Part Two: Ethics of Organ Transplant

G. I. Isong – trendsng@[Link]

 Xenograft: Also known as xenotransplantation is the transplantation of living

cells, tissues or organs from one species to another. The actual tissue or organ

being transplanted through this procedure is called xenograft.

ETHICS: DEFINING THE NEED, THE MEANS AND THE MOTIVES.

While bioethics is not a tool or set or principles set out to frustrate the advancement of

research or success in the medical field, it on the other hand seeks to set a level safe

playing ground fro the practice in order to guide against foul play. In a society where

morals, truths, values and ideas are fast becoming relative, it is easy to see the divide

of opinions in what is considered right or wrong in the medical sciences. One of the

causes of differing stance on the discourse in bioethics is the sacredness of life. Hence,

for some considered to be conservative ethicist, all life is important and is to be treated

with sanctity. Hence, the human body is sacred even at its lifeless state. To the

conservatives, the argument is that it is a violation of individual dignity and autonomy

to conduct a transplant from the death in order to save the a life of another person in

need of a transplant without consent. To the living donor, the argument persists on

how to convince a person t]o donate his or her body organ/tissue and whether such

convincing process should involve monetary incitement. From the statements above,

we are now presented with two categories of donors, viz; living donors and cadaveric

donors (also called non-living donor or deceased donor).

Living donors:
These are donor who donates his body tissue or body organ for transplant while they

are still alive. Nearly 6,000 living donations take place each year and this figure only

represents 4 out of every 10 donations ([Link]). Organs that can be

donated by living donors include, one of two kidneys, one of two lobes of the lungs or

part of a lung, art of the intestine, pancreas, skin, bone, umbilical cord blood, amnion

(after childbirth) etc ([Link]). However, it is easier to find living

donors where the person needing transplant is a relative, than it is to find those who

are willing to donate to unknown beneficiaries. This reality has led to shortage in the

availability of organs for those eligible for a transplant.

Cadaveric donors:

Cadaveric donors are donors whose organs are being harvested for a transplant after

their death. Hence, an individual may will his body tissues and organs for a transplant.

A person becomes a cadaveric donor when he indicates his interest to donate his

organs at death. According to a report by University of Minnesota’s Centre for

bioethics (6), such decisions are either expressed or documented on a drivers’ license

or in a health care directive or registry. The report also indicates that, while indicating

one’s desire to donate an organ on a drivers’ license is legally binding in states like

Minnesota, it also acknowledges that some state hospital in the United States however

have a policy that requires family consent for organ removal regardless whatever

wishes were expressed by the deceased. Where the consent was given before death, it

is called post-mortem consent (WHO, 10).

deceased to be donated for transplant. As easy and simple as this may sound, this

reality confronts us with a vital question which again has been answered from

different perspective. The question is what is death? And when is a person said to be

dead? Let us here attempt an answer to this by examining the different ways of

confirming death medically and legally.

Not only is there a wide line of divide on the beginning of life, such disparity of

opinion is also fierce and consequential in biomedical ethics. For the pro-abortionists,

life begins at birth, while the “conservatives” opine that life actually begins at

conception. It is remarkable to observe that, human win an attempt to find and define

purpose of living have engaged in bitter argument about the true value and worth of

their very life. From the philosophical angle, many doubt and question the reality of

their very existence, while from the ethical circle, others who profess to admit the

reality of their existence express uncertainty on when they actually began to exist.

Hence, the same argument has traced man to death. Hence, while some are debating

on the origin of life, others from another end are also engaged in an intellectual

exercise on when life can be said to have ended.

Legal death

According to Uniform Determination of Death Act, “an individual is dead if the

individual has sustained either;

a. Irreversible cessation of circulatory respiratory functions; or

stem ([Link]/[Link])

According to Wikipedia on its article on legal death, two categories of death are also

being outlined. These two are;

1. Cardiopulmonary death: This has to do with an irreversible cessation of

heartbeat and breathing.

2. Brain death: This is determined by irreversible cessation of functions o the

brain.

The above definitions on death also raise sharp arguments and concerns on its

implication. Ethicists, especially from the Christian perspective however argue against

brain death. For example, Larry Heather in the Journal of Biblical Ethics (25) argues

that, “the major unifying systems of the body are the brain (Central Nervous System),

circulation and respiration. To accept death even when there is destruction of just one

of these systems is not appropriate.” To Heather, brain death can be a tool of

exploitation and devaluing the worth of the dying to save a presumed more valuable

life through a transplant. Thus, from this ethical point of view, it is murderous to

declare one dead as a result of failure of only one out of the three vital organs that

sustain life. There are also worries that validating brain dead can lead to a foul play by

encouraging negligence on the part of medical care-givers to do all that is possible to

resuscitate the supposedly brain dead, especially where the prospects of organ

transplant is in view.

Is presumed consent a true consent?

made legislations that compels body organs of the dead (i.e. cadaveric donors) to be

harvested where the deceased had not, during his life time opted out from having his

organs donated at dead. Hence, the assumption is that, silence or failure to opt out

equals consenting to be a cadaveric donor. Let us here examine some biblical criteria

for authenticating death.

1. Cessation of breath precedes death

In reporting the death of the patriarch Abraham in Gen. 25:8, the bible clearly states

that, “Abraham breathed his last and died at a good old age.” Thus, we see that

Abraham was not declared dead until his respiratory organ ceased to work. Also, we

see a similar criteria being employed to describe death in other instances. Both Jacob

(Gen. P49:33) and Jesus Christ (Luke 23:46; Mrk. 15:37) are said to have breathed

their last before being declared dead. Hence, the idea of being brain dead runs

contrary to the scripture and anything done to the body of a brain dead patient without

a medial confirmation of permanent failure of the respiratory system is a mutilation

and violation of the right to life.

2. Life is in the blood

While affirming the sacredness of blood, the scripture attests that, “...the life of every

creature is in its blood.” (Lev. 17:14) Here is evidence that in the scripture, the
determination or focus of life is not in the brain but in the blood. Consequently, it is a

case that until the respiratory system fails, thereby permanently terminating the

circulation of blood to the body cells, one cannot be said to be dead. The salvation

price paid by Jesus has its efficacy in his blood and not in his brain. Hence, Christians

appeal to God for mercy through the blood of Jesus that was shed on the cross of

Calvary and not his brain that was dead thereat.

On presumed consent, George M. Abaona, (56) quotes the fundamental principle

which was endorsed by the Pope John Paul II in 1992 on behalf of Christianity that,

“organ transplantation can take place from a dead donor providing that there was a

necessity to save human life and that permission of the family is not required since

human organs belong to God an not the family.” At prima-facie, the above declaration

has issues of contention to be settled. First, it is agreed that the body organs belong to

God who is the giver of life. If life originates from God, and the said life is a gift from

God, it is criminal to interfere on how one’s gift of life (resident in the body) should

be dispensed with, considering the fact that the receiver of the gift is accountable to

the giver on how the said life was used.

Since this research is from the Christian perspective, it is also pertinent at this moment

to consider another implication of presumed consent which is the possibility of a

miraculous resurrection as seen in the case of Lazarus in the scriptures (John 11) and

some other verifiable examples in the contemporary world. However, since miracle is

a religious experience or concept that cannot be studied empirically to accentuate its

truth claims, the researcher shall attempt a mild compromise in order to accommodate

thinkers from the scientific field by adopting a relatively synonymous term which is
acknowledged in the medal profession as “Lazarus Syndrome.” Wikipedia defines

Lazarus Syndrome as auto-resuscitation after a failed cardiopulmonary resuscitation

(Wikipedia: Lazarus Syndrome).

Wikipedia documents a case of one Judith Johnson, 61 who has a cardiac arrest at

Beebe Medical centre in Lewes, Delaware, United States in May 2007. After being

declared dead at 8:34pm, she was discovered in the morgue to be alive and breathing.

She sued the medical centre for damages due to the neurological problems stemming

from the event. From the above scenario, the question that “pro-presumed” consent

ethicists would have to answer is, what happens if a patient who was declared brain

dead and upon based on the legislation of presumed consent, had his or her kidney and

some body tissues harvested suddenly resurrects after a few hours or days; what

justification will be given to him or her on waking up to discover that his or her body

parts were mutilated? What would be done to repair the psychological ad emotional

trauma from such an experience?

Should donors be rewarded financially?

While organ donation is supported or meant to be a gift or charitable act to save other

lives, though a voluntary donation of one’s body tissues or organs; there are ethical

concerns on whether the donor should be rewarded financially. The answer to the

above question outweighs a straightforward “yes” or “no”. To some, financial reward

will equal to sale of body organ which is both unethical and illegal. Also, those

against financial reward argue that there is a possibility of a potential donor being

blinded lured by the reward to donate with full grasp of the implication of his actions.
Others ague on the other hand that considering shortage in organs and the ever

increasing rise in the toll of patients eligible for a transplant for survival, financial

incentives (not payment) could serve as a motivation for voluntary donation. It is

therefore pertinent in the alight of the above fears expressed to clearly investigate the

means and the motives behind the financial incentives or rewards. Recently, a BBS

World Service report of June 13, 2018 revealed an illegal blood bank run by a medical

lab scientist in Lagos Nigeria. According to the said report, the illegal blood bank has

been in operation for about 4 years and unsuspected members of the public were

induced with a payment of N2,000.00 (about $5) per pint of blood donated. The

discovery was made when one of the donors, a 17 year old who donated 4 pints of

blood within a space of six days was found in a critical condition. The situation above

calls for prudence in introducing financial incentives for organ donors. In their

investigation of the ethical issues on financial incentives for organ donation, G. V.

Dijk and M. T. Hilhost recommends some incentives to cadaveric donors. Such

incentives recommend include, buying of little presents for whoever indicates interest,

provision of subsidized medical bill, priorities on the waiting list should the person

ever need a transplant, sponsoring of funeral cost etc. From the perspective of the

above recommendation, such incentives are made for indication of interest and not as

a payment for the organ. On living donors, caution is needed to guard against

exploitation and foul play.

Who gets the organ?

One question that the researcher observes has been ignored or remained unanswered is

whether a living donor has the right to know the beneficiary of the transplant. It is
understood that where the person needing transplant is a family member or a close

relative, such knowledge is almost inevitable since the person in need is often

involved in soliciting for or negotiating for the organ. The researcher is of the view

that legislation empowering the donor (where such desire is expressed) to have a

knowledge of who is actually benefiting from his gift. This proposition is without any

malignant intent or prejudice on the end recipient, but is a way of possibly

encouraging a more eager voluntariness to donate. Also, such knowledge proves

needful because, for instance; the donor may suffer irreversible psychological trauma

that may even result to suicide if he or she discovers that the beneficiary of his

donated organ was legally proven to be responsible for the gruesome murder of his or

her relative, or possible responsible for a damage that has left him or her with an

emotional scare.

On the other hand, one may also be more motivated to donate part of his organ to say

to a person needing transplant if he has knowledge of the financial or social state of

the person. For instance, in our society, one is more likely to be moved to help the

indigent poor and needy than they would to help a corrupt politician out of a straight.

Such knowledge does not in any way discredit the value of the donation as it would

also be accompanied by another legislation that will protect the beneficiary from

exploitation and harassment of any kind in the future. Knowledge of the beneficiary of

the donor (by the donor) will also help clear the air of all suspicions of the beneficiary

being charged for the organ at the transplant centre). In a way, even Jesus Christ who

donated his life as a ransom for humanity had a good knowledge of what he was to

suffer and who the beneficiaries of such a price would be.

Organ donation is not out rightly condemned in Christianity. As a matter of fact, the

Christian faith encourages all acts that are aimed at saving human life. However,

concerns in this practice set in when it is observed that procurements of body organ

and tissues are being made through questionable and criminal means and motives. The

bible upholds the sanctity of human life and warns against exploiting even the frailest

and smallest life in an attempt to benefit another. Also, it is imperative to state that

consent is not truly a consent if obtained either by questionable legislation, unhealthily

incited or obtained by fraud without a proper understanding of the pros and cons of

the consent by the donor. Organ donation is a great good done by biotechnology,

however, such good must be done and monitored under strict observance of laid down

ethical rules and practice.