective, the designation of suitable specialists (intensive care physicians) is required.
• More focus should be placed on organ donation among patients beyond the age of 65; in Spain, 10% of donors are 80 or older.

Read more about Xenotransplantation here

How to bridge the gap of demand and supply for organs.

For organ transplantation demands, there is always a demand-supply gap. The following proposals can be made to close this gap:

• India should adopt the Spanish “presumed consent” approach, in which everyone is presumed to be a donor after death unless they have opted out during their lifetime.
• The heart, kidney, eyes, lungs, pancreas, liver, bone marrow, blood vessels, heart valves, middle ear, connective tissues, bones, and skin are among the organs that can be easily transplanted from a brain-dead person. Thus, a single cadaver donor can save the lives of numerous individuals who are near death. Even though India legalised organ retrieval from brain-dead people in 1948, there are still several obstacles standing in the way of a viable cadaver donation programme there.
• Mass media should be used to spread the word about the advantages of organ donation, and religious commandments should be used to discourage superstition.
• The government may even think about providing donors with incentives, such as health insurance for the donor and his family. Several nations have embraced the practice. This will go a long way toward putting a stop to the illegal organ trade that has become so pervasive in the nation.

To increase ethical procedures for organ transplant procedures,

Public awareness about organ transplant:

• Encouraging dead organ donation to help the organ shortage
• The most crucial action that can increase the rates of dead organ donation is public awareness.
• For instance, the Andhra Pradesh government started showing “Punarjanam,” a one-minute short video about organ donation, before the start of each show for a week in 2017.

Infrastructure:

• The need for more transplantation centres
• Getting transplant coordinators trained
• Teaching medical professionals and paramedics
• Enhancing organ transportation and expanding air ambulance services
• Establishing tissue banks and suitable storage facilities

Finance:

• Reducing the financial issue and lowering the cost of transplants
• Public hospitals need to expand their infrastructure so they can perform transplants and give the poor access to affordable, high-quality care to improve the availability of donated organs to weaker populations.

Cross-subsidisation of organ transplant:

• Cross-subsidization is supposed to make the weaker segment more accessible. Private hospitals should provide free transplants to the segment of the community that donates the bulk of their organs for every three to four transplants.

Targeting Low-Priority Services:

• Given that India’s GDP spends only 1.2% on health, a greater emphasis on preventing organ failure will result in improved health outcomes.

Organizational:

• Enhancing the NOTTO’s coordination of the organ distribution system role
• Centralised, efficient organ donation registry

Legislation regarding organ transplant:

• All hospitals should be required to declare brain death.
• The Center advocated changing the law on motor vehicles so that applicants for new or renewal permits would have the option of voluntarily donating their organs. Implementing the Central Motor Vehicles Rules, 1989 Amendments Draft

Ensuring realization of organ sharing:

• A zonalization should be carried out to ensure more efficient sharing of organs (the USA has such a provision). This would aid with the transportation and transplantation of organs like hearts that can only be kept for brief periods.

Process of allocation to be more transparent:

• It is necessary to increase transparency in the organ allocation procedure. It should be open to the general public, monitored, and tracked.
• Additionally, the results of the transplant should be well-tracked.

Responsible media about organ transplant:

• Before reporting on scandals and rackets, the media should exercise greater responsibility. Before publication, information should be thoroughly scrutinised.

Regulation in organ transplant sector:

• The Transplantation of Human Organs Act, of 1994 has to be changed so that self-declaration and required verification involving civil society can take the place of the rigid bureaucratic approach used by hospitals.
• Second, the Act must address the issue of the federal government’s interference in organ distribution and should guarantee complete state autonomy in subjects about organ transplants. Having the organ distribution process online and making all information available online would promote transparency in organ transplants

Conclusion

The Istanbul Declaration outlines guidelines against transplant tourism and organ trafficking. Transparency in organ allocation and procurement is a goal of the World Health Organization’s Guiding Principles on Human Cell, Tissue, and Organ Transplantation.

Regulations should include the ethics of financial incentives and non-financial incentives, such as the inclusion of non-medical criteria in the allocation of organic priority projects.

Article written by Aseem Muhammed