Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient’s own body, for the purpose of replacing the recipient’s damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the patient’s own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person’s body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.
Organs that can be transplanted are the heart, kidneys, eyes, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. The cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.
Organ donors may be living, or brain dead. Tissue may be recovered from donors who are cardiac dead – up to 24 hours past the cessation of heartbeat. Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be “banked”. Transplantation raises a number of bioethical issues, including the definition of death, when and how consent should be given for an organ to be transplanted and payment for organs for transplantation. Other ethical issues include transplantation tourism and more broadly the socio-economic context in which organ harvesting or transplantation may occur. A particular problem is organ trafficking. Some organs, such as the brain, cannot yet be transplanted in humans.
According to the Washington Post, in recent years:
“… in the hopes of obtaining more organs, federal health officials, transplant surgeons and organ banks have been intensely promoting ‘donation after cardiac death,’ or ‘DCD.’ DCD usually involves patients who have devastating and irreversible brain damage but are not actually brain-dead. Their families consent to removing life support, and their organs are removed minutes after the patients’ hearts stop beating.”
That is, there may be some brain activity when life support is removed. It would not be enough to maintain bodily functions like heart beat and breathing. The patient has no chance of ever regaining consciousness. But, since the end of a person’s life is defined as the permanent cessation of brain activity, they may be theoretically still alive.
In many cases the desire to donate an organ may be based on the wish to save the
life or improve the health of a relative with whom there are already bonds of
affection and love. This may even be an overwhelming concern.
In other cases, a person may wish to do something to save the life or improve the
health of an unknown person in the community, based on more impersonal ideas
of helping others or giving to the community. For example, this may be a
consideration for those who volunteer to be placed on a register of potential bone
marrow donors (or who volunteer to donate blood).
Such donors may consider that the potential personal disadvantages or discomforts
of donating are more than outweighed by the potential benefits to the person
needing a transplant. (example from micro teachers :D)
“Despite continuing advances in medicine and technology, the demand for organs drastically outstrips the number of organ donors,” states a United Network for Organ Sharing (UNOS) fact sheet. UNOS is a nonprofit charitable organization that, under the authority of the federal government, maintains the United States’ organ transplant waiting list and works to develop organ transplantation policies and raise awareness about organ donation. According to UNOS, the chronic shortage of organ donors is the most critical issue facing the field of organ transplantation. While 22,854 lifesaving organ transplant operations were performed in 2000, over fifty-eight hundred people died while waiting for a transplant— an average of more than fifteen every day. I
Ironically, the increasing success rate of organ transplant procedures is one reason that organ transplant waiting lists have risen so dramatically since the late 1980s. The first organ transplants, performed in the late 1950s and 1960s, were characterized by high mortality rates; a major problem was that patients’ immune systems often rejected the foreign organ. The introduction of the drug cyclosporine in the 1980s helped mitigate this problem, and organ transplants subsequently became less experimental and more routine. Statistics indicate that in 1998 organ transplant procedures were successful 70 to 95 percent of the time, depending on the organ being transplanted. With these increasing success rates, more doctors have recommended the procedures.
Another factor behind the organ shortage is that, according to UNOS, “relatively few deaths occur under circumstances that make [cadaveric] organ donation possible.” There are two main types of organ donation: living-donor donation and cadaveric donation. Kidney transplants make up 95 percent of living-donor donations; the other 5 percent are largely from liver donations, a rare procedure in which an adult donates a portion of his or her liver to an infant. But the majority of kidney and liver donations, and virtually all pancreas, heart, and lung transplants, are removed surgically from donors shortly after their death. (By law, organs are only removed if the deceased carried an organ donor card or if family members give permission.)
Since the organs must be removed so quickly after death, cadaveric donors usually are individuals who have died in circumstances that make a swift determination of death possible: Among cadaveric donors in 1999, head trauma and cerebrovascular stroke accounted for 85 percent of all deaths. Thus, even if the number of people willing to donate organs in- creased at the same level as the demand for organ transplants, demand would outpace supply since only a minority of people die in circumstances that make cadaveric donation possible.
A final explanation for the organ shortage is Americans’ general reluctance to become organ donors. In a 1993 Gallup poll, 85 percent of those surveyed said that they support organ donation, but only 37 percent said that they were “very likely” to donate their own organs, and 25 percent said they were “not at all likely.” There are a variety of reasons that people may be uncomfortable with organ donation, but the Gallup poll zeroed in on a major one: 36 percent of respondents agreed that “thinking about your own death makes you uncomfortable.” Organizations such as UNOS are dedicated to encouraging Americans to overcome this reluctance to become organ donors. To this end they often stress that organ donation is a lifesaving act, not one that should be associated with death.
One of the most controversial proposals is to provide individuals with some type of incentive to become organ donors. Such incentives could range from straight cash payments for living-donor organs to government assistance with funeral expenses for the families of cadaveric donors. Currently, proposals for compensated donation would likely be in violation of the 1984 National Organ Transplant Act, which makes it illegal to buy or sell human organs. Critics also charge that payment for organ donation could lead to a black market for human organs. In fact, such a black market already exists in India, where, according to a 1998 investigative report in the New York Review of Books, wealthy foreigners with end-stage renal disease pay thousands of dollars for human kidneys “donated” by impoverished Indians.
Although tissue engineering, artificial organs, and xenotransplantation provide hope for the future, the thousands of people currently on organ transplant waiting lists are counting on altruistic organ donation. As bioethicist Arthur Caplan explains,
What is truly distinctive about transplantation is not technology but ethics. Transplantation is the only area in all of health care that cannot exist without the participation of the public. It is the individual citizen who while alive or af- ter death makes organs and tissues available for transplantation. If there were no gifts of organs or tissues, transplantation would come to a grinding halt.
The field of organ transplantation is one of the miracles of modern medicine, but its power to save lives depends directly on the availability of organs. The authors in At Issue: Organ Transplants debate the various ways to increase the number of organs available for transplant and thus reduce the number of patients who die every day waiting for a new heart, liver, or kidney.