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Transplants and Ethics

In response to society’s question of ethical guidelines, WMA, The World Medical Association published a journal (WMJ) in January, 2005. Their intention is to better unify medical ethics everywhere, an effort certainly needed in today’s global economy. Narrowing that down to the emotionally biased issue of transplants is an important step in ensuring that equal opportunity exists for all.

Guidelines

The American Medical Association in their guidelines writes that the first obligation of the physician is to his patient and this should remain the same even with controversial organ donations. However, in this situation both the donor and the recipient are patients and that compounds the problem of medical ethics. The AMA reiterates: Be equally fair to both. One patient should not be more at risk than the other.

Medical ethics demands that donors already deceased have two doctors, rather than one, confirming the reason for the death. The obvious here is not mentioned but it is an assurance that people are not intentionally killed for their organs. It makes no difference if these potential donors are social misfits or outcasts and the beneficiary is a one of society’s finest. Ethics rules here!

Both donor and recipient must know what is to take place and if this is impossible because of one or the other’s condition, relatives must decide. This is a must. No organ is acquired without forms being signed and full acknowledgement of what possibly could go wrong from both. Regardless of how important the transaction is to the physician, he must adhere to medical ethics and to leave personal choices or opinions out of the ethical decision.

Competency is another choice that must be made. Not just any surgeon can assume it’s okay to elicit organs or to actually remove them without having been specially trained. And also, not every hospital is appropriate for such procedures. They must have this accreditation or at least have adequate means of carrying out the procedure.

Who gets the organ?

In most situations people are lined up for hearts, kidneys, lungs, and other organs and who gets first choice? Ethics demand that strict guidelines be followed. The age of the patient is taken into consideration. Approval for first choice should be younger people with families to support over older people who’ve already lived most of their life.

Other considerations may take precedence however: Facts such as how healthy is the rest of the recipient’s body; are other organs diseased as well and most likely would cut short the usage of the organ also must be factors in determinations. Each organ donation is unique and therefore it’s necessary to review all angles of the proposed transplant. The list of needed organs is a natural priority and local communities cannot race to the top of the list. They must wait their turn no matter how heart rendering it may be.

There are also exceptions to this rule such as how quickly can a heart, kidney or lung get to the one needing it. If time is of importance it may be that the most ethical choice is to assign a recipient closer to the donor site. Other concerns such as relatives or friends who agree to share a kidney must not be coerced or made to feel guilty. It must be their concern and they must sign a statement to that effect.

History of organ transplants

Dr. Joseph Murray and Dr. David Hume first successfully transplanted a kidney at Brigham Young Hospital in Boston, December 23, 1954. It was a humane and loving affair: Ronald Herrick donated a kidney to his twin brother Richard. In 1962, these two transplant trailblazers, at the same hospital, successfully transplanted a kidney from a deceased person.

In 1963, Dr. James Hardy at the University of Mississippi Medical Center transplanted the first successful lung transplant. Three years later Dr. Richard Lillehei and Dr. William Kelly at the University of Minnesota in Minneapolis transplanted the first successful pancreas/kidney transplant.

A year after that, Dr. Thomas Starzl at the University of Colorado in Denver, CO first successfully transplanted a liver. And then Dr. Christiaan Barnard at Groote Schuur Hospital in Cape Town, South Africa, is credited with the first heart transplant. The next year Dr. Norman Shumway of Stanford University Hospital in Stanford, CA.is credited with the first US transplant.

US Legislation regulating donations

On and on organ transplants continued and more and ethics become a concern. In 1968 the Uniform Anatomical Gift Act made it possible for those over the age of 18 to donate an organ; In 1972, the End Stage Renal Disease Act (ESRD) made Medicare Coverage for Renal Dialysis and Kidney Transplants; in 1984, the National Organ Transplant Act (NOTA) created a computer registry for organ donation; in the same year, Organ Procurement Organizations (OPO) disallowed the trafficking and commercial use of selling organs.

In 1986 hospitals were allowed to approach patients and relatives about organ donations and in 1998 hospitals were required to refer all deaths to their local OPO.

After a lull of 14 years, Dr. Michael DeBakey performed the first successful heart transplant in the US. Although the previous transplants were successful—the patients lived but living was not what it should have been. This caused medical science to ask, is this right?