Organ Transplantation


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Organ Transplantation

  2. 2. WHAT IS ORGAN TRANSPLANT? <ul><li>Organ transplant 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 failing organ with a working one from the donor site. Organ donors can be living or deceased (previously referred to as cadaveric). </li></ul><ul><li>Organs that can be transplanted include the heart , kidneys , liver , lungs , pancreas , penis , and intestine . Tissues include bones, tendons, cornea, heart valves, veins, arms, and skin. Worldwide, the kidneys are the most commonly transplanted organs. Countries often have formal systems in place to manage the allocation and reduce the risk of rejection. Some countries are associated within international organizations like Eurotransplant in order to increase the supply of appropriate donor organs and the organ recipients. </li></ul>
  3. 3. REPUBLIC ACT NO. 7170 <ul><li>Sec. 1. Section 9 of Republic Act No. 7170 is hereby amended to read as follows: </li></ul><ul><li>&quot;Sec. 9. Manner of Executing a Donation. - Any donation by a person authorized under subsection (a) of Section 4 hereof shall be sufficient if it complies with the formalities of a donation of a movable property. </li></ul>
  4. 4. <ul><li>&quot;In the absence of any persons specified under Section 4 hereof and in the absence of any document of organ donation, the physician in charge of the patient, the head of the hospital or a designated officer of the hospital who has custody of the body of the deceased classified as accident, trauma, or other medico-legal cases, may authorize in a public document the removal from such body for the purpose of transplantation of the organ to the body of a living person: Provided, That the physician, head of the hospital or officer designated by the hospital for this purpose has exerted reasonable efforts, within forty-eight (48) hours, to locate the nearest relative listed in Section 4 hereof or guardian of the decedent at the time of death: Provided, however, That the said physician, head or designated officer of the hospital, or the medico-legal officer of any government agency which has custody of such body may authorize the removal of the cornea or corneas of the decedent within twelve (12) hours after death and upon the request of qualified legatees or donees for the sole purpose of transplantation: Provided, That such removal of the cornea or corneas will not interfere with any subsequent investigation or alter the post-mortem facial appearance of the decedent by such means as placing eye caps after the said cornea or corneas have been removed. </li></ul>
  5. 5. <ul><li>&quot;In all donations, the death of a person from whose body an organ will be removed after his death for the purpose of transplantation to a living person, shall be diagnosed separately and certified by two (2) qualified physicians neither of whom shall be: </li></ul><ul><li>&quot;(a) A member of the team of medical practitioners who will effect the removal of the organ from the body; nor </li></ul><ul><li>&quot;(b) The physician attending to recipient of the organ to be removed; nor </li></ul><ul><li>&quot;(c) The head of hospital or the designated officer authorizing the removal of the organ.&quot; </li></ul>
  6. 6. <ul><li>Sec. 2. Section 10 of Republic Act No. 7170 is also amended to read as follows: </li></ul><ul><li>&quot;Sec. 10. Person(s) Authorized to Remove and Transplant Organs and Tissues. - Only authorized medical practitioners in a hospital shall remove and/or transplant any organ which is authorized to be removed and/or transplanted pursuant to Section 5 hereof: Provided, however, That the removal of corneal tissues shall be performed only by ophthalmic surgeons and ophthalmic technicians trained in the methodology of such procedure and duly certified by the accredited National Association of Ophthalmologists.“ </li></ul>
  7. 7. <ul><li>Sec. 3. The implementing rules and regulations of Republic Act No. 7170 shall be amended accordingly by the Secretary of Health, in consultation with professional health groups and non-government health organizations, to make it consistent with the provisions of this Act. </li></ul><ul><li>Sec. 4. The provisions of this Act are hereby declared separable, and in the event any such provisions is declared unconstitutional, the other provisions not affected thereby shall remain in force and effect. </li></ul><ul><li>Sec. 5. All other laws, decrees, executive orders, administrative orders, rules and regulations or parts thereof which are inconsistent with the provisions of this Act are hereby repealed, amended or modified accordingly. </li></ul><ul><li>Sec. 6. This Act shall take effect upon its approval. </li></ul><ul><li>Approved: February 20, 1995 </li></ul>
  8. 8. Types of transplants:
  9. 9. <ul><li>Autograft </li></ul><ul><li>Transplant of tissue to the same person. Sometimes this is done with surplus tissue, or tissue that can regenerate, or tissues more desperately needed elsewhere. Sometimes an autograft is done to remove the tissue and then treat it or the person, before returning it </li></ul><ul><li>>skin grafts, vein extraction </li></ul><ul><li>>storing blood in advance of surgery </li></ul>
  10. 10. <ul><li>Allograft </li></ul><ul><li>An allograft is a transplant of an organ or tissue between two genetically non-identical members of the same species. Most human tissue and organ transplants are allografts. Due to the genetic difference between the organ and the recipient, the recipient's immune system will identify the organ as foreign and attempt to destroy it, causing transplant rejection . To prevent this, the organ recipient must take immunosuppressant . This dramatically affects the entire immune system, making the body vulnerable to pathogens . </li></ul>
  11. 11. <ul><li>Isograft </li></ul><ul><li>A subset of allografts in which organs or tissues are transplanted from a donor to a genetically identical recipient (such as an identical twin ). Isografts are differentiated from other types of transplants because while they are anatomically identical to allografts, they don't trigger an immune response . </li></ul>
  12. 12. <ul><li>Xenograft and xenotransplantation </li></ul><ul><li>A transplant of organs or tissue from one species to another. An example are porcine heart valve transplants, which are quite common and successful. Another example is attempted piscine-primate (fish to non-human primate) transplant of islet (i.e. pancreatic or insular tissue) tissue. The latter research study was intended to pave the way for potential human use, if successful. However, xenotransplantion is often an extremely dangerous type of transplant because of the increased risk of non-compatibility, rejection, and disease carried in the tissue. </li></ul>
  13. 13. <ul><li>Split transplants </li></ul><ul><li>Sometimes a deceased-donor organ, usually a liver, may be divided between two recipients, especially an adult and a child. This is not usually a preferred option because the transplantation of a whole organ is more successful. </li></ul>
  14. 14. <ul><li>Domino transplants </li></ul><ul><li>This operation is usually performed on patients with cystic fibrosis because both lungs need to be replaced and it is a technically easier operation to replace the heart and lungs at the same time. As the recipient's native heart is usually healthy, it can be transplanted into someone else needing a heart transplant. That term is also used for a special form of liver transplant in which the recipient suffers from familial amyloidotic polyneuropathy , a disease where the liver slowly produces a protein that damages other organs. This patient's liver can be transplanted into an older patient who is likely to die from other causes before a problem arises. </li></ul>
  15. 15. Major organs and tissues transplanted
  16. 16. <ul><li>Thoracic organs </li></ul><ul><li>Heart (Deceased-donor only) </li></ul><ul><li>Lung (Deceased-donor and Living-Donor) </li></ul><ul><li>Heart/Lung (Deceased-donor and Domino transplant) </li></ul>
  17. 17. <ul><li>Abdominal organs </li></ul><ul><li>Kidney (Deceased-donor and Living-Donor) </li></ul><ul><li>Liver (Deceased-donor and Living-Donor) </li></ul><ul><li>Pancreas (Deceased-donor only) </li></ul><ul><li>Intestine (Deceased-donor and Living-Donor) </li></ul><ul><li>Stomach (Deceased-donor only) </li></ul>
  18. 18. <ul><li>Tissues, cells, fluids </li></ul><ul><li>Hand (Deceased-donor only) [5] </li></ul><ul><li>Cornea (Deceased-donor only) [6] </li></ul><ul><li>Skin including Face replant (autograft) and Face transplant (extremely rare) </li></ul><ul><li>Islets of Langerhans (Pancreas Islet Cells) (Deceased-donor and Living-Donor) </li></ul><ul><li>Bone marrow /Adult stem cell (Living-Donor and Autograft) </li></ul><ul><li>Blood transfusion /Blood Parts Transfusion (Living-Donor and Autograft) </li></ul><ul><li>Blood vessels (Autograft and Deceased-Donor) </li></ul><ul><li>Heart valve (Deceased-Donor, Living-Donor and Xenograft[Porcine/bovine]) </li></ul><ul><li>Bone (Deceased-Donor and Living-Donor) </li></ul>
  19. 19. Types of donor
  20. 20. Living or deceased <ul><li>In living donors , the donor remains alive and donates a renewable tissue, cell, or fluid (e.g. blood, skin); or donates an organ or part of an organ in which the remaining organ can regenerate or take on the workload of the rest of the organ (primarily single kidney donation, partial donation of liver, small bowel). Regenerative medicine may one day allow for laboratory-grown organs, using patient's own cells (stem cells, or healthy cells extracted from the failing organs.) </li></ul><ul><li>Deceased (formerly cadaveric) are donors who have been declared brain-dead and whose organs are kept viable by ventilators or other mechanical mechanisms until they can be excised for transplantation. Apart from brain-stem dead donors, who have formed the majority of deceased donors for the last twenty years, there is increasing use of Donation after Cardiac Death - DCD- Donors (formerly non-heart beating donors) to increase the potential pool of donors as demand for transplants continues to grow. </li></ul><ul><li>These organs have inferior outcomes to organs from a brain-dead donor; however given the scarcity of suitable organs and the number of people who die waiting, any potentially suitable organ must be considered. </li></ul>
  22. 22. 1.United States <ul><li>Acceptable organ donors can range in age from newborn to 65 years plus. People who are 65 years of age or older may be acceptable donors, particularly of corneas, skin, bone, for total body donation. An estimated 10,000 to 14,000 people who die each year meet the criteria for an organ donation, but less than half of that number becomes actual organ donors. Donor organs are matched to waiting recipients by a national computer registry, called the National Organ Procurement and Transplatation Network (OPTN). This computer registry is operated by an organization known as the United Network for Organ Sharing (UNOS) , which is located in Richmond, Virginia. Currently there are 58 organ procurement organizations (OPOs) across the country, which provide organ procurement services to some 261 transplant centers. All hospitals are required by law to have a &quot;Required Referral&quot; system in place. Under this system, the hospital must notify the local Organ Procurement Organization (OPO) of all patient deaths. If the OPO determines that organ and/or tissue donation is appropriate in a particular case, they will have a representative contact the deceased patient's family to offer them the option of donating their loved one's organs and tissues. By signing a Uniform Donor Card, an individual indicates his or her wish to be a donor. However, at the time of death, the person's next-of-kin will still be asked to sign a consent form for donation. It is important for people who wish to be organ and tissue donors to tell their family about this decision so that their wishes will be honored at the time of death. It is estimated that about 35 percent of potential donors never become donors because family members refuse to give consent. </li></ul>
  23. 23. 2.United Kingdom <ul><li>In the UK the number of people needing organ transplants is significantly greater than the number of organs available. To ensure that the patients awaiting transplants are treated fairly, there is a UK-wide organ allocation system run by a body called NHS Blood and Transplant (NHSBT), which is part of the UK’s National Health Service . </li></ul><ul><li>All patients who are waiting for transplants are registered on the UK Transplant National Transplant Database. </li></ul><ul><li>Allocation is carried out on the patient's need and the importance of achieving the closest possible match between donor and recipient. The rules for allocating organs are determined by the medical profession in consultation with other health professionals, the Department of Health and the specialist advisory groups of NHSBT. </li></ul><ul><li>The blood group, age and size of the donor and recipient are all taken into account to ensure the best possible match for each patient. For kidney transplant patients, tissue type match is also a consideration. NHSBT to identify the best matched patient, or alternatively, the transplant unit to which the organ is to be offered. </li></ul>
  24. 24. TRANSPLANT IN THE PHILIPPINES <ul><li>Blood and marrow transplantation or hematopoietic stem cell transplantation has emerged as a life-saving treatment for hematologic malignancies and other second patient had a relapse of his leukemia 15 months after the transplant. non-malignant disorders of the hematopoietic and immune system. Although blood and marrow transplantation has been practiced for several decades, it was first introduced in the country only in 1990 at the National Kidney and Transplant Institute. Our first patients included an 18-year-old male with severe aplastic anemia and a 20-year-old male with CML in chronic phase. Both patients engrafted successfully and were apparently doing well until the first patient succumbed to a severe fungal infection 12 months later and the </li></ul>
  25. 25. <ul><li>Unfortunately, a fire gutted the area of the hospital, which was designated as the transplant unit, and it took several years before another one could be set up. In 1999, there was a renewed interest in blood and marrow transplantation when we received a referral to transplant a 2.5-month-old baby boy with SCID syndrome. This was also the first time a child was diagnosed with SCID syndrome in the country. The transplant proved to be a success with the child now 8 years of age and leading a normal life. </li></ul><ul><li>The National Kidney and Transplant Institute used to have a one-bed stem cell transplant unit with HEPA filter. The St Luke's Medical Center maintains a two-room blood and marrow transplant unit located in a low-traffic area of the hospital. Features include positive pressure ventilation and high efficiency particulate air (HEPA) filtration. The water quality is maintained using reverse osmosis. Water and air quality is checked at regular intervals. A total of six nurses trained to care for the needs of transplant patients are made available whenever a transplant is performed. The core physician staff is composed of one adult hematologist, one adult hematologist-oncologist and one pediatric hematologist-oncologist. There is also a core of physicians from different subspecialties to support the blood and marrow transplantation team. St Luke's Medical Center is the first hospital in the Philippines to be accredited by the Joint Commission International and is affiliated with several hospitals in the United States. </li></ul>
  27. 27. Living related donors <ul><li>Living related donors donate to family members or friends in whom they have an emotional investment. The risk of surgery is offset by the psychological benefit of not losing someone related to them, or not seeing them suffer the ill effects of waiting on a list. </li></ul><ul><li>Paired-exchange </li></ul>
  28. 28. <ul><li>A &quot;paired-exchange&quot; is a technique of matching willing living donors to compatible recipients. For example a spouse may be more than willing to donate a kidney to their partner but cannot since there is not a biological match. The willing spouse's kidney is donated to a matching recipient who also has an incompatible but willing spouse. The second donor must match the first recipient to complete the pair exchange. Typically the surgeries are scheduled simultaneously in case one of the donors decides to back out and the couples are kept anonymous from each other until after the transplant. </li></ul><ul><li>Paired exchange programs were popularized in the New England Journal of Medicine article &quot;Ethics of a paired-kidney-exchange program&quot; in 1997 by L.F. Ross. It was also proposed by Felix T. Rapport in 1986 as part of his initial proposals for live-donor transplants &quot;The case for a living emotionally related international kidney donor exchange registry&quot; in Transplant Proceedings .A paired exchange is the simplest case of a much larger exchange registry program where willing donors are matched with any number of compatible recipients. </li></ul>
  29. 29. Good Samaritan <ul><li>&quot;Good Samaritan&quot; or &quot;altruistic&quot; donation is giving a donation to someone not well-known to the donor. Some people choose to do this out of a need to donate. Some donate to the next person on the list; others use some method of choosing a recipient based on criteria important to them. Web sites are being developed that facilitate such donation. It has been featured in recent television journalism that over half of the members of the Jesus Christians , an Australian religious group, have donated kidneys in such a fashion. </li></ul><ul><li>In compensated donation, donors get money or other compensation in exchange for their organs. This practice is common in some parts of the world, whether legal or not, and is one of the many factors driving medical tourism . </li></ul>
  30. 30. Forced donation <ul><li>There have been various accusations that certain authorities are harvesting organs from those the authorities deem undesirable, such as prison populations. The World Medical Association stated that individuals in detention are not in the position to give free consent to donate their organs . Illegal dissection of corpses is a form of body-snatching and may have taken place to obtain allografts. </li></ul><ul><li>According to the Chinese Deputy Minister of Health, Huang Jiefu, approximately 95% of all organs used for transplantation are from executed prisoners. The lack of public organ donation program in China is used as a justification for this practice. However reports in Chinese media raised concerns if executed criminals are the only source for organs used in transplants. </li></ul>
  31. 31. <ul><li>In October 2007, bowing to international pressure, the Chinese Medical Association agreed on a moratorium of commercial organ harvesting from condemned prisoners, but did not specify a deadline. China agreed to restrict transplantations from donors to their immediate relatives. </li></ul><ul><li>People in other parts of the world are responding to this availability of organs, and a number of individuals (including US and Japanese citizens) have elected to travel to China or India as medical tourists to receive organ transplants which may have been sourced in what might be considered elsewhere to be unethical ways (see later). </li></ul>
  32. 32. Allocation of donated organs <ul><li>The overwhelming majority of deceased-donor organs in the United States are allocated by federal contract to the Organ Procurement and Transplantation Network (OPTN), held since it was created by the Organ Transplant Act of 1984 by the United Network for Organ Sharing or UNOS. UNOS does not handle donor cornea tissue. Corneal donor tissue is usually handled by various eye banks. This allocates organs based on the method considered most fair by the scientific leadership in the field. For kidneys, for instance, that is by waiting time; for livers, it is by MELD (Model of End-Stage Liver Disease), an empirical score based on lab values indicative of the sickness of the patient from liver disease. Experiencing somewhat increased popularity, but still very rare, is directed or targeted donation, in which the family of a deceased donor (often honoring the wishes of the deceased) requests an organ be given to a specific person. If medically suitable, the allocation system is subverted, and the organ is given to that person. In the United States, there are various lengths of waiting due to the different availabilities of organs in different UNOS regions. In other countries such as the UK , only medical factors and the position on the waiting list can affect who receives the organ. If this is not the desired person, it is noted that this puts them higher on the list. </li></ul>
  33. 33. <ul><li>Ethical Issues Regarding Procurement of Organs and Tissues </li></ul>
  34. 34. <ul><li>Buying and Selling Human Organs and Tissues </li></ul><ul><li>Some argue in favor of allowing human organs and tissues to be bought and sold to increase the supply and to respect people's autonomy. Others argue against such saying that to treat the human body and its parts as commodities violates human dignity.(cf. LRCC, 56-62; and May, 165-7) Human tissues and organs are in fact being sold in some places. For example, a French pharmaceutical firm buys placentas from 110 Canadian hospitals to manufacture vaccines and other blood products (Aikenhead), and some living poor people in countries such as India sell one of their kidneys for $700 or so. In Bombay, for example, there have also been some cases of kidnapping where victims regain consciousness to find that one of their kidneys was removed while they were drugged.(Wallace; cf. Rinehart) </li></ul>
  35. 35. <ul><li>Concerning this whole issue some distinguish between human waste products such as placentas, body parts that regenerate such as blood, and nonregenerative human organs such as kidneys. Many distinguish profit making from covering the donor's expenses. Paying for organs can constitute unjust moral pressure on the donor. It could invalidate any free consent or a contract. Some also fear that the buying and selling of organs and tissues, if it became widespread, would undermine the altruism (giving motivated by love) and social bonding now associated with transplants. It could also lead to organs going to the highest bidder. Equity would be violated with ability to pay rather than medical need determining the distribution of organs. Some others, however, argue that this could be controlled by regulating sales, and that totally forbidding the buying and selling of human tissues and organs would drive the market underground. Because of the controversy and ethical problems surrounding the buying and selling of human body parts, some say that other alternatives should be pursued to increase the supply.(cf. LRCC, 78-86; and Garrett et al., 203-4 ) </li></ul>
  36. 36. b) Media Publicity <ul><li>Sometimes an organ or tissue is procured for a person by publicizing their need through the media. This could bypass the regular transplant channels and their selecting recipients for an available organ on the basis of greatest need and greatest likelihood of benefit, and first come first serve . On the other hand, media pleas frequently bring in more volunteers than those required for the case being publicized. Media publicity also increases public awareness of the need for transplants and so in the long run should increase the supply of donated tissues and organs. Garrett et al. argue that at this stage of medical history media publicity for a particular case should be tolerated, but in time it should be eliminated as much as possible. </li></ul>
  37. 37. c) Types of Consent (Voluntary or Expressed, Family, Presumed, Required Request, Routine Inquiry) <ul><li>Voluntary or expressed consent involves a person making known their free offer to donate one or more of their organs and/or bodily tissue, after they have died or while alive.(cf. 1.a and b above) Concerning cadaver donation, a person can express their wishes by some form of advanced directives, such as by filling out the Universal Donor Card attached to their driver's license. Free and informed consent is required when the transplant is from a living donor. </li></ul><ul><li>Previously expressed voluntary consent regarding a deceased donor is the ideal because it involves an act of love and responsible stewardship over one's body </li></ul>
  38. 38. <ul><li>It also communicates to others, including one's family and health care professionals, one's wishes. In the absence of clearly expressed voluntary consent, the family or person lawfully responsible for the body of the deceased may be approached regarding donation. Proper respect involves due consideration of the wishes of the deceased and their loved ones. </li></ul><ul><li>Many potential organs and tissues for transplantation (e.g. of brain-dead accident victims) are lost because the person did not previously express voluntary consent and their families were not approached about donating. Because of this and the shortage of organs and tissues for transplantation, some have proposed other models of consent including presumed, required request and routine inquiry, to hopefully increase the supply. </li></ul>
  39. 39. <ul><li>Although only a minority of deceased potential donors have signed donor cards, surveys show that most people favor organ donation. Some argue that it is ethical to presume consent on their behalf, unless the person while alive gave clear indications to the contrary, since a transplant does not harm the donor after death and it can benefit others. France, Belgium and some other countries have various forms of presumed consent legislation in place. People can opt out by registering their intention not to be a donor. Questions concerning this approach include: Should minors and the mentally disabled be included? To what extent should health care professionals check to see if the person has expressed a wish not to donate? Can not this be a form of exploiting human ignorance and weakness. </li></ul>
  40. 40. D) Fears, Confusion and the Need for Education <ul><li>There is a need for education of the general public and many health care professionals concerning the whole area of organ and tissue transplants. Many people are not well informed of the needs, the shortage of organs and tissues, and the great potential benefit of many people for transplants. Many have unfounded fears or reservations or are confused about some of the issues of being a donor. In a recent United States survey, &quot;the two most common reasons given for not permitting organ donation were (1) they might do something to me before I am really dead; (2) doctors might hasten my death.&quot;(LRCC, note 226) This shows ignorance of standard policy and procedure concerning transplants. These include strict criteria for determining total brain death and the separation of the ill or dying patient's health care team and the transplant team. </li></ul>
  41. 41. <ul><li>Although surveys show that most people think transplantation is a good thing, only a minority sign an organ donor card. Why? First of all, many are not fully aware of the advantages of this type of voluntary expressed consent.(see section 4.c above) Some people may be unwilling to think about their own mortality, an inevitable fact, or be superstitious. For example, they may mistakenly think that signing a donor card will increase their chance of a fatal accident. Some may have concerns about the mutilation of their body. Organs and tissues, however, are carefully removed and incisions are closed, so that it will not be apparent to anyone viewing the body that organs or tissues have been donated.(HOPE, 3) Also, </li></ul><ul><li>Some people wonder what will happen to their bodies if at death they donate an organ. The truth is that every earthly body decays. Therefore, the alternative is between an organ decomposing or serving to keep an other human being alive. We Christians believe, as St Paul tells us, that our corruptible body will be transformed into a spiritual body for the glory of God (cf. 1 Cor 15:35-53)(Chilean Bishops' Permanent Conference, 375) </li></ul>
  42. 42. Organ Transplants and Cloning FR. WILLIAM SAUNDERS <ul><li>I saw an article in the Post about the Holy Father condemning the cloning of human embryos for organ transplants. Would you please explain better the Church’s teaching on this subject? </li></ul>
  43. 43. <ul><li>In general, the Catholic Church approves organ transplantation, as reiterated by Pope John Paul II in an Address to the International Congress of Transplants on Aug. 29. Quoting from his encyclical The Gospel of Life, the Holy Father said, “...One way of nurturing a genuine culture of life is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even of life itself to the sick who sometimes have no other hope” (No. 86). This teaching echoes the Catechism: “Organ transplants conform with the moral law and can be meritorious if the physical and psychological dangers and risks incurred by the donor are proportionate to the good sought for the recipient” (No. 2296). To better understand this teaching, let’s take it one step at a time. Keep in mind that the issue was first clearly addressed by Pope Pius XII in the 1950s, and then has been refined with the advances in this field of medicine. </li></ul><ul><li>First a distinction is made between transplanting organs (including tissue) from a dead person to a living person, versus transplanting organs (including tissue) from a living person to another living person. In the first instance, when the organ donor is a dead person, no moral concern arises. Pope Pius XII taught, “A person may will to dispose of his 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” (Allocution to a Group of Eye Specialists, May 14, 1956). </li></ul>
  44. 44. <ul><li>Basically, if the organs of a deceased person, such as a kidney, a heart, or a cornea, can help save or improve the life of a living person, then such a transplant is morally good and even praiseworthy. Note that the donor must give his free and informed consent prior to his death, or his next of kin must do so at the time of their relative’s death: “Organ transplants are not morally acceptable if the donor or those who legitimately speak for him have not given their informed consent” (Catechism, No. 2296). </li></ul><ul><li>One caution needs to be made: The success of an organ transplant significantly depends upon the freshness of the organ, meaning that the transplant procedure must take place as soon as possible after the donor has died. However, the donor must not be declared dead prematurely or his death hastened just to utilize his organs. The moral criterion demands that the donor must be dead before his organs are used for transplantation. To avoid a conflict of interest, the Uniform Anatomical Gift Act requires that “The time of death be determined by the physician who attends the donor at his death, or, if none, the physician who certifies the death. This physician shall not participate in the procedures for removal or transplanting a part” (Section 7(b)). While this caution does not impact upon the morality of organ transplantation per se, the dignity of the dying person must be preserved, and to hasten his death or to terminate his life to acquire organs for transplant is immoral. Here again the Catechsim teaches, “It is morally inadmissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons” (No. 2296), a point underscored by the Holy Father in his recent address (cf. No. 4). </li></ul>
  45. 45. <ul><li>The transplantation of organs from a living donor to another person is more complicated. The ability to perform the first kidney transplant in 1954 caused a great debate among theologians. The debate focused on the principle of totality — whereby certain circumstances permit a person to sacrifice one part or function of the body for the interest of the whole body. For instance, a person may remove a diseased organ to preserve the health of his whole body, such as removing a cancerous uterus. These theologians, however, argued that a person cannot justify the removal of a healthy organ and incur the risk of future health problems when his own life is not in danger, as in the case of a person sacrificing a healthy kidney to donate to a person in need. Such surgery, they held, entails an unnecessary mutilation of the body and is thereby immoral. </li></ul><ul><li>Other theologians argued from the point of fraternal charity, namely that a healthy person who donates a kidney to a person in need is making a genuine act of sacrifice to save that person’s life. Such generosity is modeled after our Lord’s sacrifice of Himself on the cross, and reflects His teaching at the Last Supper: “This is my commandment: Love one another as I have loved you. There is no greater love than this: to lay down one’s life for one’s friends” (Jn 15:12-13). Such a sacrifice, these theologians held, is morally acceptable if the risk of harm to the donor, both from the surgery itself and the loss of the organ, is proportionate to the good for the recipient. </li></ul>
  46. 46. <ul><li>Moving from this reasoning, these “pro-transplant” theologians re-examined the principle of totality. They argued that while organ transplants from living donors may not preserve anatomical or physical integrity (i.e. there is a loss of a healthy organ), they do comply with a functional totality (i.e. there is the preservation of the bodily functions and system as a whole). For instance, a person can sacrifice one healthy kidney (a loss of anatomical integrity) and still be able to maintain health and proper bodily functions with the remaining kidney; such a donation would be morally permissible. Using the same reasoning, however, a person cannot sacrifice an eye to give to a blind person, because such an act impairs the bodily functions of the individual. </li></ul><ul><li>Pope Pius XII agreed with this understanding of charity and the broader interpretation of the principle of totality, and thereby declared organ transplants from living donors morally acceptable. He underscored the point that the donor is making a sacrifice of himself for the good of another person. Our Holy Father, Pope John Paul II, has also emphasized this point: A...Every organ transplant has its source in a decision of great ethical value: the decision to offer without reward a part of one’s own body for the health and well-being of another person’“ (Address to the Participants in a Congress on Organ Transplants, June 20 1991, No. 3). Here precisely lies the nobility of the gesture, a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves . . .” (No. 3). </li></ul>
  47. 47. <ul><li>Nevertheless, the transplantation of organs from a living donor to another person must fulfill four criteria: (1) the risk involved to the donor in such a transplant must be proportionate to the good obtained for the recipient; (2) the removal of the organ must not seriously impair the donor’s health or bodily function; (3) the prognosis of acceptance is good for the recipient, and (4) the donor must make an informed and free decision recognizing the potential risks involved. </li></ul><ul><li>Having established the basic moral teaching governing organ transplants, we need to address several issues which impact upon their morality. While the advances of medical science have enabled the transplantation of organs with increasing success, certain procedures that have been introduced may be possible but not morally acceptable. What is technologically possible is not always morally good. In judging the morality of a procedure, one must maintain the dignity of the human person, who is both body and soul. </li></ul><ul><li>As Pope John Paul II taught, “An this area of medical science too the fundamental criterion must be the defense and promotion of the integral good of the human person, in keeping with that unique dignity which is ours by virtue of our humanity. Consequently, it is evident that every medical procedure performed on the human person is subject to limits: not just the limits of what is technically possible, but also limits determined by respect for human nature itself, understood in its fullness: ‘what is technically possible is not for that reason alone morally admissible’ (Congregation for the Doctrine of the Faith, Donum Vitae, #4)” (Address to the International Congress on Transplants, No. 2). </li></ul>
  48. 48. <ul><li>One issue concerns the use of animal organs for transplantation to human beings, such as using the heart valve of a pig to replace a human heart valve. This kind of transplantation is called a xenotransplant. First addressed by Pope Pius XII in 1956, the Church maintains that such transplants are morally acceptable on three conditions: (1) the transplanted organ does not impair the integrity of the genetic or psychological identity of the recipient, (2) the transplant has a proven biological record of possible success, and (3) the transplant does not involve inordinate risk for the recipient. (Cf. Pius XII, Address to the Italian Association of Cornea Donors and to Clinical Oculists and Legal Medical Practitioners, May 14, 1956.) </li></ul><ul><li>A second issue concerns the use of organs or tissues from aborted children (such as those murdered through partial birth abortion procedures). Actually a lucrative organ “Harvesting” industry is developing which utilizes the organs and tissues of aborted fetuses. A critical point here is that these abortions are performed with the intention of utilizing the organs or tissues of the infant, and in direct conjunction with a particular recipient in mind. </li></ul>
  49. 49. <ul><li>Another facet of this issue is when a child is conceived naturally or through in vitro fertilization to obtain the best genetic match, and then born or even aborted simply for organs or tissues. For example, recently a couple conceived a child for the sole purpose of being a bone marrow donor for another sibling suffering from leukemia; while the conceived child determined to be a good match while still in the womb and was born, one must wonder if the child would have been aborted if he had not been a good match. To participate in an abortion to obtain organs, to conceive a child for organs, or to knowingly use organs from aborted fetuses is morally wrong. </li></ul><ul><li>This issue has even become more complicated with the technological research in cloning. Some researchers hope to grow tissue and even organs from stem cells retrieved from human embryos; however, to do so necessitates the destruction of the embryo. Since human life begins at conception and is sacred from that very moment, such destruction is immoral. Pope John Paul II, affirming consistent Catholic principles, asserted, A...These techniques, insofar as they involve the manipulation and destruction of human embryos, are not morally acceptable, even when their proposed goal is good in itself” (Address to International Congress on Transplants, No. 8). Basically, the end does not justify the means. However, the Holy Father encouraged scientists to pursue paths of research which involve using adult stem cells, and which avoid cloning and the use of embryonic cells. In sum, any research must respect the dignity of the human person from the moment of conception. </li></ul>
  50. 50. <ul><li>Another moral question involves the distribution and assignment of organs to waiting recipients. Essentially, the number of recipients exceeds the number of available organs for transplant. While no perfect system will ever exist, the plan of assignment should not be discriminatory (based on age, sex, race, social status, and the like) or utilitarian (based on work capacity, social usefulness, and the like) but should strive to recognize the intrinsic value of each person. Instead, the assignment of organs to donors should proceed on immunological and clinical factors. </li></ul><ul><li>Finally, whether someone can sell one of his own organs for transplantation is another issue. The answer is a definitive “No.” The selling of an organ violates the dignity of the human being, eliminates the criterion of true charity for making such a donation, and promotes a market system which benefits only those who can pay, again violating genuine charity. Pope John Paul II has repeatedly underscored this teaching: AA transplant, even a simple blood transfusion, is not like other operations. It must not be separated from the donor’s act of self-giving, from the love that gives life” (Address to the First International Congress of the Society for Organ Sharing, June 24, 1991) </li></ul>
  51. 51. <ul><li>and “Accordingly, any procedure which tends to commercialize human organs or to consider them as items for exchange or trade must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person” (Address to the International Congress on Transplants, No. 3). </li></ul><ul><li>Therefore, organ donation is morally permissible under certain conditions. The Ethical and Religious Directives for Catholic Health Care Services provides the following guidance: “The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of the donor must be respected, and economic advantages should not accrue to the donor” (No. 30). Generally, in the case of donating organs after death, the gifts that God has given to us to use in this life — our eyes, hearts, liver, and so on — can be passed on to someone in need. In the case of donating organs while alive, such as giving a healthy kidney to a relative in need, the donor needs to weigh all of the implications; in charity, a potential donor may decide he can not offer an organ, such as if he were a parent and would not want to increase the risk of not being able to care for his own dependent children. Although organ donation is not mandatory, it is commendable as an act of charity. </li></ul>
  52. 52. Some Cases and Questions For Discussion
  53. 53. <ul><li>1. Don and Dan are identical twins. After Don suffers kidney failure, Dan is requested by his brother's wife to donate one of his healthy kidneys to Don. Does Dan have any obligation to surrender one of his healthy kidneys to his brother? Under what condition would you defend Dan's decision not to surrender his kidney </li></ul><ul><li>2. Is it ethical for a living person with two good eyes to donate an eye to enable a blind person to see? </li></ul>
  54. 54. <ul><li>3. Mrs. Simpatico, a nurse, had cared for Joseph, who was 30 years old, a few weeks before he died. The hospital has a policy requiring nurses to ask the families of all dead patients for organ donations. Both she and the family are very upset about the death. She believes Joseph's young wife and three children need comfort and not decisions at this moment, so she does not ask for the organ donation, even though the hospital has a long waiting list. When the nursing supervisor discovers this omission, she reprimands Mrs. Simpatico and warns her: &quot;One more incident like that and you will be fired.&quot; Is the hospital's policy good? Was it right for Mrs. Simpatico to make an exception in this case? </li></ul><ul><li>4. Anissa is 17 years old when it is discovered she has leukemia. Her primary hope for survival rests on a bone marrow transplant, but there are no likely donors for her unusual genetic characteristics. Her parents decide to have another child in the hope that the infant will provide a tissue match (a 25% chance). Is it ethically right to conceive a child for the purpose of generating tissue for transplantation? If the infant is a tissue match, is it right for the parents to decide for the infant? </li></ul>
  55. 55. END
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