Organ Transplant Ethics seminar

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ETHICAL ISSUES IN ORGAN TRANSPLANTS: 

ETHICAL ISSUES IN ORGAN TRANSPLANTS PRESENTED TO : MS. KIRANA SHEKHAR DEPT. OF MICROBIOLOGY

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Objectives INTRODUCTION TO ORGAN TRANSPLANTATION TYPES OF ORGAN TRANSPLANTS GUIDING PRINCIPLES BY WHO PROVIDING A HISTORY ON ORGAN TRANSPLANTATION ORGAN SUPPLY VS ORGAN DEMAND STATISTICS INVOLVED REPUBLIC ACT 7170 ETHICAL ISSUES INVOVED ETHICAL PRINCIPLES ALLOCATION OF RESOURCES CERTAIN GUIDELINES ORGAN MARKET:A CONTROVERSY CONCLUSION REFERENCES

Organ Transplant: 

Organ Transplant The transfer of a whole or partial organ from one body to another Removal of an organ from: A deceased donor A living human person For the purpose of replacing the recipient’s damaged or failing organ with a working one from the donor site

Organ donation: 

Organ donation The gift of an organ donated by a human being to another human being Giving of tissue or organ by a person to another person or institution

Types of Organ Transplant: 

Types of Organ Transplant Autograft A transplant of tissue from one to oneself Skin grafts, vein extraction for CABG, storing blood in advance of surgery Allograft Transplanted organ or tissue from a genetically non – identical member of the same species Most human tissue and organ transplant

Types of Organ Transplant: 

Types of Organ Transplant Isograft A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient (e.g. identical twin) Anatomically identical to allografts, closer to autografts in terms of the recipient’s immune response Xenograft Replacement of an individual’s defective organ with an organ harvested from another species Source of organs for human use: primates (genetic similarities to humans) and pigs (large availability)

Guiding Principles on Human Organ Transplantation (WHO): 

Guiding Principles on Human Organ Transplantation (WHO) Intended to provide an orderly, ethical and acceptable framework for regulating the acquisition and transplantation of human organs for therapeutic purposes Organs and tissues may be removed from the bodies of deceased and living persons for the purpose of transplantation only in accordance with the following principles:

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Organs may be removed from the bodies of deceased persons for the purpose of transplantation if: Any consents required by law are obtained and, There is no reason to believe that the deceased person objected to such removal

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Physicians determining that the death of the potential donor has occurred, should not be directly involved in organ removal from the donor and subsequent transplantation procedures , or be responsible for the care of potential recipients of such organs

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Organs for transplantation should be removed preferably from the bodies of deceased persons Adult living persons may donate organs, but in general such donors should be genetically related to the recipients An organ may be removed from the body of an adult living donor for the purpose of transplantation if the donor gives free consent

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No organ should be removed from the body of a living minor for the purpose of transplantation The human body and its parts cannot be the subject of commercial transactions . Accordingly, giving or receiving payments (including any compensation or reward) for organs should be prohibited

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HISTORY Prehistoric transplantation exists in mythological tales of chimeric beings. 1903-1905 : Modern transplantation began with the work of Alexis Carrel who refined vascular anastomoses as well as transplanted organs within animals 1914-1918 : Skin grafting in WWI 1953 : HLA described by Medawar, Billingham and Brent 1952 : Dr. Hume at Peter Bent Bringham Hospital in Boston attempted allograft kidney from unrelated donor and found that it functioned for a short period; attributed chronic uremia as suppressant of the immune function for the recipient 1954 : Dr. Joseph E. Murray transplanted kidney from Ronald Herrick to his identical twin, Richard Herrick, to allow him to survive another 8 years despite his ESRD 1956 : First successful BMT by Dr. Donnall Thomas, the recipient twin received whole body radiation prior to transplant

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1954 : Dr. Joseph E. Murray transplanted kidney from Ronald Herrick to his identical twin, Richard Herrick, to allow him to survive another 8 years despite his ESRD 1956 : First successful BMT by Dr. Donnall Thomas, the recipient twin received whole body radiation prior to transplant 1957 : Azathioprine deveoped by Drs. Hitchings and Elion 1966 : First successful pancreas transplant by Kelly and Lillehei 1967 : First successful heart transplant by Christiaan Barnard in South Africa, recipient was 54 yo male who died 18 days after transplant from Pseudomonas pneumonia . That same yr., first successful liver transplant performed by Thomas Starzl 1981 : First successful heart/lung transplant by Dr. Reitz at Standford 1983 : First successful lung transplant by Dr. Joel Cooper; cyclosporin approved 1984 : Congress passed the National Organ Transplant Act (NOTA) which stated that it was illegal to buy/sell organs, OPTN and UNOS were created. as well as the scientific registry of transplant recipients 1990 : tacrolimus approved 1995 : mycophenolate mofetil approved 1997 : daclizumab approved 1999 : pancreatic islet cell transplant by Dr. Shapiro 2008 : face transplant

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1990 : tacrolimus approved 1995 : mycophenolate mofetil approved 1997 : daclizumab approved 1999 : pancreatic islet cell transplant by Dr. Shapiro 2008 : face transplant

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Results from a rapidly increasing demand due to high success rate of organ transplantation Creating an ever-widening gap between organ demand and organ supply Ethical or unethical? ORGAN SELLING

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Statistics All organs 7282 Kidney 5827 Liver 743 Pancreas 106 Kid/Panc 182 Heart 211 Lung 200 Heart/Lung 5 Intestine 30 All organs 2662 Kidney 1498 Liver 610 Pancreas 86 Kid/Panc 115 Heart 174 Lung 144 Heart/Lung 1 Intestine 12 On Waitlist as of 1/9/09 (reg 10) Transplanted in 2007 (reg 10)

International Organ Trade: 

International Organ Trade developed by WHO due to the shortage of an indigenous “supply” of organs, where potential recipients travel abroad to obtain organs through commercial transactions.

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Organ exporting countries India 2000 kidneys sold per year Pakistan 2000 kidney transplants in 2005, approximately 1333 were for foreigners Philippines 468 kidney transplants in 2003, 110 were for foreigners Organ importing countries Australia Canada Japan Israel Oman Saudi Arabia USA

Republic Act 7170: 

Republic Act 7170 Organ Donation Act of 1991 An act authorizing the legacy or donation of all or part of a human body after death for specified purposes

ETHICAL ISSUES: 

ETHICAL ISSUES IS THE HUMAN BODY A COMMODITY? HOW SHOULD DECISIONS BE MADE ABOUT WHO RECEIVES SCARCE ORGANS? WHO SHOULD PAY FOR TRANSPLANTS? SHOULD ONE PERSON RECEIVE SEVERAL ORGANS OR SEVERAL PERSONS RECEIVE ONE?

ETHICAL ISSUES: 

ETHICAL ISSUES SHOULD ONE PERSON HAVE A SECOND TRANSPLANT WHEN THE FIRST ONE FAILS OR SHOULD A DIFFERENT PERSON BE GIVEN A FIRST CHANCE AT A NEW ORGAN? SHOULD ORGANS BE DONATED TO THOSE PERSONS WHO HAVE ABUSED THEIR BODIES BY DRINKING AND SMOKING OR ONLY TO THOSE WHOSE ORGANS ARE DAMAGED BY DISEASE? SHOULD STATE OR FEDERAL LAW MAKERS BE INVOLVED IN TRANSPLANTATION?

ETHICAL PRINCIPLES: 

ETHICAL PRINCIPLES

Principle of Common Good and Subsidiary: 

Principle of Common Good and Subsidiary Human communities exist only to promote the common good of their members, and that each person or social group has a right and a responsibility to participate in this effort. “from each according to ability, to each according to need” Ethics of Health Care, 3 rd Edition, Benedict M. Ashley, O.P and Kevin D. O’ Rourke, O.P.

Principle of Common Good and Subsidiary: 

Principle of Common Good and Subsidiary One can donate an organ only when it is probable that one’s own health will be preserved and the recipient will receive a proportionate benefit. Because such a donation is not one of justice but a free act of charity, it is possible for donors to refuse to make such a free gift, nor should others pressure them into doing so or condemn then for not doing so. Ethics of Health Care, 3 rd Edition, Benedict M. Ashley, O.P and Kevin D. O’ Rourke, O.P.

PRINCIPLE OF INTEGRITY AND TOTALITY: 

PRINCIPLE OF INTEGRITY AND TOTALITY These principles dictate that the well-being of the whole person must be taken into account in deciding about any therapeutic intervention or use of technology “Integrity“  "preserve a view of the whole human person in which the values of the intellect, will, conscience, and fraternity are pre-eminent" ( Gaudium et Spes , n. 61).

PRINCIPLE OF INTEGRITY AND TOTALITY: 

PRINCIPLE OF INTEGRITY AND TOTALITY “Totality" refers to the duty to preserve intact the physical component of the integrated bodily and spiritual nature of human life, whereby every part of the human body "exists for the sake of the whole as the imperfect for the sake of the perfect" (St. Thomas Aquinas, Summa Theologica II, Question 65, Article 1).

PRINCIPLE OF RESPECT FOR AUTONOMY: 

PRINCIPLE OF RESPECT FOR AUTONOMY Autonomy is the capacity for self-determination. However, to respect an autonomous agent is to acknowledge that person’s right to make choices and take action based on that person’s own values and belief system. The principle of respect for autonomy implies that one should be free from coercion in deciding to act, and that others are obligated to protect confidentiality, respect privacy, and tell the truth.

PRINCIPLE OF RESPECT FOR AUTONOMY: 

PRINCIPLE OF RESPECT FOR AUTONOMY In the practice of health care, a person’s autonomy is exercised through the process of obtaining informed consent. The principle of respect for autonomy, however, does not imply that one must cooperate with another’s actions in order to respect that individual’s autonomy.

ALLOCATION OF RESOURCES : 

ALLOCATION OF RESOURCES PRINCIPLE Allocation of resources must be done in an ethical manner. The criteria for allocation must be made known to all, and the needs of the poor and the powerless must be respected.

Allocation of Resources: 

Allocation of Resources “Those who are dangerously wounded must be tended first, entirely without regard to rank or distinction.Those less severely injured must wait until the gravely wounded have been operated upon and dressed. (Hinds 1975, 6)

Guidelines: 

Guidelines The functional integrity of the donor as a human person should not be impaired, even though anatomical integrity may suffer. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. The donor’s consent is free and informed. The recipients for the scarce organs are selected justly . Ethics of Health Care, 3 rd edition. Ashley, O’Rourke, O.P.

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ORGAN SELLING AND BUYING -an organ market A Vicious Cycle Needs money Has organs Has money Needs organs Over 2,000 kidneys are sold annually in developing countries to wealthy recipients from the rich countries!

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Main Issues on Organ Trade It is contrary to the dignity of the human body and depersonalizing Organ sale promotes coercion and exploitation of people, especially of the poor. Insufficient screening compromises quality of organ and health of both donor and recipient It promotes poor quality of care as a result of poor standards of donor selection and inadequate screening for transmissible disease Ashley, BM and O’Rourke KD. Ethics of Health Care. 1986.

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Main Issues on Organ Trade All those who need such a gift should receive it, rather than only those who could pay. There is favor for those who have the resources to purchase these “entities” Discrimination IT MAKES HUMAN ORGANS A COMMODITY FOR PROFIT AND SALE.

REFERENCES: 

REFERENCES National Institute of Allergy and Infectious Diseases. Available at: http://www3.niaid.nih.gov/topics/transplant/history. Accessed January 12 , 2009. M.k sateesh,Bioethics and Biosafety,I.k International Publishing House Pvt. Ltd.,page no.641-648 Sade RM. Transplantation at 100 Years: Alexis Carrel, Pioneer Surgeon. Ann Thorac Surg . 2005;80:2415-8. United Network for Organ Sharing. Available at: http://www.unos.org . Accessed January 12, 2009.

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Department of Health and Human Services. Available at: http://www.organdonor.gov . Accessed January 10, 2009. Ad Hoc Committee of the Harvard Medical School. A Definition of Irreversible Coma. JAMA .1968;205(6):337-40. Steinbrook R. Organ Donation after Cardiac Death. NEJM. 2007;357(3):209-13. Pascual J, Zamora J, Pirsch JD. A Systematic Review of Kidney Transplantation From Expanded Criteria Donors. Am J Kid Dis . 2008; 52(3):553-586 Siminoff LA, Gordon N, Hewlett J. Factors Influencing Families’ Consent for Donation of Solid Organs for Transplantation. JAMA . 2001;286(1):71-77.

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Thank you