Organ transplantation

ORGAN TRANSPLANT
ORGAN TRANSPLANT

WHAT IS ORGAN TRANSPLANT?
WHAT IS ORGAN TRANSPLANT?
 Organ transplant
Organ transplant is the moving of an organ from one
is the moving of an organ from one
body to another (or from a donor site on the patient's own
body to another (or from a donor site on the patient's own
body), for the purpose of replacing the recipient's
body), for the purpose of replacing the recipient's
damaged or failing organ with a working one from the
damaged or failing organ with a working one from the
donor site. Organ donors can be
donor site. Organ donors can be living
living or
or deceased
deceased
(previously referred to as cadaveric).
(previously referred to as cadaveric).
 Organs that can be transplanted include the
Organs that can be transplanted include the heart
heart,
,
kidneys
kidneys,
, liver
liver,
, lungs
lungs,
, pancreas
pancreas,
, penis
penis, and
, and intestine
intestine.
.
Tissues include bones, tendons, cornea, heart valves,
Tissues include bones, tendons, cornea, heart valves,
veins, arms, and skin. Worldwide, the kidneys are the
veins, arms, and skin. Worldwide, the kidneys are the
most commonly transplanted organs. Countries often have
most commonly transplanted organs. Countries often have
formal systems in place to manage the allocation and
formal systems in place to manage the allocation and
reduce the risk of rejection. Some countries are associated
reduce the risk of rejection. Some countries are associated
within international organizations like Eurotransplant in
within international organizations like Eurotransplant in
order to increase the supply of appropriate donor organs
order to increase the supply of appropriate donor organs
and the organ recipients.
and the organ recipients.

REPUBLIC ACT NO. 7170
REPUBLIC ACT NO. 7170
 Sec. 1. Section 9 of Republic Act No. 7170 is hereby
Sec. 1. Section 9 of Republic Act No. 7170 is hereby
amended to read as follows:
 "Sec. 9. Manner of Executing a Donation. - Any donation by
"Sec. 9. Manner of Executing a Donation. - Any donation by
a person authorized under subsection (a) of Section 4
a person authorized under subsection (a) of Section 4
hereof shall be sufficient if it complies with the formalities of
hereof shall be sufficient if it complies with the formalities of
a donation of a movable property.
a donation of a movable property.

 "In the absence of any persons specified under Section 4
"In the absence of any persons specified under Section 4
hereof and in the absence of any document of organ
hereof and in the absence of any document of organ
donation, the physician in charge of the patient, the head of
donation, the physician in charge of the patient, the head of
the hospital or a designated officer of the hospital who has
the hospital or a designated officer of the hospital who has
custody of the body of the deceased classified as accident,
custody of the body of the deceased classified as accident,
trauma, or other medico-legal cases, may authorize in a public
trauma, or other medico-legal cases, may authorize in a public
document the removal from such body for the purpose of
document the removal from such body for the purpose of
transplantation of the organ to the body of a living person:
transplantation of the organ to the body of a living person:
Provided, That the physician, head of the hospital or officer
Provided, That the physician, head of the hospital or officer
designated by the hospital for this purpose has exerted
designated by the hospital for this purpose has exerted
reasonable efforts, within forty-eight (48) hours, to locate the
reasonable efforts, within forty-eight (48) hours, to locate the
nearest relative listed in Section 4 hereof or guardian of the
nearest relative listed in Section 4 hereof or guardian of the
decedent at the time of death: Provided, however, That the
decedent at the time of death: Provided, however, That the
said physician, head or designated officer of the hospital, or
said physician, head or designated officer of the hospital, or
the medico-legal officer of any government agency which has
the medico-legal officer of any government agency which has
custody of such body may authorize the removal of the
custody of such body may authorize the removal of the
cornea or corneas of the decedent within twelve (12) hours
cornea or corneas of the decedent within twelve (12) hours
after death and upon the request of qualified legatees or
after death and upon the request of qualified legatees or
donees for the sole purpose of transplantation: Provided, That
donees for the sole purpose of transplantation: Provided, That
such removal of the cornea or corneas will not interfere with
such removal of the cornea or corneas will not interfere with
any subsequent investigation or alter the post-mortem facial
any subsequent investigation or alter the post-mortem facial
appearance of the decedent by such means as placing eye
appearance of the decedent by such means as placing eye
caps after the said cornea or corneas have been removed.
caps after the said cornea or corneas have been removed.

 "In all donations, the death of a person from whose
"In all donations, the death of a person from whose
body an organ will be removed after his death for the
body an organ will be removed after his death for the
purpose of transplantation to a living person, shall be
purpose of transplantation to a living person, shall be
diagnosed separately and certified by two (2) qualified
diagnosed separately and certified by two (2) qualified
physicians neither of whom shall be:
physicians neither of whom shall be:
 "(a) A member of the team of medical practitioners who
"(a) A member of the team of medical practitioners who
will effect the removal of the organ from the body; nor
will effect the removal of the organ from the body; nor
 "(b) The physician attending to recipient of the organ to
"(b) The physician attending to recipient of the organ to
be removed; nor
be removed; nor
 "(c) The head of hospital or the designated officer
"(c) The head of hospital or the designated officer
authorizing the removal of the organ."
authorizing the removal of the organ."

 Sec. 2. Section 10 of Republic Act No. 7170 is also
Sec. 2. Section 10 of Republic Act No. 7170 is also
 "Sec. 10. Person(s) Authorized to Remove and
"Sec. 10. Person(s) Authorized to Remove and
Transplant Organs and Tissues. - Only authorized
Transplant Organs and Tissues. - Only authorized
medical practitioners in a hospital shall remove and/or
medical practitioners in a hospital shall remove and/or
transplant any organ which is authorized to be removed
transplant any organ which is authorized to be removed
and/or transplanted pursuant to Section 5 hereof:
and/or transplanted pursuant to Section 5 hereof:
Provided, however, That the removal of corneal tissues
Provided, however, That the removal of corneal tissues
shall be performed only by ophthalmic surgeons and
shall be performed only by ophthalmic surgeons and
ophthalmic technicians trained in the methodology of
ophthalmic technicians trained in the methodology of
such procedure and duly certified by the accredited
such procedure and duly certified by the accredited
National Association of Ophthalmologists.“
National Association of Ophthalmologists.“

 Sec. 3. The implementing rules and regulations of
Sec. 3. The implementing rules and regulations of
Republic Act No. 7170 shall be amended accordingly by
Republic Act No. 7170 shall be amended accordingly by
the Secretary of Health, in consultation with professional
the Secretary of Health, in consultation with professional
health groups and non-government health organizations,
health groups and non-government health organizations,
to make it consistent with the provisions of this Act.
to make it consistent with the provisions of this Act.
 Sec. 4. The provisions of this Act are hereby declared
Sec. 4. The provisions of this Act are hereby declared
separable, and in the event any such provisions is
separable, and in the event any such provisions is
declared unconstitutional, the other provisions not
declared unconstitutional, the other provisions not
affected thereby shall remain in force and effect.
affected thereby shall remain in force and effect.
 Sec. 5. All other laws, decrees, executive orders,
Sec. 5. All other laws, decrees, executive orders,
administrative orders, rules and regulations or parts
administrative orders, rules and regulations or parts
thereof which are inconsistent with the provisions of this
thereof which are inconsistent with the provisions of this
Act are hereby repealed, amended or modified
Act are hereby repealed, amended or modified
accordingly.
accordingly.
 Sec. 6. This Act shall take effect upon its approval.
Sec. 6. This Act shall take effect upon its approval.
 Approved: February 20, 1995
Approved: February 20, 1995

Types of transplants:
Types of transplants:

Autograft
Autograft
 Transplant of tissue to the same person. Sometimes
Transplant of tissue to the same person. Sometimes
this is done with surplus tissue, or tissue that can
this is done with surplus tissue, or tissue that can
regenerate, or tissues more desperately needed
regenerate, or tissues more desperately needed
elsewhere. Sometimes an autograft is done to remove
elsewhere. Sometimes an autograft is done to remove
the tissue and then treat it or the person, before
the tissue and then treat it or the person, before
returning it
returning it
 >skin grafts, vein extraction
>skin grafts, vein extraction
 >storing blood in advance of surgery
>storing blood in advance of surgery

Allograft
Allograft
 An allograft is a transplant of an organ or tissue
An allograft is a transplant of an organ or tissue
between two genetically non-identical members of the
between two genetically non-identical members of the
same species. Most human tissue and organ
same species. Most human tissue and organ
transplants are allografts. Due to the genetic
transplants are allografts. Due to the genetic
difference between the organ and the recipient, the
difference between the organ and the recipient, the
recipient's
recipient's immune system
immune system will identify the organ as
will identify the organ as
foreign and attempt to destroy it, causing
foreign and attempt to destroy it, causing
transplant rejection
transplant rejection. To prevent this, the organ
. To prevent this, the organ
recipient must take
recipient must take immunosuppressant
immunosuppressant. This
. This
dramatically affects the entire immune system, making
dramatically affects the entire immune system, making
the body vulnerable to
the body vulnerable to pathogens
pathogens.
.

Isograft
Isograft
 A subset of allografts in which organs or tissues are
A subset of allografts in which organs or tissues are
transplanted from a donor to a genetically identical
transplanted from a donor to a genetically identical
recipient (such as an
recipient (such as an identical twin
identical twin). Isografts are
). Isografts are
differentiated from other types of transplants because
differentiated from other types of transplants because
while they are anatomically identical to allografts, they
while they are anatomically identical to allografts, they
don't trigger an
don't trigger an immune response
immune response.
.

Xenograft and xenotransplantation
Xenograft and xenotransplantation
 A transplant of organs or tissue from one species to
A transplant of organs or tissue from one species to
another. An example are porcine heart valve
another. An example are porcine heart valve
transplants, which are quite common and successful.
transplants, which are quite common and successful.
Another example is attempted piscine-primate (fish to
Another example is attempted piscine-primate (fish to
non-human primate) transplant of islet (i.e.
non-human primate) transplant of islet (i.e. pancreatic
pancreatic
or insular tissue) tissue. The latter research study was
or insular tissue) tissue. The latter research study was
intended to pave the way for potential human use, if
intended to pave the way for potential human use, if
successful. However, xenotransplantion is often an
successful. However, xenotransplantion is often an
extremely dangerous type of transplant because of the
extremely dangerous type of transplant because of the
increased risk of non-compatibility, rejection, and
increased risk of non-compatibility, rejection, and
disease carried in the tissue.
disease carried in the tissue.

Split transplants
Split transplants
 Sometimes a deceased-donor organ, usually a liver,
Sometimes a deceased-donor organ, usually a liver,
may be divided between two recipients, especially an
may be divided between two recipients, especially an
adult and a child. This is not usually a preferred option
adult and a child. This is not usually a preferred option
because the transplantation of a whole organ is more
because the transplantation of a whole organ is more
successful.
successful.

Domino transplants
Domino transplants
 This operation is usually performed on patients with
This operation is usually performed on patients with
cystic fibrosis
cystic fibrosis because both lungs need to be replaced
because both lungs need to be replaced
and it is a technically easier operation to replace the
and it is a technically easier operation to replace the
heart and lungs at the same time. As the recipient's
heart and lungs at the same time. As the recipient's
native heart is usually healthy, it can be transplanted
native heart is usually healthy, it can be transplanted
into someone else needing a heart transplant. That
into someone else needing a heart transplant. That
term is also used for a special form of liver transplant
term is also used for a special form of liver transplant
in which the recipient suffers from
in which the recipient suffers from
familial amyloidotic polyneuropathy
familial amyloidotic polyneuropathy, a disease where
, a disease where
the liver slowly produces a protein that damages other
the liver slowly produces a protein that damages other
organs. This patient's liver can be transplanted into an
organs. This patient's liver can be transplanted into an
older patient who is likely to die from other causes
older patient who is likely to die from other causes
before a problem arises.
before a problem arises.

Major organs and tissues
Major organs and tissues
transplanted
transplanted

Thoracic organs
Thoracic organs
 Heart
Heart (Deceased-donor only)
(Deceased-donor only)
 Lung
Lung (Deceased-donor and Living-Donor)
(Deceased-donor and Living-Donor)
 Heart/Lung
Heart/Lung (Deceased-donor and Domino
(Deceased-donor and Domino
transplant)
transplant)

Abdominal organs
Abdominal organs
 Kidney
Kidney (Deceased-donor and Living-
(Deceased-donor and Living-
Donor)
Donor)
 Liver
Liver (Deceased-donor and Living-Donor)
 Pancreas
Pancreas (Deceased-donor only)
 Intestine
Intestine (Deceased-donor and Living-
(Deceased-donor and Living-
Donor)
Donor)
 Stomach
Stomach (Deceased-donor only)

Tissues, cells, fluids
Tissues, cells, fluids
 Hand
Hand (Deceased-donor only)
(Deceased-donor only)[5]
[5]
 Cornea
Cornea (Deceased-donor only)
(Deceased-donor only)[6]
[6]
 Skin
Skin including
including Face replant
Face replant (autograft) and
(autograft) and
Face transplant
Face transplant (extremely rare)
(extremely rare)
 Islets of Langerhans
Islets of Langerhans (Pancreas Islet Cells)
(Pancreas Islet Cells)
 Bone marrow
Bone marrow/Adult
/Adult stem cell
stem cell (Living-Donor and
(Living-Donor and
Autograft)
Autograft)
 Blood transfusion
Blood transfusion/Blood Parts Transfusion (Living-
/Blood Parts Transfusion (Living-
Donor and Autograft)
Donor and Autograft)
 Blood vessels
Blood vessels (Autograft and Deceased-Donor)
(Autograft and Deceased-Donor)
 Heart valve
Heart valve (Deceased-Donor, Living-Donor and
(Deceased-Donor, Living-Donor and
Xenograft[Porcine/bovine])
Xenograft[Porcine/bovine])
 Bone
Bone (Deceased-Donor and Living-Donor)
(Deceased-Donor and Living-Donor)

Living or deceased
Living or deceased
 In
In living donors
living donors, the donor remains alive and donates a renewable
, the donor remains alive and donates a renewable
tissue, cell, or fluid (e.g. blood, skin); or donates an organ or part of
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
an organ in which the remaining organ can regenerate or take on the
workload of the rest of the organ (primarily single kidney donation,
workload of the rest of the organ (primarily single kidney donation,
partial donation of liver, small bowel).
partial donation of liver, small bowel). Regenerative medicine
Regenerative medicine may one
may one
day allow for laboratory-grown organs, using patient's own cells (stem
day allow for laboratory-grown organs, using patient's own cells (stem
cells, or healthy cells extracted from the failing organs.)
cells, or healthy cells extracted from the failing organs.)
 Deceased (formerly cadaveric)
Deceased (formerly cadaveric) are donors who have been
are donors who have been
declared
declared brain-dead
brain-dead and whose organs are kept viable by ventilators or
and whose organs are kept viable by ventilators or
other mechanical mechanisms until they can be excised for
other mechanical mechanisms until they can be excised for
transplantation. Apart from brain-stem dead donors, who have formed
transplantation. Apart from brain-stem dead donors, who have formed
the majority of deceased donors for the last twenty years, there is
the majority of deceased donors for the last twenty years, there is
increasing use of Donation after Cardiac Death - DCD- Donors
increasing use of Donation after Cardiac Death - DCD- Donors
(formerly non-heart beating donors) to increase the potential pool of
(formerly non-heart beating donors) to increase the potential pool of
donors as demand for transplants continues to grow.
donors as demand for transplants continues to grow.
These organs have inferior outcomes to organs from a brain-dead donor;
These organs have inferior outcomes to organs from a brain-dead donor;
however given the scarcity of suitable organs and the number of
however given the scarcity of suitable organs and the number of
people who die waiting, any potentially suitable organ must be
people who die waiting, any potentially suitable organ must be
considered.
considered.

EXAMPLES OF ORGAN TRANSPLANT
EXAMPLES OF ORGAN TRANSPLANT
IN OTHER COUNTRIES:
IN OTHER COUNTRIES:

1.United States
1.United States
 Acceptable organ donors can range in age from newborn to 65 years plus.
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,
People who are 65 years of age or older may be acceptable donors,
particularly of corneas, skin, bone, for total body donation. An estimated
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
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.
donation, but less than half of that number becomes actual organ donors.
Donor organs are matched to waiting recipients by a national computer
Donor organs are matched to waiting recipients by a national computer
registry, called the National Organ Procurement and Transplatation Network
registry, called the National Organ Procurement and Transplatation Network
(OPTN). This computer registry is operated by an organization known as the
(OPTN). This computer registry is operated by an organization known as the
United Network for Organ Sharing (UNOS)
United Network for Organ Sharing (UNOS), which is located in Richmond,
, which is located in Richmond,
Virginia. Currently there are 58 organ procurement organizations (OPOs)
Virginia. Currently there are 58 organ procurement organizations (OPOs)
across the country, which provide organ procurement services to some 261
across the country, which provide organ procurement services to some 261
transplant centers. All hospitals are required by law to have a "Required
transplant centers. All hospitals are required by law to have a "Required
Referral" system in place. Under this system, the hospital must notify the
Referral" system in place. Under this system, the hospital must notify the
local Organ Procurement Organization (OPO) of all patient deaths. If the
local Organ Procurement Organization (OPO) of all patient deaths. If the
OPO determines that organ and/or tissue donation is appropriate in a
OPO determines that organ and/or tissue donation is appropriate in a
particular case, they will have a representative contact the deceased
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
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
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-
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
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
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
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
estimated that about 35 percent of potential donors never become donors
because family members refuse to give consent.
because family members refuse to give consent.

2.United Kingdom
2.United Kingdom
 In the UK the number of people needing organ transplants is
In the UK the number of people needing organ transplants is
significantly greater than the number of organs available. To
significantly greater than the number of organs available. To
ensure that the patients awaiting transplants are treated fairly,
ensure that the patients awaiting transplants are treated fairly,
there is a UK-wide organ allocation system run by a body called
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
NHS Blood and Transplant (NHSBT), which is part of the UK’s
National Health Service
National Health Service.
.
 All patients who are waiting for transplants are registered on the
All patients who are waiting for transplants are registered on the
UK Transplant National Transplant Database.
UK Transplant National Transplant Database.
 Allocation is carried out on the patient's need and the importance
Allocation is carried out on the patient's need and the importance
of achieving the closest possible match between donor and
of achieving the closest possible match between donor and
recipient. The rules for allocating organs are determined by the
recipient. The rules for allocating organs are determined by the
medical profession in consultation with other health professionals,
medical profession in consultation with other health professionals,
the Department of Health and the specialist advisory groups of
the Department of Health and the specialist advisory groups of
NHSBT.
NHSBT.
 The blood group, age and size of the donor and recipient are all
The blood group, age and size of the donor and recipient are all
taken into account to ensure the best possible match for each
taken into account to ensure the best possible match for each
patient. For kidney transplant patients, tissue type match is also a
patient. For kidney transplant patients, tissue type match is also a
consideration. NHSBT to identify the best matched patient, or
consideration. NHSBT to identify the best matched patient, or
alternatively, the transplant unit to which the organ is to be
alternatively, the transplant unit to which the organ is to be
offered.
offered.

TRANSPLANT IN THE PHILIPPINES
TRANSPLANT IN THE PHILIPPINES
Blood and marrow transplantation or hematopoietic stem cell
Blood and marrow transplantation or hematopoietic stem cell
transplantation has emerged as a life-saving treatment for
transplantation has emerged as a life-saving treatment for
hematologic malignancies and other second patient had a
hematologic malignancies and other second patient had a
relapse of his leukemia 15 months after the transplant. non-
relapse of his leukemia 15 months after the transplant. non-
malignant disorders of the hematopoietic and immune
malignant disorders of the hematopoietic and immune
system. Although blood and marrow transplantation has been
system. Although blood and marrow transplantation has been
practiced for several decades, it was first introduced in the
practiced for several decades, it was first introduced in the
country only in 1990 at the National Kidney and Transplant
country only in 1990 at the National Kidney and Transplant
Institute. Our first patients included an 18-year-old male with
Institute. Our first patients included an 18-year-old male with
severe aplastic anemia and a 20-year-old male with CML in
severe aplastic anemia and a 20-year-old male with CML in
chronic phase. Both patients engrafted successfully and were
chronic phase. Both patients engrafted successfully and were
apparently doing well until the first patient succumbed to a
apparently doing well until the first patient succumbed to a
severe fungal infection 12 months later and the
severe fungal infection 12 months later and the

Unfortunately, a fire gutted the area of the hospital, which was
Unfortunately, a fire gutted the area of the hospital, which was
designated as the transplant unit, and it took several years before
designated as the transplant unit, and it took several years before
another one could be set up. In 1999, there was a renewed interest
another one could be set up. In 1999, there was a renewed interest
in blood and marrow transplantation when we received a referral to
in blood and marrow transplantation when we received a referral to
transplant a 2.5-month-old baby boy with SCID syndrome. This was
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
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
country. The transplant proved to be a success with the child now 8
years of age and leading a normal life.
years of age and leading a normal life.
The National Kidney and Transplant Institute used to have a one-bed
The National Kidney and Transplant Institute used to have a one-bed
stem cell transplant unit with HEPA filter. The St Luke's Medical
stem cell transplant unit with HEPA filter. The St Luke's Medical
Center maintains a two-room blood and marrow transplant unit
Center maintains a two-room blood and marrow transplant unit
located in a low-traffic area of the hospital. Features include positive
located in a low-traffic area of the hospital. Features include positive
pressure ventilation and high efficiency particulate air (HEPA)
pressure ventilation and high efficiency particulate air (HEPA)
filtration. The water quality is maintained using reverse osmosis.
filtration. The water quality is maintained using reverse osmosis.
Water and air quality is checked at regular intervals. A total of six
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
nurses trained to care for the needs of transplant patients are made
available whenever a transplant is performed. The core physician
available whenever a transplant is performed. The core physician
staff is composed of one adult hematologist, one adult
staff is composed of one adult hematologist, one adult
hematologist-oncologist and one pediatric hematologist-oncologist.
hematologist-oncologist and one pediatric hematologist-oncologist.
There is also a core of physicians from different subspecialties to
There is also a core of physicians from different subspecialties to
support the blood and marrow transplantation team. St Luke's
support the blood and marrow transplantation team. St Luke's
Medical Center is the first hospital in the Philippines to be accredited
Medical Center is the first hospital in the Philippines to be accredited
by the Joint Commission International and is affiliated with several
by the Joint Commission International and is affiliated with several
hospitals in the United States.
hospitals in the United States.

REASON FOR DONATION AND
REASON FOR DONATION AND
ETHICAL ISSUES
ETHICAL ISSUES

Living related donors
Living related donors
Living related donors donate to family members or friends in
Living related donors donate to family members or friends in
whom they have an emotional investment. The risk of surgery
whom they have an emotional investment. The risk of surgery
is offset by the psychological benefit of not losing someone
is offset by the psychological benefit of not losing someone
related to them, or not seeing them suffer the ill effects of
related to them, or not seeing them suffer the ill effects of
waiting on a list.
waiting on a list.
Paired-exchange
Paired-exchange

A "paired-exchange" is a technique of matching willing living
A "paired-exchange" is a technique of matching willing living
donors to compatible recipients. For example a spouse may
donors to compatible recipients. For example a spouse may
be more than willing to donate a kidney to their partner but
be more than willing to donate a kidney to their partner but
cannot since there is not a biological match. The willing
cannot since there is not a biological match. The willing
spouse's kidney is donated to a matching recipient who also
spouse's kidney is donated to a matching recipient who also
has an incompatible but willing spouse. The second donor
has an incompatible but willing spouse. The second donor
must match the first recipient to complete the pair exchange.
must match the first recipient to complete the pair exchange.
Typically the surgeries are scheduled simultaneously in case
Typically the surgeries are scheduled simultaneously in case
one of the donors decides to back out and the couples are
one of the donors decides to back out and the couples are
kept anonymous from each other until after the transplant.
kept anonymous from each other until after the transplant.
Paired exchange programs were popularized in the
Paired exchange programs were popularized in the
New England Journal of Medicine
New England Journal of Medicine article "Ethics of a paired-
article "Ethics of a paired-
kidney-exchange program" in 1997 by L.F. Ross. It was also
kidney-exchange program" in 1997 by L.F. Ross. It was also
proposed by Felix T. Rapport in 1986 as part of his initial
proposed by Felix T. Rapport in 1986 as part of his initial
proposals for live-donor transplants "The case for a living
proposals for live-donor transplants "The case for a living
emotionally related international kidney donor exchange
emotionally related international kidney donor exchange
registry" in
registry" in Transplant Proceedings
Transplant Proceedings.A paired exchange is the
.A paired exchange is the
simplest case of a much larger exchange registry program
simplest case of a much larger exchange registry program
where willing donors are matched with any number of
where willing donors are matched with any number of
compatible recipients.
compatible recipients.

Good Samaritan
Good Samaritan
"Good Samaritan" or "altruistic" donation is giving a donation
"Good Samaritan" or "altruistic" donation is giving a donation
to someone not well-known to the donor. Some people
to someone not well-known to the donor. Some people
choose to do this out of a need to donate. Some donate to the
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
next person on the list; others use some method of choosing
a recipient based on criteria important to them. Web sites are
a recipient based on criteria important to them. Web sites are
being developed that facilitate such donation. It has been
being developed that facilitate such donation. It has been
featured in recent television journalism that over half of the
featured in recent television journalism that over half of the
members of the
members of the Jesus Christians
Jesus Christians, an
, an Australian
Australian religious
religious
group, have donated kidneys in such a fashion.
group, have donated kidneys in such a fashion.
In compensated donation, donors get money or other
In compensated donation, donors get money or other
compensation in exchange for their organs. This practice is
compensation in exchange for their organs. This practice is
common in some parts of the world, whether legal or not, and
common in some parts of the world, whether legal or not, and
is one of the many factors driving
is one of the many factors driving medical tourism
medical tourism.
.

Forced donation
Forced donation
There have been various accusations that certain authorities
There have been various accusations that certain authorities
are harvesting organs from those the authorities deem
are harvesting organs from those the authorities deem
undesirable, such as prison populations. The World Medical
undesirable, such as prison populations. The World Medical
Association stated that individuals in detention are not in the
Association stated that individuals in detention are not in the
position to give free consent to donate their organs . Illegal
position to give free consent to donate their organs . Illegal
dissection of corpses is a form of
dissection of corpses is a form of body-snatching
body-snatching and may
and may
have taken place to obtain allografts.
have taken place to obtain allografts.
According to the Chinese Deputy Minister of Health, Huang
According to the Chinese Deputy Minister of Health, Huang
Jiefu, approximately 95% of all organs used for
Jiefu, approximately 95% of all organs used for
transplantation are from executed prisoners. The lack of
transplantation are from executed prisoners. The lack of
public organ donation program in China is used as a
public organ donation program in China is used as a
justification for this practice. However reports in Chinese
justification for this practice. However reports in Chinese
media raised concerns if executed criminals are the only
media raised concerns if executed criminals are the only
source for organs used in transplants.
source for organs used in transplants.

 In October 2007, bowing to international pressure, the
In October 2007, bowing to international pressure, the
Chinese Medical Association agreed on a moratorium of
Chinese Medical Association agreed on a moratorium of
commercial organ harvesting from condemned prisoners, but
commercial organ harvesting from condemned prisoners, but
did not specify a deadline. China agreed to restrict
did not specify a deadline. China agreed to restrict
transplantations from donors to their immediate relatives.
transplantations from donors to their immediate relatives.
 People in other parts of the world are responding to this
People in other parts of the world are responding to this
availability of organs, and a number of individuals (including
availability of organs, and a number of individuals (including
US and Japanese citizens) have elected to travel to China or
US and Japanese citizens) have elected to travel to China or
India as
India as medical tourists
medical tourists to receive organ transplants which
to receive organ transplants which
may have been sourced in what might be considered
may have been sourced in what might be considered
elsewhere to be unethical ways (see later).
elsewhere to be unethical ways (see later).

Allocation of donated organs
Allocation of donated organs
 The overwhelming majority of deceased-donor organs in the United
The overwhelming majority of deceased-donor organs in the United
States are allocated by federal contract to the
States are allocated by federal contract to the
Organ Procurement and Transplantation Network
Organ Procurement and Transplantation Network (OPTN), held since it
(OPTN), held since it
was created by the
was created by the Organ Transplant Act of 1984
Organ Transplant Act of 1984 by the
by the
United Network for Organ Sharing
United Network for Organ Sharing or UNOS. UNOS does not handle
or UNOS. UNOS does not handle
donor cornea tissue. Corneal donor tissue is usually handled by various
donor cornea tissue. Corneal donor tissue is usually handled by various
eye banks. This allocates organs based on the method considered most
eye banks. This allocates organs based on the method considered most
fair by the scientific leadership in the field. For kidneys, for instance,
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
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
Liver Disease), an empirical score based on lab values indicative of the
sickness of the patient from liver disease. Experiencing somewhat
sickness of the patient from liver disease. Experiencing somewhat
increased popularity, but still very rare, is directed or targeted donation,
increased popularity, but still very rare, is directed or targeted donation,
in which the family of a deceased donor (often honoring the wishes of
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
the deceased) requests an organ be given to a specific person. If
medically suitable, the allocation system is subverted, and the organ is
medically suitable, the allocation system is subverted, and the organ is
given to that person. In the United States, there are various lengths of
given to that person. In the United States, there are various lengths of
waiting due to the different availabilities of organs in different UNOS
waiting due to the different availabilities of organs in different UNOS
regions. In other countries such as the
regions. In other countries such as the UK
UK, only medical factors and the
, only medical factors and the
position on the waiting list can affect who receives the organ. If this is
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.
not the desired person, it is noted that this puts them higher on the list.

Ethical Issues Regarding
Ethical Issues Regarding
Procurement of Organs and Tissues
Procurement of Organs and Tissues

n Buying and Selling Human Organs and
Buying and Selling Human Organs and
Tissues
Tissues
 Some argue in favor of allowing human organs and tissues
Some argue in favor of allowing human organs and tissues
to be bought and sold to increase the supply and to respect
to be bought and sold to increase the supply and to respect
people's autonomy. Others argue against such saying that to
people's autonomy. Others argue against such saying that to
treat the human body and its parts as commodities violates
treat the human body and its parts as commodities violates
human dignity.(cf. LRCC, 56-62; and May, 165-7) Human
human dignity.(cf. LRCC, 56-62; and May, 165-7) Human
tissues and organs are in fact being sold in some places. For
tissues and organs are in fact being sold in some places. For
example, a French pharmaceutical firm buys placentas from
example, a French pharmaceutical firm buys placentas from
110 Canadian hospitals to manufacture vaccines and other
110 Canadian hospitals to manufacture vaccines and other
blood products (Aikenhead), and some
blood products (Aikenhead), and some living
living poor people in
poor people in
countries such as India sell one of their kidneys for $700 or
countries such as India sell one of their kidneys for $700 or
so. In Bombay, for example, there have also been some
so. In Bombay, for example, there have also been some
cases of kidnapping where victims regain consciousness to
cases of kidnapping where victims regain consciousness to
find that one of their kidneys was removed while they were
find that one of their kidneys was removed while they were
drugged.(Wallace; cf. Rinehart)
drugged.(Wallace; cf. Rinehart)

 Concerning this whole issue some distinguish between human
Concerning this whole issue some distinguish between human
waste products such as placentas, body parts that regenerate
waste products such as placentas, body parts that regenerate
such as blood, and nonregenerative human organs such as
such as blood, and nonregenerative human organs such as
kidneys. Many distinguish profit making from covering the
kidneys. Many distinguish profit making from covering the
donor's expenses. Paying for organs can constitute unjust
donor's expenses. Paying for organs can constitute unjust
moral pressure on the donor. It could invalidate any free
moral pressure on the donor. It could invalidate any free
consent or a contract. Some also fear that the buying and
consent or a contract. Some also fear that the buying and
selling of organs and tissues, if it became widespread, would
selling of organs and tissues, if it became widespread, would
undermine the altruism (giving motivated by love) and social
undermine the altruism (giving motivated by love) and social
bonding now associated with transplants. It could also lead to
bonding now associated with transplants. It could also lead to
organs going to the highest bidder. Equity would be violated
organs going to the highest bidder. Equity would be violated
with ability to pay rather than medical need determining the
with ability to pay rather than medical need determining the
distribution of organs. Some others, however, argue that this
distribution of organs. Some others, however, argue that this
could be controlled by regulating sales, and that totally
could be controlled by regulating sales, and that totally
forbidding the buying and selling of human tissues and organs
forbidding the buying and selling of human tissues and organs
would drive the market underground. Because of the
would drive the market underground. Because of the
controversy and ethical problems surrounding the buying and
controversy and ethical problems surrounding the buying and
selling of human body parts, some say that other alternatives
selling of human body parts, some say that other alternatives
should be pursued to increase the supply.(cf. LRCC, 78-86;
should be pursued to increase the supply.(cf. LRCC, 78-86;
and Garrett et al., 203-4
and Garrett et al., 203-4)
)

b) Media Publicity
b) Media Publicity
 Sometimes an organ or tissue is procured for a person by
Sometimes an organ or tissue is procured for a person by
publicizing their need through the media. This could bypass the
publicizing their need through the media. This could bypass the
regular transplant channels and their selecting recipients for an
regular transplant channels and their selecting recipients for an
available organ on the basis of greatest need and greatest
available organ on the basis of greatest need and greatest
likelihood of benefit, and first come first serve . On the other hand,
likelihood of benefit, and first come first serve . On the other hand,
media pleas frequently bring in more volunteers than those
media pleas frequently bring in more volunteers than those
required for the case being publicized. Media publicity also
required for the case being publicized. Media publicity also
increases public awareness of the need for transplants and so in
increases public awareness of the need for transplants and so in
the long run should increase the supply of donated tissues and
the long run should increase the supply of donated tissues and
organs. Garrett et al. argue that at this stage of medical history
organs. Garrett et al. argue that at this stage of medical history
media publicity for a particular case should be tolerated, but in
media publicity for a particular case should be tolerated, but in
time it should be eliminated as much as possible.
time it should be eliminated as much as possible.

c) Types of Consent (Voluntary or
c) Types of Consent (Voluntary or
Expressed, Family,
Expressed, Family,
Presumed, Required Request, Routine
Presumed, Required Request, Routine
Inquiry)
Inquiry)
 Voluntary or expressed consent involves a person making known their
Voluntary or expressed consent involves a person making known their
free offer to donate one or more of their organs and/or bodily tissue,
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
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
cadaver donation, a person can express their wishes by some form of
advanced directives, such as by filling out the Universal Donor Card
advanced directives, such as by filling out the Universal Donor Card
attached to their driver's license. Free and informed consent is
attached to their driver's license. Free and informed consent is
required when the transplant is from a living donor.
required when the transplant is from a living donor.
 Previously expressed voluntary consent regarding a deceased donor
Previously expressed voluntary consent regarding a deceased donor
is the ideal because it involves an act of love and responsible
is the ideal because it involves an act of love and responsible
stewardship over one's body
stewardship over one's body

 It also communicates to others, including one's family and health
It also communicates to others, including one's family and health
care professionals, one's wishes. In the absence of clearly expressed
care professionals, one's wishes. In the absence of clearly expressed
voluntary consent, the family or person lawfully responsible for the
voluntary consent, the family or person lawfully responsible for the
body of the deceased may be approached regarding donation.
body of the deceased may be approached regarding donation.
Proper respect involves due consideration of the wishes of the
Proper respect involves due consideration of the wishes of the
deceased and their loved ones.
deceased and their loved ones.
 Many potential organs and tissues for transplantation (e.g. of brain-
Many potential organs and tissues for transplantation (e.g. of brain-
dead accident victims) are lost because the person did not
dead accident victims) are lost because the person did not
previously express voluntary consent and their families were not
previously express voluntary consent and their families were not
approached about donating. Because of this and the shortage of
approached about donating. Because of this and the shortage of
organs and tissues for transplantation, some have proposed other
organs and tissues for transplantation, some have proposed other
models of consent including presumed, required request and routine
models of consent including presumed, required request and routine
inquiry, to hopefully increase the supply.
inquiry, to hopefully increase the supply.

 Although only a minority of deceased potential donors have
Although only a minority of deceased potential donors have
signed donor cards, surveys show that most people favor
signed donor cards, surveys show that most people favor
organ donation. Some argue that it is ethical to presume
organ donation. Some argue that it is ethical to presume
consent on their behalf, unless the person while alive gave
consent on their behalf, unless the person while alive gave
clear indications to the contrary, since a transplant does not
clear indications to the contrary, since a transplant does not
harm the donor after death and it can benefit others. France,
harm the donor after death and it can benefit others. France,
Belgium and some other countries have various forms of
Belgium and some other countries have various forms of
presumed consent legislation in place. People can opt out by
presumed consent legislation in place. People can opt out by
registering their intention not to be a donor. Questions
registering their intention not to be a donor. Questions
concerning this approach include: Should minors and the
concerning this approach include: Should minors and the
mentally disabled be included? To what extent should health
mentally disabled be included? To what extent should health
care professionals check to see if the person has expressed a
care professionals check to see if the person has expressed a
wish not to donate? Can not this be a form of exploiting
wish not to donate? Can not this be a form of exploiting
human ignorance and weakness.
human ignorance and weakness.

D) Fears, Confusion and the Need for
D) Fears, Confusion and the Need for
Education
Education
 There is a need for education of the general public and many
There is a need for education of the general public and many
health care professionals concerning the whole area of organ and
health care professionals concerning the whole area of organ and
tissue transplants. Many people are not well informed of the
tissue transplants. Many people are not well informed of the
needs, the shortage of organs and tissues, and the great potential
needs, the shortage of organs and tissues, and the great potential
benefit of many people for transplants. Many have unfounded
benefit of many people for transplants. Many have unfounded
fears or reservations or are confused about some of the issues of
fears or reservations or are confused about some of the issues of
being a donor. In a recent United States survey, "the two most
being a donor. In a recent United States survey, "the two most
common reasons given for not permitting organ donation were
common reasons given for not permitting organ donation were
(1) they might do something to me before I am really dead; (2)
(1) they might do something to me before I am really dead; (2)
doctors might hasten my death."(LRCC, note 226) This shows
doctors might hasten my death."(LRCC, note 226) This shows
ignorance of standard policy and procedure concerning
ignorance of standard policy and procedure concerning
transplants. These include strict criteria for determining total brain
transplants. These include strict criteria for determining total brain
death and the separation of the ill or dying patient's health care
death and the separation of the ill or dying patient's health care
team and the transplant team.
team and the transplant team.

 Although surveys show that most people think transplantation is a
Although surveys show that most people think transplantation is a
good thing, only a minority sign an organ donor card. Why? First
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
of all, many are not fully aware of the advantages of this type of
voluntary expressed consent.(see section 4.c above) Some people
voluntary expressed consent.(see section 4.c above) Some people
may be unwilling to think about their own mortality, an inevitable
may be unwilling to think about their own mortality, an inevitable
fact, or be superstitious. For example, they may mistakenly think
fact, or be superstitious. For example, they may mistakenly think
that signing a donor card will increase their chance of a fatal
that signing a donor card will increase their chance of a fatal
accident. Some may have concerns about the mutilation of their
accident. Some may have concerns about the mutilation of their
body. Organs and tissues, however, are carefully removed and
body. Organs and tissues, however, are carefully removed and
incisions are closed, so that it will not be apparent to anyone
incisions are closed, so that it will not be apparent to anyone
viewing the body that organs or tissues have been donated.
viewing the body that organs or tissues have been donated.
(HOPE, 3) Also,
(HOPE, 3) Also,
 Some people wonder what will happen to their bodies if at death
Some people wonder what will happen to their bodies if at death
they donate an organ. The truth is that every earthly body
they donate an organ. The truth is that every earthly body
decays. Therefore, the alternative is between an organ
decays. Therefore, the alternative is between an organ
decomposing or serving to keep an other human being alive. We
decomposing or serving to keep an other human being alive. We
Christians believe, as St Paul tells us, that our corruptible body
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
will be transformed into a spiritual body for the glory of God (cf. 1
Cor 15:35-53)(Chilean Bishops' Permanent Conference, 375)
Cor 15:35-53)(Chilean Bishops' Permanent Conference, 375)

Organ Transplants and Cloning
Organ Transplants and Cloning
FR. WILLIAM SAUNDERS
FR. WILLIAM SAUNDERS
 I saw an article in the Post about
I saw an article in the Post about
the Holy Father condemning the
the Holy Father condemning the
cloning of human embryos for organ
cloning of human embryos for organ
transplants. Would you please
transplants. Would you please
explain better the Church’s teaching
explain better the Church’s teaching
on this subject?
on this subject?

 In general, the Catholic Church approves organ transplantation, as
In general, the Catholic Church approves organ transplantation, as
reiterated by Pope John Paul II in an Address to the International Congress
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,
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
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
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
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
sometimes have no other hope” (No. 86). This teaching echoes the
Catechism: “Organ transplants conform with the moral law and can be
Catechism: “Organ transplants conform with the moral law and can be
meritorious if the physical and psychological dangers and risks incurred by
meritorious if the physical and psychological dangers and risks incurred by
the donor are proportionate to the good sought for the recipient” (No.
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.
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
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
the 1950s, and then has been refined with the advances in this field of
medicine.
medicine.
 First a distinction is made between transplanting organs (including tissue)
First a distinction is made between transplanting organs (including tissue)
from a dead person to a living person, versus transplanting organs
from a dead person to a living person, versus transplanting organs
(including tissue) from a living person to another living person. In the first
(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.
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
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,
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
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
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
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).
positively justified” (Allocution to a Group of Eye Specialists, May 14, 1956).

 Basically, if the organs of a deceased person, such as a kidney, a heart, or a
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
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
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
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
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
morally acceptable if the donor or those who legitimately speak for him
have not given their informed consent” (Catechism, No. 2296).
have not given their informed consent” (Catechism, No. 2296).
 One caution needs to be made: The success of an organ transplant
One caution needs to be made: The success of an organ transplant
significantly depends upon the freshness of the organ, meaning that the
significantly depends upon the freshness of the organ, meaning that the
transplant procedure must take place as soon as possible after the donor
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
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
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
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
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
“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
at his death, or, if none, the physician who certifies the death. This
physician shall not participate in the procedures for removal or transplanting
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
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
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
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
for transplant is immoral. Here again the Catechsim teaches, “It is morally
inadmissible directly to bring about the disabling mutilation or death of a
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.
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.
2296), a point underscored by the Holy Father in his recent address (cf. No.
4).
4).

 The transplantation of organs from a living donor to another person is more
The transplantation of organs from a living donor to another person is more
complicated. The ability to perform the first kidney transplant in 1954
complicated. The ability to perform the first kidney transplant in 1954
caused a great debate among theologians. The debate focused on the
caused a great debate among theologians. The debate focused on the
principle of totality — whereby certain circumstances permit a person to
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.
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
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,
of his whole body, such as removing a cancerous uterus. These theologians,
however, argued that a person cannot justify the removal of a healthy
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
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
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
to a person in need. Such surgery, they held, entails an unnecessary
mutilation of the body and is thereby immoral.
mutilation of the body and is thereby immoral.
 Other theologians argued from the point of fraternal charity, namely that a
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
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
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
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
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
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,
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
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
itself and the loss of the organ, is proportionate to the good for the
recipient.
recipient.

 Moving from this reasoning, these “pro-transplant” theologians re-examined
Moving from this reasoning, these “pro-transplant” theologians re-examined
the principle of totality. They argued that while organ transplants from living
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
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
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
the preservation of the bodily functions and system as a whole). For
instance, a person can sacrifice one healthy kidney (a loss of anatomical
instance, a person can sacrifice one healthy kidney (a loss of anatomical
integrity) and still be able to maintain health and proper bodily functions
integrity) and still be able to maintain health and proper bodily functions
with the remaining kidney; such a donation would be morally permissible.
with the remaining kidney; such a donation would be morally permissible.
Using the same reasoning, however, a person cannot sacrifice an eye to
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
give to a blind person, because such an act impairs the bodily functions of
the individual.
the individual.
 Pope Pius XII agreed with this understanding of charity and the broader
Pope Pius XII agreed with this understanding of charity and the broader
interpretation of the principle of totality, and thereby declared organ
interpretation of the principle of totality, and thereby declared organ
transplants from living donors morally acceptable. He underscored the point
transplants from living donors morally acceptable. He underscored the point
that the donor is making a sacrifice of himself for the good of another
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:
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:
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
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
and well-being of another person’“ (Address to the Participants in a
Congress on Organ Transplants, June 20 1991, No. 3). Here precisely lies
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
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
just a matter of giving away something that belongs to us but of giving
something of ourselves . . .” (No. 3).
something of ourselves . . .” (No. 3).

 Nevertheless, the transplantation of organs from a living donor to another
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
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)
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
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,
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
and (4) the donor must make an informed and free decision recognizing the
potential risks involved.
potential risks involved.
 Having established the basic moral teaching governing organ transplants,
Having established the basic moral teaching governing organ transplants,
we need to address several issues which impact upon their morality. While
we need to address several issues which impact upon their morality. While
the advances of medical science have enabled the transplantation of organs
the advances of medical science have enabled the transplantation of organs
with increasing success, certain procedures that have been introduced may
with increasing success, certain procedures that have been introduced may
be possible but not morally acceptable. What is technologically possible is
be possible but not morally acceptable. What is technologically possible is
not always morally good. In judging the morality of a procedure, one must
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.
maintain the dignity of the human person, who is both body and soul.
 As Pope John Paul II taught, “An this area of medical science too the
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
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
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
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
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
limits of what is technically possible, but also limits determined by respect
for human nature itself, understood in its fullness: ‘what is technically
for human nature itself, understood in its fullness: ‘what is technically
possible is not for that reason alone morally admissible’ (Congregation for
possible is not for that reason alone morally admissible’ (Congregation for
the Doctrine of the Faith, Donum Vitae, #4)” (Address to the International
the Doctrine of the Faith, Donum Vitae, #4)” (Address to the International
Congress on Transplants, No. 2).
Congress on Transplants, No. 2).

 One issue concerns the use of animal organs for transplantation to
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 beings, such as using the heart valve of a pig to replace a
human heart valve. This kind of transplantation is called a
human heart valve. This kind of transplantation is called a
xenotransplant. First addressed by Pope Pius XII in 1956, the Church
xenotransplant. First addressed by Pope Pius XII in 1956, the Church
maintains that such transplants are morally acceptable on three
maintains that such transplants are morally acceptable on three
conditions: (1) the transplanted organ does not impair the integrity of
conditions: (1) the transplanted organ does not impair the integrity of
the genetic or psychological identity of the recipient, (2) the
the genetic or psychological identity of the recipient, (2) the
transplant has a proven biological record of possible success, and (3)
transplant has a proven biological record of possible success, and (3)
the transplant does not involve inordinate risk for the recipient. (Cf.
the transplant does not involve inordinate risk for the recipient. (Cf.
Pius XII, Address to the Italian Association of Cornea Donors and to
Pius XII, Address to the Italian Association of Cornea Donors and to
Clinical Oculists and Legal Medical Practitioners, May 14, 1956.)
Clinical Oculists and Legal Medical Practitioners, May 14, 1956.)
 A second issue concerns the use of organs or tissues from aborted
A second issue concerns the use of organs or tissues from aborted
children (such as those murdered through partial birth abortion
children (such as those murdered through partial birth abortion
procedures). Actually a lucrative organ “Harvesting” industry is
procedures). Actually a lucrative organ “Harvesting” industry is
developing which utilizes the organs and tissues of aborted fetuses. A
developing which utilizes the organs and tissues of aborted fetuses. A
critical point here is that these abortions are performed with the
critical point here is that these abortions are performed with the
intention of utilizing the organs or tissues of the infant, and in direct
intention of utilizing the organs or tissues of the infant, and in direct
conjunction with a particular recipient in mind.
conjunction with a particular recipient in mind.

 Another facet of this issue is when a child is conceived naturally or through
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
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
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
conceived a child for the sole purpose of being a bone marrow donor for
another sibling suffering from leukemia; while the conceived child
another sibling suffering from leukemia; while the conceived child
determined to be a good match while still in the womb and was born, one
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
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
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
child for organs, or to knowingly use organs from aborted fetuses is morally
wrong.
wrong.
 This issue has even become more complicated with the technological
This issue has even become more complicated with the technological
research in cloning. Some researchers hope to grow tissue and even organs
research in cloning. Some researchers hope to grow tissue and even organs
from stem cells retrieved from human embryos; however, to do so
from stem cells retrieved from human embryos; however, to do so
necessitates the destruction of the embryo. Since human life begins at
necessitates the destruction of the embryo. Since human life begins at
conception and is sacred from that very moment, such destruction is
conception and is sacred from that very moment, such destruction is
immoral. Pope John Paul II, affirming consistent Catholic principles,
immoral. Pope John Paul II, affirming consistent Catholic principles,
asserted, A...These techniques, insofar as they involve the manipulation and
asserted, A...These techniques, insofar as they involve the manipulation and
destruction of human embryos, are not morally acceptable, even when their
destruction of human embryos, are not morally acceptable, even when their
proposed goal is good in itself” (Address to International Congress on
proposed goal is good in itself” (Address to International Congress on
Transplants, No. 8). Basically, the end does not justify the means. However,
Transplants, No. 8). Basically, the end does not justify the means. However,
the Holy Father encouraged scientists to pursue paths of research which
the Holy Father encouraged scientists to pursue paths of research which
involve using adult stem cells, and which avoid cloning and the use of
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
embryonic cells. In sum, any research must respect the dignity of the
human person from the moment of conception.
human person from the moment of conception.

 Another moral question involves the distribution and assignment of
Another moral question involves the distribution and assignment of
organs to waiting recipients. Essentially, the number of recipients
organs to waiting recipients. Essentially, the number of recipients
exceeds the number of available organs for transplant. While no
exceeds the number of available organs for transplant. While no
perfect system will ever exist, the plan of assignment should not be
perfect system will ever exist, the plan of assignment should not be
discriminatory (based on age, sex, race, social status, and the like) or
discriminatory (based on age, sex, race, social status, and the like) or
utilitarian (based on work capacity, social usefulness, and the like)
utilitarian (based on work capacity, social usefulness, and the like)
but should strive to recognize the intrinsic value of each person.
but should strive to recognize the intrinsic value of each person.
Instead, the assignment of organs to donors should proceed on
Instead, the assignment of organs to donors should proceed on
immunological and clinical factors.
immunological and clinical factors.
 Finally, whether someone can sell one of his own organs for
Finally, whether someone can sell one of his own organs for
transplantation is another issue. The answer is a definitive “No.” The
transplantation is another issue. The answer is a definitive “No.” The
selling of an organ violates the dignity of the human being, eliminates
selling of an organ violates the dignity of the human being, eliminates
the criterion of true charity for making such a donation, and
the criterion of true charity for making such a donation, and
promotes a market system which benefits only those who can pay,
promotes a market system which benefits only those who can pay,
again violating genuine charity. Pope John Paul II has repeatedly
again violating genuine charity. Pope John Paul II has repeatedly
underscored this teaching: AA transplant, even a simple blood
underscored this teaching: AA transplant, even a simple blood
transfusion, is not like other operations. It must not be separated
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”
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
(Address to the First International Congress of the Society for Organ
Sharing, June 24, 1991)
Sharing, June 24, 1991)

 and “Accordingly, any procedure which tends to commercialize human organs
and “Accordingly, any procedure which tends to commercialize human organs
or to consider them as items for exchange or trade must be considered moral
or to consider them as items for exchange or trade must be considered moral
unacceptable, because to use the body as an ‘object’ is to violate the dignity o
unacceptable, because to use the body as an ‘object’ is to violate the dignity o
the human person” (Address to the International Congress on Transplants, No
the human person” (Address to the International Congress on Transplants, No
3).
3).
 Therefore, organ donation is morally permissible under certain conditions. The
Therefore, organ donation is morally permissible under certain conditions. The
Ethical and Religious Directives for Catholic Health Care Services provides the
Ethical and Religious Directives for Catholic Health Care Services provides the
following guidance: “The transplantation of organs from living donors is
following guidance: “The transplantation of organs from living donors is
morally permissible when such a donation will not sacrifice or seriously impair
morally permissible when such a donation will not sacrifice or seriously impair
any essential bodily function and the anticipated benefit to the recipient is
any essential bodily function and the anticipated benefit to the recipient is
proportionate to the harm done to the donor. Furthermore, the freedom of th
proportionate to the harm done to the donor. Furthermore, the freedom of th
donor must be respected, and economic advantages should not accrue to 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
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
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 organ
so on — can be passed on to someone in need. In the case of donating organ
while alive, such as giving a healthy kidney to a relative in need, the donor
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
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
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.
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
Although organ donation is not mandatory, it is commendable as an act of

Some Cases and Questions For
Some Cases and Questions For
Discussion
Discussion

 1. Don and Dan are identical twins. After Don suffers kidney
1. Don and Dan are identical twins. After Don suffers kidney
failure, Dan is requested by his brother's wife to donate one of
failure, Dan is requested by his brother's wife to donate one of
his healthy kidneys to Don. Does Dan have any obligation to
his healthy kidneys to Don. Does Dan have any obligation to
surrender one of his healthy kidneys to his brother? Under what
surrender one of his healthy kidneys to his brother? Under what
condition would you defend Dan's decision not to surrender his
condition would you defend Dan's decision not to surrender his
kidney
kidney
 2. Is it ethical for a living person with two good eyes to donate
2. Is it ethical for a living person with two good eyes to donate
an eye to enable a blind person to see?
an eye to enable a blind person to see?

 3. Mrs. Simpatico, a nurse, had cared for Joseph, who was 30
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
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
requiring nurses to ask the families of all dead patients for organ
donations. Both she and the family are very upset about the
donations. Both she and the family are very upset about the
death. She believes Joseph's young wife and three children need
death. She believes Joseph's young wife and three children need
comfort and not decisions at this moment, so she does not ask for
comfort and not decisions at this moment, so she does not ask for
the organ donation, even though the hospital has a long waiting
the organ donation, even though the hospital has a long waiting
list. When the nursing supervisor discovers this omission, she
list. When the nursing supervisor discovers this omission, she
reprimands Mrs. Simpatico and warns her: "One more incident like
reprimands Mrs. Simpatico and warns her: "One more incident like
that and you will be fired." Is the hospital's policy good? Was it
that and you will be fired." Is the hospital's policy good? Was it
right for Mrs. Simpatico to make an exception in this case?
right for Mrs. Simpatico to make an exception in this case?
 4. Anissa is 17 years old when it is discovered she has leukemia.
4. Anissa is 17 years old when it is discovered she has leukemia.
Her primary hope for survival rests on a bone marrow transplant,
Her primary hope for survival rests on a bone marrow transplant,
but there are no likely donors for her unusual genetic
but there are no likely donors for her unusual genetic
characteristics. Her parents decide to have another child in the
characteristics. Her parents decide to have another child in the
hope that the infant will provide a tissue match (a 25% chance).
hope that the infant will provide a tissue match (a 25% chance).
Is it ethically right to conceive a child for the purpose of
Is it ethically right to conceive a child for the purpose of
generating tissue for transplantation? If the infant is a tissue
generating tissue for transplantation? If the infant is a tissue
match, is it right for the parents to decide for the infant?
match, is it right for the parents to decide for the infant?

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