Tuesday, 22 February 2011

Ethics of Transplants

This has come up recently:

Should a convicted sex offender be accepted as an organ doner?

Just off the top of my head ...

The morality of the donor can impact the medical risk to the recipient ... someone convicted of sex offences could pose a higher risk of disease. This risk would need to be balanced against the need for the organ. We should realise that there are restriction on all srts of biological material donated by the public, for instance, you cannot donate blood if you have visited some countries. It is not always proactical to screen people who are seen to be high risk to the extent needed to be assured that the risk is justified.

In this case we are assured that the offending in question was non-contact and of a manner which does not lend itself to the conclusion that the donor was engaged in risky activity.

The situation of the donor refects the freedom of the choice they are making to donate. A prisoner of the state may feel, whatever the actual situation, that they are compelled to make the offer. By definition, a prisoner is not free. Even if we can determine that a particular prisoner is makig a free and informed choice, accepting the offer may lead to a situation where other prisoners feel pressured to follow suit.

The organisation performing the operation is also at risk.
The operation harvesting the organ is, itself, risky - as is follow up treatment for the donor. If anything went wrong, the surgeon etc are vulnerable to the accusation that they were less careful than they would otherwise have been.

But thats just me: have a look at this.
Nondirected donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life-threatening sacrifice for a stranger calls for careful scrutiny. One recent case involved a man who seemed pathologically obsessed with giving away everything, from his money to his organs, saying that doing so was "as much a necessity as food, water, and air."[3] After donating one kidney to a stranger, he wondered how he might give away all his other organs in a dramatic suicide. Other psychologically suspect motivations need to be ruled out as well. Is the person trying to compensate for depression or low self-esteem, seeking media attention, or harboring hopes of becoming involved in the life of the recipient? Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern.[1]
The references are:
[1] Abecassis M, Adams M, Adams P, et al. Consensus statement on the live organ donor. JAMA 2000;284:2919-2926.
[3] Parker I. The gift: Zell Kravinsky gave away millions: but somehow it wasn't enough. The New Yorker. August 2, 2004:54-63.
John Campbell was asking the wrong questions.

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