|
HOME
ASSOCIATES
|
|
Determination of death
Acceptance of organ procurement and
transplantation depends, in large part on public
confidence that cadaver organs including livers are
being taken from people who are truly dead in the
public's understanding of that term and not as one
pundit joked Kind of dead . In other words the
often-quoted truism that the determination of death is a
medical decision hides the reality that the concept of
death while given both a medical and legal rationale, is
fundamentally a social concept informed by cultural and
religious beliefs, not a scientific concept.
There have been efforts to broaden
the category of what constitutes death in humans
including suggestions that infants with anencephaly and
persons in persistent vegetative states be treated as
though dead for purposes of organ donation. These
efforts have met with significant public and
professional resistance. There are two opposing schools
of thought from those who are unhappy with the current
definition of death for transplant
procurement purposes
:
Those who believe that the current
whole brain death criteria should be narrowed to require
stricter criteria, prolonged absolution and more
mandatory neurological testing and
Those who believe
that the criteria should be widened to include patients who have
been declared dead by traditional cardiopulmonary criteria or who
are by current criteria alive but have been diagnosed with
'permanent loss of consciousness'
Altruism Vs Duty or Payment for Organs
Living donors are usually classified into three
categories:
|
1. Living Related Donors (such as
parents, siblings or children) who are
genetically related to the recipients.
2. Living Emotionally Related
Donors (Such as spouses, significant others and
close friends) who are genetically unrelated.
3. Living Unrelated Donors who are
strangers to the recipient and who may or may
not be compensated for their donated organ (not
recommended anytime).
| Organ donation by
living donors brings in focus perplexing ethical
problems because of the dangers of coercion and external
as well as self-generated pressures on the donor.
Although wishing to respect the freely made decisions of
prospective donors with decision making capacity and
valuing the life-saving potential of this gift to the
recipients and the satisfaction of donors, liver
transplantation teams have been forced to evaluate the
motives, the capacities and feelings of prospective
donors in a variety of factual contexts.
Anencephalic and xenograft
organs
Human organ transplants
using anencephalic and xenograft organ donors
are not a common practice in India.
Selection of patients for
transplantation |  |
Equitable selection and access
The system of distribution of
cadaver livers is theoretically blind to the possibility
of discrimination based on age, race, gender and
socio-economic status. In practice, this equity has not
always proved to be the case and unanticipated
distortions in the allocation of donor organs made.
Competition between large and small transplantation
programmes purportedly deprive the neediest end stage
liver disease patients of available organs of the
special relationships between certain hospitals and
organ procurement agencies that lead to organs going to
specific hospitals rather than patients with greatest
priority. These contribution issues do not instill a
public sense of fairness about the organ allocation
process. Age has also become a contentious issue; Some
argue that liver transplantation patients older than 60
years do as well as younger patients and should not be
excluded solely on the grounds of age whereas others
argue in this youth oriented society, organs should go
to the young on the basis of future productivity rather
than to older candidates on the basis of future
productivity.
Patients with end stage alcoholic
disease (Cirrhosis)
Adding
to the stigma of alcoholism have been the medical
arguments of
|
1. Typical Multiple organ damage
and severe malnutrition that could complicate
the patient's ability to withstand long surgical
procedure and post operative care.
2. The prospect of patient's
non-compliance with the lifelong
immune-suppressive regimen in a manner (i.e. a
return to alcohol) leading to a rejection of the
transplanted organ.
| Re-transplantation
As a
generalization, one can observe a serious difference in
perception of ethical duties towards specific patients
on the part of transplantation surgeons and other team
members compared with non- transplantation team
professionals. Transplantation surgeons in particular
almost invariably feel a greater duty towards patients
on whom they have already operated in contrast to
patients who have been accepted for transplantation and
are awaiting their first organ despite the fact that
technically all are their patients, at least in terms of
the transplantation programmes in which they are
involved or lead. This is particularly true in the case
of paediatric patients. For this reason, the issue of
re-transplantation can become extremely controversial
for some and totally routine for others, even if the
patient's lives hang in the balance.If donor livers are
scarce and re-transplantation of one patient is chosen
over primary transplantation of another, the latter
might die on the waiting list and the issue of fairness
or equity becomes irrelevant.
|
