Ethical and legal issues in organ transplantation
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Answer:
In 1994, the Government of India enacted the Transplantation of Human Organs Act (THOA) to prevent commercial dealings in human organs. However, a greater number of scandals involving medical practitioners and others in the kidney trade has surfaced periodically in every state in India. The present regulatory system has failed mainly due to the misuse of Section 9(3) of the THOA, which approves the consent given by a live unrelated donor for the removal of organs for the reason of affection or attachment towards the recipient or for any other special reason. Currently in India, approximately 3500-4000 kidney transplants and 150-200 liver transplants are performed annually. However, the availability of organs from brain-dead persons is very low. As a result, live related or unrelated donors form the main source of organ transplantation. Therefore, physicians and policy-makers should re-examine the value of introducing regulated incentive-based organ donation to increase the supply of organs for transplantation and to end unlawful financial transaction.
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Explanation:
ETHICAL ISSUES
The ethics of transplantation can be expressed in three requirements:
1. Medical integrity: Patients and the public must be able to trust their doctors not to sacrifice the interest of one to that of another. Individual may make that sacrifice, but not their doctors.
2. Scientific validity: The basic biology and technology must be sufficiently assured to offer a probability of beneficial outcome, case by case.
3. Consent: Consent based upon information adequately presented, weighted and understood, and unforced.
There are certain ethical principles evolved to suggest that transplantation would be within the bounds of ethics if certain criteria are fulfilled, in instances of living donor transplantation. These are:
1. The removal of the tissue or organ does not impair the health or functional integrity of the donor.
2. The benefits expected to be given to the recipient bear an acceptable proportion to the harm likely to the donor.
3. The donation should be altruistic and is given without any coercion or any other form of external pressure.
4. The donor must be fully informed of the nature of the procedure and the possible even if rare complications. This entails the need for follow-up of the donor’s health in the future.
5. The views of close relatives such as the spouse or adult children are taken into account.
6. There must be no element of commercialization or exploitation in the donation.
The practice of medicine is largely unregulated in India. Medical councils and organizations have played a passive role on ethical issues. They have failed to make their stand public or take action even in obvious malpractice. Although the press has been publishing explicit details on rackets in kidney transplantation in various cities no medical body has thought it fit to even conduct an investigation into them.
Distributive justice theory states that there is not one “right” way to distribute organs, but rather many ways a person could justify giving an organ to one particular individual over someone else, to each person an equal share, to each person according to need, to each person according to effort, to each person according to contribution, to each person according to merit, to each person according to free-market exchanges.
One distributive justice criteria is equal access. Organs allocated according to equal access criteria are distributed to patients based on objective factors aimed to limit bias and unfair distribution. Equal access supporters believe that organ transplantation is a valuable medical procedure and worth offering to those who need it. To encourage equality in organ transplantation, the equal access theory encourages a distribution process for transplantable organs that is free of biases based on race, sex, income level and geographic distance from the organ being punished for offenses against society.
The primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs. “On average, 17 patients die every day while awaiting an organ one person every 85 minutes. The number of donated organs has stayed fairly constant over the last few years while the number of people needing organs continues to increase.
LEGAL AND SOCIAL ISSUES
The kidney trade is a global phenomenon; it is present in both the developing and the developed world. Since the introduction of the immuno-suppressant drug Cyclosporine in the early 1980s, organ transplantation has become a relatively safe operation. More and more patients suffering from End Stage Renal Disease opt for kidney transplants instead of remaining on dialysis. The result in many parts of the world is, the demand for kidneys far outweighs the supply. Brokers have stepped in, offering kidneys for sale to cover the deficit.
Two central issues related to the trade in organs need to be addressed: the effectiveness in implementing the current law and the financial compulsions that make people donate their organs
Transplantation of organs from one human being to another has thrown up complex religious and moral questions. If a heart is removed from a cadaver, does it mean that the latter is now devoid of a ‘soul’? Will removal of organs in any way affect the process of ‘rebirth’ or resurrection?
Hindu and Vedic scholars accept the concept of brain death. The concept of giving or daan is ingrained in Hindu thought. Pursuant to the Organ Transplantation Act, in India consent is a major factor when you are talking about organ transplantation. Organs can only be procured willfully, not forcefully. The donor has to directly agree for transplantation in order for the organs to be removed.
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