Organ Donation and Transplant, Research Paper Example

This paper addresses the concept of Organ donations and transplants.  It is concerned with how the need arises and some of the ethical considerations in reaching decisions.  This covers the implications from the healthcare environment, the patient and donor or family thereof.  The paper is split into four distinct parts : (i) Introduction and background (ii) The issues that arise and how these are addressed (iii) The ethical considerations and (iv) Concluding remarks.  It addresses the important question of – how would you explain the situation to the donor (family) and the patient receiving the donated organ?

Introduction

The concept of human organ transplants really evolved  from the early 1950s.  It started off with several successful kidney transplants, and then the doctors quickly moved on with transplanting other organs.  Since this time, the science has greatly improved and we now have a high success rate with organ transplants.  Doctors now face new challenges, “simply put, there are not enough organ donors, said there is a long waiting list for patient’s chances of recovery”  (Harry.T, 2002).

Organ transplants are  a surgical option when a particular organ is failing.  Transplants are normally considered the option of last resort.  Diseases normally fall within the following categories: Liver disease, kidney disease, heart disease and lung disease.  The kidneys and liver may be considered as a viable transplant options from a living donor, however this itself poses issues and still remains an uncommon practice.  Other transplants, like heart, lungs, pancreas or cornea have to come from deceased patients.  This has been termed as someone who is considered brain-dead and on artificial life support.  The difficulty here is that the organs  have a rapid rate of deterioration once the  patient dies.

The diagram to the right ( Source: how stuff works.com 2002) illustrates clearly the number of different organ transplants that were carried out in the USA during the year 2000.  Kidney Transplants are still the largest amount of transplant operations being carried out.

It has been estimated that organs from a single donor can save as many as 50 lives. Organs that are available for donation include Kidneys, Heart, Liver, Pancreas, Intestines, Lungs, Skin, Bone Marrow, and Cornea.  Most organ transplants take place upon the death of a patient.

Issues that arise

There are many ethical considerations when looking at the donation of organs for transplantation purposes. This can be examined from a number of different perspectives. The Catholic Church puts forward the following views ” A person may will to dispose of his [or her] body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it….this decision should not be condemned but positively justified.” (quoted from Ashley and O’Rourke 1989, 305).

One of the main issues is that of respect to the immediate deceased person and the matter needs to be addressed with a great deal of care, sensitivity and dignity. This particularly to any remaining family or relatives of the deceased. ” The probably dying potential donor should be provided the usual care that should be given to any critically ill or dying person. Because of a potential conflict of interest, it is widely agreed that the transplant team should be different from the team providing care for the potential donor, who is not to be “deprived of life or of the essential integrity of their bodily functions”  (Flaman, 1994).

Ethical Considerations

A number of additional ethical questions have arose in recent years.  These include such questions as:

• sources of organs used in transplant procedures?
• Who should pay for the organs? Should a person who has had one transplant be allowed a second?
• Should proven alcoholics be allowed liver transplants?
• Does the cost justify the means?
• Is transplantation a denial of a person’s last rites or an act of charity?

The underlying root of the problem rests with that of procurement and supply vs. demand situation . How are the organs properly sourced and who ultimately decides upon who will  obtain the implant?  This dilemma is the reason that some 5000 people die every  year as they await a suitable donor  implant. ” should the choice of who gets new organs also depend upon social worth? That is to say, should a doctor get a new organ but a prisoner be refused? What about alcoholics – should they be denied new livers because they “deserve” what has happened to them?”  (Cline, 2010).

There is no doubt that transplant procedures are extremely expensive, and everyone has to pay in order to obtain a transplant.  Test the procedure has really been for the more affluent person or those with adequate insurance cover.  Another ethical and moral consideration is the exact occurrence of what is defined as death.  One definition is that of brain death.  Other explanations have stated that it is when the heart and lungs cease to function.  Hence, should the concept of consent be changed so that it is automatically assumed unless a person says no!

We have the ethical dilemma, where poor people in third world countries have sold one of their kidneys of money.  Hence they have undergone surgical procedures in order to remove a healthy kidney as a means to raise money.  In addition, although transplants can save lives they are not what medical conditions would describe as a cure.  It is more a question of trading a terminal condition for that of a chronic condition.  You will be on anti-rejection drugs for your remaining life in order to ensure that your immune system does not reject the newly transplanted organ.

As to date research is somewhat limited in terms of the psychological implications concerning organ donors and transplant operations.  Factors that increase the risk of psychological problems in transplant patients include: lack of social support, substance abuse and fear of organ rejection.  A leading soccer star in the UK became a severe alcoholic and subsequently had a liver transplant.  He changed his habits temporarily and then succumbed to alcoholism again.  George best, died 59 after suffering multiple organ failures.  It was stated that the anti-rejection drugs after the transplant made him more susceptible to infection.  Another emphasis in the differentiation between that of a cure i.e.  , moving from a terminal illness state to a chronic illness state.

The transplant Hospital at the  University of Zurich in Switzerland,  conducted a simple screening of patients undergoing transplant operations.  This was accomplished over a three-month period, and the following conclusions were made: ” Psychosocial screening methods prior to waiting list placement for organ transplantation reveal important information on the course of psychosocial factors before and after organ transplantation. Psychological counselling should be available at all stages of the organ transplant process”  (Götzmann, 2005).

Families have also had to deal with the concept of  where there is life there is hope and a family member that is dying and has volunteered or consented to organ donation. The concept of the definition of death becomes very important here.  The organs have to be taken as close to the death state or as soon as death occurs to avoid degeneration of the organ to be transplanted.  This can be a very difficult decision even for someone who has been declared as brain dead on a life support machine.  A surviving spouse for example may be faced with a very traumatic decision in terms of deciding the point that the persons life is ended.

Socioeconomic factors in organ transplantation being somewhat controversial.  The influence of ethnic origin and organ donation, together with a renal allograft survival have been  hotly debated.  ” Several large studies have reported inferior a renal allograft survival in black implant recipients”  (Devin E. Eckhoff, 2003).  The precise reasons for this but still being explored, however, the city race in organ donation.  Patient referral/selection has not been carried out in liver transplantation studies.  The percentage of black donors has increased from 6.1% in 1988 to 21.9% in 1996.  Disproportional fewer black patients have been referred for liver transplants than that of white patients.  This has contributed  to the lack of firm data, and ability to complete research in this area.  The one on three year survival rates between white and black patients were as follows:

• White:  88% (1)   81%(3)
• Black: 96%(1)   84% (3)

There are a number of political considerations applicable to supporting the organ donor programs.  Whilst medical technology advances, a shortage of donors increases.  This could be radically altered if more people sign a donor cards.  By contrast, more than 60,000 people await transplant operations; whilst there are only  around 10,000 donors.  There has been widespread support from the religious leaders in the community, but relatively little by way of the political agenda.  The Nobel prize-winning economist Gary Becker has suggested a possible solution to solving the current crisis might be to “increase the incentives to donors.  i.e. paying a few extends to the donors”  (Tabarrok, 2000).

Tabarrok also raised the possibility of organ donors belonging to a club.  For example, if you were card-carrying holder or organ donator, and in the event you experienced in organ failure yourself and subsequently requited transplant, you would have a priority call from the other members in the organ donor club.  The concept of insurance as a reward for signing up on your donor card.

On a personal level I do not hold an organ donor card but would have no objections to this on religious or moral grounds. There is however some room for doubt as to whether Doctors might save your life in extreme circumstances when you carry a donor card. This is a question of faith and trust in the medical system.  There is also the question of burial with some form of dignity rather than some basic remains after all of your vital organs have been removed for use elsewhere.  As such this becomes somewhat of an emotive decision but the concept of saving other peoples lives at the time of your death is a powerful argument in favour of donating organs.

As a Health care professional explaining this to a spouse or family of a terminally ill patient would require a great deal of empathy, tact, sincerity, professionalism and the ability to put this into context as a ‘gift’ to the living from the deceased person.  The most important aspect is that the deceased, a recently living person, does not lose dignity in his last rites.  The donor must not be viewed as a person comprising spare parts that are to be distributed to anonymous donors.  It is often useful to personify this in terms of other real people that are terminally ill and how the deceased organs is a gift of life to the recipient.  In essence a gift of life from the dearly departed and a vote of recognition in humanity that even in the uncertainty of death we can pass on something of true meaning to others.  The supreme act of benevolence and kindness to our fellow humans.  This will be particularly emotive when the person has been declared as brain dead and is being kept temporarily alive on life support machines.  The spouse may have to decide that it is proper to support the concept of turning off the life support and letting the partner peacefully slip away.

Nurses often come face to face with this when dealing with terminally ill patients and Section 5.1 of the ANA Ethics code looks towards dignity and care towards patients and equally a moral obligation to yourself.  The nurses will also be the closest to the patients immediate family and maybe asked questions accordingly.  Although the Doctors assume the direct patient relationship in the donor situation it is often the nurses that provide the human dimension, retention of dignity and care in those final moments.

Bibliography

Cline, A. (2010). Ethics of Organ Transplants . Retrieved 4 21, 2010, from About.com: http://atheism.about.com/library/weekly/aa052302a.htm

Devin E. Eckhoff, M. 1. (2003, 12 30). Race: A critical factor in organ donation, patient referral and selection, and orthotopic liver transplantation. Retrieved 4 24, 2010, from Interscience: http://www3.interscience.wiley.com/journal/106592859/abstract?CRETRY=1&SRETRY=0

Flaman, P. (1994). Organ and Tissue Transplants: Some Ethical Issues. Retrieved 4 22, 2010, from St. Joseph’s College, University of Alberta, Edmonton, Canada): http://www.ualberta.ca/~pflaman/organtr.htm

Götzmann, D. m. (2005, 12). Psychosocial risk factors before and after organ transplantation. Retrieved 4 21, 2010, from University of Zurich: http://www.forschungsportal.ch/unizh/p2197.htm

Harry.T. (2002, 2 5). How Organ Transplants Work. Retrieved 4 21, 2010, from howstuffworks.com: http://health.howstuffworks.com/organ-transplant.htm

Tabarrok, A. T. (2000, 2 19). Paying the funeral expenses of the donors. Retrieved 4 21, 2010, from Independent Institute: http://www.independent.org/newsroom/article.asp?id=283