Introduction
Significant advances have been made in health care provision over the decades. These developments have led to the promotion of health and wellbeing for many people. A significant innovation has been in the area of organ transplantation. Through this technology, it is possible to replace or remove most of the body organs and therefore restore health. Due to organ transplantation, patients who previously had no chance of surviving due to dysfunctional organs can have their lives saved. The potential of organ transplantation to save lives and restore health has led to the prevalence in its use.
The organs used in the transplantation process can be obtained from living or dead donors. Living donors are individuals who decide to donate a non-vital organ to a relative, friend, or even a stranger. Recently deceased people can also serve as organ donors and this class of donors can provide vital-organs for transplantation. However, organ transplantation is plagued by the problem of organ scarcity. While many people need these procedures to restore health, there are a limited number of donors. This leads to a number of ethical issues that must be addressed by health care professionals.
Background of the key issue & its relevance to health care/and or nursing
The potential of organ transplantation to improve health and save lives has led to an increase in the demand of this procedure by many patients. Guttman et al. (2011) reveal that the shortage in transplantable organs has been caused by the biomedical advances of the last three decades. These advances have made successful medical outcomes for organ transplantation increasingly common and increased the prominence of transplantation as a procedure that can significantly prolong or enhance the lives of people with serious medical conditions including organ failure. However, organ donors are not widely available and this has led to a significant gap between the number of available organs and the needed organs to satisfy the demand.
The shortage of organs leads to a number of important ethical concerns. There are ethical issues with regard to where the organs should be obtained. As noted in this paper, organs can be obtained from living donors or dead donors. With regard to living donors, there are questions on whether the donor should be compensated for his organ. Proponents of such an approach argue that commercial incentives are needed to increase the number of donors.
The deceased present a potential solution to the organ shortage problem. However, this source has not been fully exploited since the relatives of the deceased often refuse to provide consent to have the dead body’s organs harvested (Hakan et al., 2010). Some states want to introduce the principle of presumed consent where it will be assumed that a person was a willing donor unless he/she explicitly refused to be a donor.
Another ethical issue raised by organ donation is who should be given priority when distributing the available organs. This concern is driven by the fact that the demand for transplant organs far exceeds the supply (Childress, 2001). As such, there is always a shortage of organs while and patients have to wait in long transplant lists for a chance that they will get an organ. Hospitals are therefore required to decide on how the available organs should be distributed among the many patients.
Scholarly Literature Views on the Topic
There are a number of opinions expressed by scholars with regard to the organ shortage problem. Scholars and policy makers agree that something needs to be done to alleviate the problem. The low supply of organs and the increase in the number of people in official transplantation waiting lists has raised concerns about commercial organ trade activities. Data from the US government reveals that over 110,000 people were in the transplantation waiting list as of January 2011 (Guttman et al., 2011). Some of the people on the waiting list are in dire medical conditions due to failing organs. As a result, it is estimated that 20 people die each day while they wait for a viable organ to become available. If nothing is done, people are likely to engage in unethical practices such as commercial organ trade activities.
Some scholars support the “presumed consent law” which makes everybody a potential donor following death. This law has been implemented by Belgium with great success (Hakan et al., 2010). In this system, individuals are encouraged to complete donation forms that make them automatic organ donors when they die, with or without the consent of their families. If a person has not filled this form, he is presumed to be an organ donation volunteer and will his/her organs may be harvested after death unless the family clearly objects. However, there is no legal obligation to inform the family about the harvesting, which makes it possible for transplant teams to obtain numerous organs (Hakan et al., 2010). Proponents of this model assert that it is justified since organ donation is a debt that every citizen owes his/her country.
A number of scholars have addressed the issue of organ distribution. Most experts agree that there should be an organ distribution policy in place to help determine a fair allocation of the available organs. The policy should consider a number of major attributes when allocating organs and they include “patient medical need, probability of success, and time on the waiting list” (Childress, 2001, p.366). Another group of experts suggests that priority for organs should be given to patients who are regarded as worthy of receiving them. This worth candidates are those who do not engage in lifestyle choices that led to the damage of their organs in the first place. In addition to this, the organs should be distributed to individuals who can give back to the society in some way. Another group of experts suggests that the available organs should be distributed in a way that results in the maximum benefit. As such, the organs should not be given to individuals who are likely to benefit the most from the organs (Glenn, 2013). Using this rationale, individuals who have already had an unsuccessful transplant should not be given a high priority. In addition to this, younger patients are given priority over the older patients who are unlikely to utilize the organs for long.
Some scholars are in support of commercialization of transplant organs. This group argues that such a move would not only deal with the current shortage of organs but also render the illegal organ market irrelevant. Organ shortage has already led to the rise of medical tourism, a phenomenon characterized by individuals traveling to other countries for treatment (Glenn, 2013). However, this practice is illegal since organ sale is illegal in all countries with the exception of Iran where a payment (regarded as a reward), is given to the donor. Support for legal organ sale is opposed by a majority of scholars who demonstrate that commercialization would lead to an exploitation of the poor.
Ethical Principles Applicable in the Issue
A number of ethical principles can be used to address the ethical issues raised by organ donation. Concerning whether organ sale should be permitted, the principle of altruism is relied upon. For the organ to be considered a donation, the person giving it must do so freely and without any form of coercion. Organ sale violates this principle since most of the individuals who sell their organs are poor. Glenn (2013) asserts that procurement of organs from such individuals can be rightfully classified as coercive since it targets vulnerable members of the population.
The concept of distributive justice has been used to determine how the available organs should be issued to the pool of individuals in the organ waiting list. According to this principle, the available organs should be distributed in a fair manner and without bias (Mercer, 2013). Race, sex, and economic status should not be used as a basis for determining who is given priority when distributing transplantable organs.
The ethical principle of utilitarianism supports some of the organ distribution criteria. The utilitarian philosophy dictates that resources should be used in a manner that results in maximum benefits for the greatest number of people in the society (Center for Bioethics, 2004). Using this principle, organs should be distributed in such a way that maximum returns are obtained from the process. This approach encourages the individuals making decisions on who should receive the organs to be pragmatic in their choices.
To address the organ shortage issue, many countries propose using the implied consent rule. This rule is a violation of the medical ethics principle of autonomy and the individual’s right to decide about his or her own body. Hakan et al. (2010) states that people who did not express any preference to organ donation during their lifetime may well have opposed the process. Getting organs from these individuals under the implied consent rule is therefore incompatible with the principles of autonomy and individual right.
Suggestions and Recommendations
Evidently, organ donation presents some major ethical issues that must be addressed. The discussions given so far demonstrate that the major ethical issues in organ donation are caused by the scarcity in transplant organs. It can therefore be surmised that the ethical issues will be dealt with if more organs are available. I would therefore suggest that health care practitioners and policy makers adopt more aggressive ways to increase organ availability. Health care practitioners should engage in advocacy to boost organ donation. Nursing professionals should take it upon themselves to educate the population on the significance of registering as a donor. Hakan et al. (2010) confirms that the role of nurses in convincing people to volunteer as donors is crucial since these professionals have a personal relationship with patients and their relatives. This idea would work for most people are ignorant of the importance of donating organs. Raising awareness has the potential to increase the number of volunteer donors. This will ensure that ethically unsound practices such as the implied concept rule are not used.
Policy makers should come up with policies that give incentives for individuals to register as donors. One ethical way of doing this is by giving preferred status to registered donors and their families if they ever need to receive organs for transplantation in the future. Glenn (2013) reveals that this approach has been enacted in Israel with positive results. This approach increases the number of volunteer donors and promotes fairness by giving priority to individuals who have demonstrated a willingness to be organ donors over those who have not.
Because of the complex nature of organ donation, it is unlikely that any one strategy can lead to a significant increase in the rate of organ donation rates (Mercer, 2013). As such, the various proposed strategies should be used together in order to improve organ donation rates significantly and adequately address the ethical issues that shortage brings about.
With regard to organ distribution, I would also recommend the adoption of an unbiased distribution model for the available organs. The most important criteria when choosing who will receive an organ should be time on the waiting list. Such an approach will ensure that the organ distribution process is not prone to bias or unfair practices that might occur if attributes such as patient age or social worth are considered.
Opinions of Prominent Organizations on the Issue
The organization that maintains a list of the individuals who are waiting for transplant organs, the United Network for Organ Sharing, favors a distribution policy that gives the available organs to any person who requires it (Center for Bioethics, 2004). This organization is opposed to subjective criteria that consider the social worth of the patient therefore leading to bias against individuals who would be deemed unworthy of the organ.
The international public health branch of the UN, the World Health Organization (WHO) has a strong opinion regarding the sale of transplant organs. According to this organization, organ transplantation is a novel technology that has the potential to improve health outcomes of thousands of patients. However, commercialization of organ sale will result in many negative health consequences for the poor who will be coerced into selling their organs (Glenn, 2013).
The American Nurses Association (2013) is opposed to the implied consent rule since it goes against the principle of patient autonomy and individual right. This association promotes patient rights and encourages its members to respect the wishes of the individual and allow for freedom of choice without coercion. The American Nurses Association (2013) is in support of the equal access model of organ distribution. This model ensures that justice is served by ensuring that the available resources are distributed in a fair and equal manner in spite of the individual patient’s social standing.
Conclusion
This paper set out to address the ethical issues associated with organ donation. It has demonstrated that the ethical issues arise with respect to organ source, method of obtaining organ, and organ distribution. The shortage of organs is responsible for the presence of these ethical concerns. Some of the views expressed by scholars on the subject have been highlighted. It has been shown that most scholars are opposed to commercialization of organ sale and support a fair distribution of organs. There is agreement that measures to increase organ availability are needed. The paper has offered some recommendations for achieving this. By implementing these strategies, the ethical concerns raised by organ donation can be addressed without violating the ethical standards endorsed by the medical community.
References
American Nurses Association (2013). Ethical Principles. Web.
Center for Bioethics (2004). Ethics of Organ Transplantation. Web.
Childress J. F. (2001). Putting patients first in organ allocation: an ethical analysis of the U.S. debate. Cambridge Quarterly of Healthcare Ethics, 10(4). 365-76.
Glenn, C.I. (2013). Transplant Tourism: The Ethics and Regulation of International Markets for Organs. Journal of Law, Medicine & Ethics, 41(1), 269-285.
Guttman, N., Tamar, A., Anat, G., & Vered, S. (2011). Laypeople’s Ethical Concerns about a New Israeli Organ Transplantation Prioritization Policy Aimed to Encourage Organ Donor Registration among the Public. Journal of Health Politics, Policy & Law, 36 (4), 694-716.
Hakan, E., Arzu, H., Selami, F., & Basagaoglu, I. (2010). Nurse-focused ethical solutions to problems in organ transplantation. Nursing Ethics, 17 (6), 705-714.
Mercer, L. (2013). Improving the rates of organ donation for transplantation. Nursing Standard, 27 (1), 35-40.