Ethical Issues Haunt The Transplant Field

ETHICAL ISSUES
A number of ethical issues haunt the transplant field. With few exceptions, donated organs go to the patient who is nearest death, even though a healthier patient might benefit more by living longer after the transplant. People who need a second, third, or fourth transplant because their prior transplants failed usually gain top priority, even though they are not likely to do as well as patients who have not already had a transplant.

Some critics object to giving organs to patients whose organ failure was the result of their own actions, such as cirrhosis of the liver resulting from alcohol abuse.
Money is also a major issue. Access to transplantation is impossible without access to good primary medical care and good insurance, both of which are largely unavailable to the poor. To be placed on the waiting list, patients must show they can pay for the transplant.

In 2000 a kidney transplant cost about $111,000 and a liver transplant as much as $250,000 in the first year after the surgery. Many insurance companies do not cover such costs, particularly for the new procedures, such as lung, pancreas, or multiple organ transplants, which are still considered experimental.

Although organs cannot be bought and sold legally in the United States, there is evidence that a black market in organs exists in China and other countries. Persistent allegations have been made of people traveling to China and paying for organ transplants. Human rights groups have reported evidence that the bodies of executed prisoners are the source for most of the organs transplanted in China.

In the United States, where organ donation is voluntary, ethical questions arise over the nature of the consent and the use of incentives. Intensive donor solicitations in recent years have not made much of a dent in the shortages of organs.

Even though many people sign organ donor cards, their families are often reluctant to grant permission at the moment of crisis. Some ethicists debate whether family members should have the right to refuse donation if the deceased signed an organ donor card.
Presumed consent laws, in which everyone would be considered willing donors unless they have specifically said they were unwilling, have been tried in Europe and South America, and on a limited basis in Pennsylvania and Maryland. Some experts have suggested financial incentives, such as cash rebates, estate tax discounts, or payment for burial expenses.

Others have suggested broadening the criteria used to determine death beyond the lack of all brain activity. This would permit a surgeon to use organs from anencephalic children, who are born without a brain, and from people in a persistent vegetative state.
The implantation of tissues from aborted fetuses into the brain has proved a possible treatment for both Parkinson and Huntington’s disease, but the treatment has raised its own set of ethical questions.

The foremost is the question of abortion itself. The possibility of using embryonic stem cells to create replacement organs has faced opposition for similar reasons.
Some researchers believe that this issue can be surmounted by growing cells in the laboratory or by genetically engineering a patient’s own skin cells. Fetal pig cells have also been used as a treatment for Parkinson and Huntington’s disease, but that raises other ethical issues regarding the treatment of animals.