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Ethical Dilemma In Organ Transplant

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Ethical Dilemma In Organ Transplant Question: Discuss about the Ethical dilemma in Organ Transplant.     Answer: Introduction Organ donation and transplantation (ODT) is regarded as the life-saving intervention undertaken with the objective of enhancing the health and wellness of the patients affected by specific organ failure (Australian_Government, 2007). Numerous people acquire a better quality of life and health status following the transplant of the target organs. However, many people encounter co-morbidities and mortality following the transplantation of the committed organ. The solid organ transplantation is undertaken to effectively treat a multitude of complex diseases that deteriorate the normal physiological functions of the vital human organs including lung, heart, pancreas, liver, and kidney. The composite tissue transplants substantiate the requirement of replacing the entire limb, face, and trachea. The success stories of organ transplantation continue to inspire the physicians, surgeons, and the treated patients since several years. However, the ethical and moral obligations associated with the organ transplantation barricade the utilization of this invasive intervention in a range of clinical scenarios. The absence of an equilibrium between the requirement and availability of the donor organs continues to create ethical and moral complications for the donors, recipients as well as the healthcare professionals. The consent of an organ donor depends on his/her individual knowledge regarding the process of organ donation along with the desire of bringing life to the intended recipient. The process of acquiring presumed consent for organ donation was followed until 2010 in many European nations (Simpson, 2012). This consent procedure did not require the acknowledgment of donor’s direct expression or desire to donate the intended organ. The presumed consent (or mandated choice) was diligently practiced in the regions of Virginia and Texas, where the organ donor was forced to give his/her consent regarding the organ donation. The presumed consent process was practiced in various developed nations with the core objective of improving the number of organ donors. However, the utilization of this procedure gave an impression of the State dictatorship in relation to forcing the individuals for relieving their organ ownership rights after death (Simpson, 2012). Therefore, the mandatory choice was abandoned by the US government and another system related to the voluntary sign-up was introduced for taking the consent of individuals in the context of utilizing their vital organs (after death) for the intended recipients.   ODT proves to be a lucrative option in treating various acute and chronic diseases. However, the delays in registries in the ODR (organ donor register) due to the absence of a suitable match, have resulted in the extension of warm ischemia time and elevation in the risk of failure and mortality following the organ transplantation (Tennankore, et al., 2016). This essay effectively discusses similar ethical, moral, and legal dilemmas related to the organ transplantation along with the recommended mitigative measures that require implementation in the context of optimizing the process of organ transplant in the healthcare sector.   Organ Transplantation – Advantages And Disadvantages In The Context Of Ethical Parameters The recently followed trend in organ transplantation advocates the requirement of organs acknowledgment from the donors irrespective of their chronic disease conditions (ABC, 2014). For example, individuals affected with transmissible infection, obesity, and diabetes have the privilege to donate their organs irrespective of their chronic disease status. This indeed increases the numbers of organ donors at the risk of the transmission of various clinical complications. The healthcare professionals recommend the organ transplantation between the individuals who acquire the same clinical condition and associated manifestations. For example, an HIV infected donor might be able to donate his/her organs to an HIV infected recipient. Similarly, patients affected with hepatitis B or diabetes might donate their organs to other patients with same disease pattern. Cadaveric transplantation from an elderly donor to an elderly recipient is now recommended by the transplant surgeons in the hospital settings. Indeed, these types of transplants are associated with a range of ethical complications. One school of thought advocates the requirement of sharing the overall donor health status with the recipients in the context of updating them the risk of clinical complications that they might develop after transplantation. Contrarily, another school of thought does not consider the health status of donors as an important attribute in relation to the functional status of their organs. The proponents of this school of thought do not consider it necessary to share the details of the donor health status with the organ recipients. The organ matching and effective transplantation are core focus areas that they emphasize for the recipient population. The European Convention on Human Rights emphasizes the requirement of protecting the morals and health of the individuals of various age groups and geographical locations. This necessitates the utilization of safe medical practices for improving the wellness outcomes of candidates of organ transplants (ECHR, 2018). The organ recipients possess the right and privilege to understand the types of safety measures and practices followed during the process of organ transplant. They also require understanding the risk of potential complications and prognostic outcomes before receiving the selected organ. This information should be thoroughly shared with the organ recipients without the utilization of complex medical terminology. The entire treatment options associated with the organ transplant must be thoroughly discussed with the recipients in the context of reducing the scope of ethical and legal complications (HSE, 2013). However, the acquisition of consent is highly necessary following the ethical conventions of the organ donation. The disclosure of complete ODT information to both donor and recipient is ethically and legally required with the objective of reducing the risk of legal implications. The explicit consent results in the acquisition of fewer organs in comparison to the presumed consent. Indeed, mutual trust between the healthcare teams, organ donors, and recipients are highly required with the objective of minimizing the barriers to organ transplantation. The assessment of the immunity pattern of the organ recipients is essentially needed to understand and evaluate the risk of organ rejection and associated mortality. The surgeons and physicians need to ascertain the technology and basic biology of the organ transplantation in the context of assessing the probability of the transplantation advantage. The ethical complications related to the bone marrow transplantation substantially barricade the implementation of this novel transplantation approach in the clinical settings. The organ recipients require receiving radiation or chemotherapy treatment to facilitate the process of bone marrow transplantation. This process might permanently deteriorate the fertility of the organ recipients. Refusal from donors or recipients eventually increases the emotional pressures within the associated families. Similarly, bone marrow extraction from a child might require the administration of interventions that might not be in his/her best interest (Dunstan, 1997). The healthcare teams require gaining professional and administrative competence in handling the ethical and legal issues related to the organ transplantation. Xenotransplantation in humans might require exploiting and overcoming the religious and cultural beliefs of the human recipients. This might lead to the potential ethical and legal complications for the stakeholders.    ODT assists in saving the lives of several terminally/chronically ill patients. This process also facilitates the enhancement of the quality of life of the intended recipients (Grinyó, 2013). Organ transplantation in adults, adolescents, and children substantially assists in elevating their life expectancy and wellness outcomes. However, the organ recipients acquire a range of co-morbid conditions that require consistent medical intervention for an extended duration. For example, renal transplantation increases patient’s dependence on dialysis. However, despite these dependencies, the lifesaving organ implants are absolutely necessary to treat a range of irreversible clinical conditions including the lung, heart, and liver diseases. The practice of solid organ transplants is substantially required with the objective of enhancing the efficiency and development of the healthcare systems. The shortlisting of the organ transplant donors in accordance with their health status is highly needed to minimize the risk of potential post-transplantation complications. ODT not just benefits the organ recipients but also decreases the psychological and financial burden of their families (Moritsugu, 2013). A successful organ transplantation increases the satisfaction level of the recipient and his/her family members and also instills new hope regarding health and wellness in the entire stakeholders. The donor morbidity appears minimal following the interventions related to the sperm, blood, and hair implants. However, the donors of the vital organs like kidney, and liver experience the high risk of co-morbidity and mortality. The ethical dilemma related to the exchange of organs in lieu of money leads to several conflicts in the process of organ transplantation. The payment involvement in the organ transplantation process increases the risk of donor exploitation to a considerable extent. However, the critics of this thought justify the need for payment engagement in ODT with the objective of expanding the process on a wider scale for reducing the shortage of donor organs in the hospital settings (Friedman, 2006). The organ donation incentives are presently restricted in many countries that leads to substantial reduction in the organ donation frequency. The potential disincentive related ODT includes the risk of elevated financial burden under the impact of accommodation, travel, income loss, health insurance acquisition constraints, and employment loss after organ donation. The fear and apprehension related to functional constraints, disability, and death after organ transplantation drastically impact the childbearing capacity and fertility level of the organ donors. These fears indeed reduce the organ donation willingness of the individuals to a considerable extent. The development of an efficient healthcare structure for the organ donors is therefore required to minimize their frequency of back out as well as financial and socioeconomic repercussions. The autonomy of the organ donor requires preservation to facilitate his/her informed choice regarding organ donation. The donor must receive the desired information to facilitate the process of informed decision-making. The organ donor must receive free medical assessment and follow-up sessions to minimize his/her healthcare burden. The live donor incentive should be provided in a manner to enhance the donor situation. The expression of gratitude for the organ donation act increases the donor satisfaction level and hope for a healthy survival to a considerable extent (WGILD, 2012). Liver transplantation is the recommended strategy for treating the patients affected by the end-stage liver disease. Researchers and healthcare professionals have developed the living donor liver transplantation (LDLT) strategy in the context of minimizing the acute shortage of the donor’s liver for the intended recipients (Kaido & Uemoto, 2010). LDLT substantially reduces the patient mortality based on the increased waiting time. LDLT assists in minimizing the donor drop-out rate and waiting time for organ transplantation.        Ethical Perspective Of Organ Transplantation – A Comparative Assessment The tough process of donor and recipient selection substantially barricades the process of organ transplantation. Many candidates who aspire to receive or donate their organs fail to acquire selection for the process of because of their age and nationality. The absence of a primary care physician’s referral for organ transplantation subdues the candidature of the intended recipients in the medical facilities (Caplan, 2014). The clinical history of substance abuse and mental impairment, as well as the past criminal record in many situations, become the cause of canceling the ODT candidature of the individuals in the specialized medical facilities. The ODT candidates face financial constraints in accessing the waiting lists related to the organ transplantation across the United States. The patients requiring organ transplants fail to receive the desired organ because of the restricted organ transplantation capacity of the hospital settings. The inappropriate demand-supply ratio of the intended organs leads to their rationing by the healthcare authorities.    The determination of circulatory death and brain death proves highly challenging in many clinical facilities in the context of taking legitimate and ethical decisions regarding organ transplantation (Freeman & Bernat, 2012). The absence of uniformity and standardization of the death determination conventions substantially impacts the administration of circulatory procedures warranted for improving the functionality of the transplanted organ in the intended recipients. The expansion of illegitimate organ procurement practices (including organ trafficking) substantially leads to the deterioration of ethics in ODT. The illegal persuasion, coercion, and allurement of the organ donors deteriorates their organ donation consent and degrades altruism in the entire process of organ transplantation. The organ trafficking in many situations resulted in the manipulation of significant patient data by the transplant departments in various German healthcare settings. This resulted in the reduction of 12.8% organ donors within the transplantation units. These episodes continue to downgrade the morale and motivation of the organ donors that eventually defeats the ODT objective. A similar episode happened in the Chinese prisons where coercion was utilized for acquiring the organs from the detained prisoners in the absence of their informed consent (Trey, et al., 2013). These findings indicate the requirement of developing ODT monitoring interventions and practices for effectively minimizing the risk of unethical organ harvesting in the clinical settings. Several media campaigns have been promoted by the United States government with the core objective of increasing the public awareness regarding organ donation and associated beneficial outcomes (Ghaly, 2012). These campaigns assisted in mobilizing the awareness of masses regarding organ donation that resultantly elevated the frequency of donor registration. However, the work strategies adopted while organizing these media campaigns and organ donation programs are associated with serious ethical complications and challenges. The scientific accuracy and impartiality adopted in communicating the significant ODT information appeared questionable in many scenarios (Ghaly, 2012). The explanation of the concept of brain death while ignoring the religious, scientific, and medical controversies results in the development of misconceptions regarding transplantation-related death and co-morbidity issues. The media campaigns fail to evaluate, recognize, and disseminate information regarding the potential conflicts of interest related to the healthcare of the organ donors and the intended recipients. This might impact the healthcare process in the acute hospital settings and degrade the quality of life of both organ donors and recipients. The configuration of informed decisions by the organ donors and recipients substantiate the requirement of enhancing the accuracy and transparency in information dissemination regarding the healthcare concerns related to the post-transplantation tenure. Indeed, the media campaigns should minimize the bias in ODT information sharing and escalate the authentic information to the common masses (Ghaly, 2012). The media campaigns must publicise their conflicts of interest while effectively retaining the public transparency to the feasible extent. The disclosure of the religious and cultural controversies related to organ donation is highly required with the objective of minimizing the risk of prospective ethical and legal complications. The organ donor registration must not proceed in the absence of informed consent acquisition from the concerned donors/recipients. The focus of ODT media campaigns must be confined to public education rather than incentivization from donor registrations.    The HOPE (HIV Organ Policy Equity) act effectively facilitates the organ transplantation from the HIV infected patients and deceased donors to the HIV infected patients affected by the end-stage-renal disease (Durand, 2016). However, the ethical issues related to the donation right, fairness, and privacy requires require consideration by the healthcare professionals and surgeons while transplanting the organs of interest to the intended recipients. However, the healthcare workers and other patients experience high-risk of HIV acquisition following the initiation of this organ donation process. The ethnographic research conducted in South Africa, India, and Brazil by the University of California tracked the gender, class, and race-based injustices and inequalities related to the process of organ distribution, harvesting, and acquisition (Shroff, 2009). The university also evaluated the national laws that barricade the sale of various organs to the intended recipients. The findings revealed several market pressures that resulted in the dissolution of various religious and cultural sanctions related to the organ transplantation. The appearance of debt servitude related to the commodified kidney also resulted in several ODT-based ethical and legal complications. The university also evaluated the cadaver rights violations in various public morgues where the illegitimate organ removal was reported in the absence of formal consent. The theft of cadaver bodies or body parts resulted in several ethical and legal complications that necessitated the requirement of re-evaluating the ODT process on a measurable scale. The elevated demand for organ transplant across several developed and developing nations of the world have resulted in the traveling of patients to various destinations in the context of acquiring the organ transplant in an illegitimate manner. Indeed, the countries including Romania, Bulgaria, Russia, Ukraine, Moldova, Turkey, Brazil, and the Philippines have weak regulatory system related to the organ transplantation. Resultantly, various patients travel to these locations with the objective of acquiring the desired organ at negotiable rates (Shroff, 2009). These events continue to promote ‘Transplant commercialism’ and associated legal complications. Transplantation ethics indeed substantiate the requirement of advocating and defending the appropriate conduct related to organ donation while concomitantly defying the illegitimate interventions that establishment of ‘Transplant commercialism’ in various countries (Dalal, 2015). The federal governments of the established and developed countries need to review the international ODT legislations and configure new reforms to elevate the incorporation of ethical/moral conventions for effectively challenging the unlawful and biased transplantation interventions across the globe.     Conclusion The development of innovative policies, rules, and laws is highly essential with the objective of reducing the scope of illegitimate and unethical conduct related to the organ donation and transplantation. The incorporation of altruism in the ODT process is highly essential in the context of improving the organ supply for the intended recipients while effectively minimizing the ethical and legal conflicts. The governments of various established nations must modify the policies and consent laws related to the ODT process for minimizing the frequency of illegal enforcement of the organ donors. Strict measures need to be implemented for reducing the commercialization of organ transplantation in the healthcare sector. The configuration of explicit consent legislation is highly required for linking each organ donation in the state registries. The ODT from the diseased donors to the diseased recipients requires re-evaluation for exploring the associated clinical complications as well as ethical and legal issues that the organ donors and recipients might experience following the organ transplantation. The re-evaluation of various types of transplantation-related consents is necessarily required to optimize the organs’ demand and supply ratio in the medical facilities. In summary, the healthcare authorities and governments must promote the ODT process in a manner to minimize the scope of ‘Transplant commercialism’ on an international scale.   References ABC, 2014. On the Ethics of Organ Transplantation: A Catholic Perspective – The report of a working party, Birmingham: The Anscombe Bioethics Centre. Australian_Government, 2007. MAKING A DECISION ABOUT LIVING ORGAN AND TISSUE DONATION, Australia: Australian Government. Caplan, A., 2014. Bioethics of Organ Transplantation. Cold Spring Harb Perspect Med, 4(3). Dalal, A. R., 2015. Philosophy of organ donation: Review of ethical facets. World Journal of Transplantation, 5(2), pp. 44-51. Dunstan, G. R., 1997. The ethics of organ donation. Bnhih Medical Bulletin, 53(4), pp. 921-939. Durand, C. M., 2016. Realizing HOPE: The Ethics of Organ Transplantation from HIV infected Donors. Ann Intern Med, 165(2), pp. 138-142. ECHR, 2018. European Convention on Human Rights, Strasbourg: Council of Europe. Freeman, R. B. & Bernat , J. L., 2012. Ethical issues in organ transplantation. Progress in Cardiovascular Diseases, 55(3), pp. 282-289. Friedman, A. L., 2006. Payment for living organ donation should be legalised. BMJ, 333(7571), pp. 746-748. Ghaly, M., 2012. The ethics of organ transplantation: how comprehensive the ethical framework should be?. Med Health Care Philos, 15(2), pp. 175-179. Grinyó, J. M., 2013. Why Is Organ Transplantation Clinically Important?. Cold Spring Harb Perspect Med, 3(6). HSE, 2013. National Consent Policy, Ireland: HSE Live. Kaido , T. & Uemoto, S., 2010. Does living donation have advantages over deceased donation in liver transplantation?. Journal of Gastroenterology and Hepatology, 25(10), pp. 1598-1603. Moritsugu, K. P., 2013. The Power of Organ Donation to Save Lives Through Transplantation. Public Health Reports, 128(4), pp. 245-246. Shroff, S., 2009. Legal and ethical aspects of organ donation and transplantation. Indian Journal of Urology, 25(3), pp. 348-355. Simpson, P. J., 2012. What are the issues in organ donation in 2012?. British Journal of Anaesthesia, 108(1). Tennankore, K. K., Kim, S. J., Alwayn, I. P. & Kiberd , B. A., 2016. Prolonged warm ischemia time is associated with graft failure and mortality after kidney transplantation. Kidney International, 89(3), pp. 648-658. Trey, T., Caplan, A. L. & Lavee, J., 2013. Transplant ethics under scrutiny – responsibilities of all medical professionals. Croat Med J, 54(1), pp. 71-74. WGILD, 2012. Incentives for Organ Donation: Proposed Standards for an Internationally Acceptable System. Am J Transplant, 12(2), pp. 306-312

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