Nowadays, it is possible for patients with organ failure to live for decades after receiving an organ transplant. Since the first successful kidney transplant in the 1950s,1,2 advances in the procedure, including the improvement of drugs that facilitate acceptance of the foreign body parts,3 have allowed surgeons to transplant a wider variety of organs, such as the heart, lungs, liver, and pancreas.2,4 Over 750,000 lives have been saved and extended through the use of organ transplants, an unthinkable feat just over 50 years ago.2 Limitations to organ transplantation, such as the lack of available organs, and the development of new advancements that can improve the process promote ongoing discussion regarding the ethics of transplants.
The idea behind an organ transplant is simple. When both the recipient and the new organ are ready, surgeons detach the blood vessels attached to the failing organ before putting the new one in its place by reattaching the patient’s blood vessels to the functioning organ. To prevent rejection of the new organ, the recipient will continue to take immunosuppressant drugs3. In exchange for this lifelong commitment, the patient often receives a longer, more enjoyable life.2
The organs used in transplants usually originate from a cadaver or a living donor.1-3 Some individuals are deterred from becoming an organ donor because they are concerned that doctors will not do their best to save them if their organs are needed. This concern is further complicated by blurred definitions of “dead”; in one ethically ambiguous situation, dying patients who are brain dead may be taken off of life support so that their organs may be donated.1-3 Stories of patients who reawaken from comas after being pronounced “dead” may give some encouragement, but a patient’s family and doctors must decide when to give up that hope. Aside from organs received from the deceased, living donors, who may be family, friends, or strangers to the recipient, may donate organs that they can live without, such as a lung or a kidney.1-3 However, the potential injuring of a healthy person for the sake of another may contradict the oath that doctors take, which instructs physicians to help, not harm their patients.1
One of the most pressing issues today stems from the following question: who receives the organs? The transplant waiting list is constantly growing because the number of organs needed greatly exceeds the number of organs that are available.1-3 Unfortunately, 22 patients die every day while they are waiting for a new organ.4 Because the issue of receiving a transplant is time-sensitive, medical officials must decide who receives a transplant first. Should the person who needs a transplant the most have greater priority over another who has been on the waiting list longer? Should a child be eligible before a senior? Should a lifelong smoker be able to obtain a new lung? Currently, national policy takes different factors into account depending on the organ to be transplanted. For example, other than compatibility requirements, patients on the waiting list for liver transplants are ranked solely on their medical need and distance from the donor hospital.4 On the other hand, people waiting for kidneys are further considered based on whether they have donated a kidney previously, their age, and their time spent on the waiting list.4
Despite various efforts to increase the number of organ donors through education and legislation, the supply of organs does not meet the current and increasing need for them.1-3 As a result, other methods of obtaining these precious resources are currently being developed, one of which is the use of animal organs, a process known as xenotransplantation. Different animal cells, tissues, and organs are being researched for use in humans, giving some hope to those on the waiting list or those who do not quite qualify for a transplant.2,3 In the past, surgeons have attempted to use a primate’s heart and liver for transplantation, but the surgical outcomes were poor.2 Other applications of animal tissue are more promising, such as the use of pigs’ islet cells, which can produce insulin, in humans.2 However, a considerable risk of using these animal parts is that new diseases may be passed from animal to human. Additionally, animal rights groups have protested the use of primates as a source of whole organs.2
Another possible solution to the deficit of organs is the use of stem cells, which have the potential to grow and specialize. Embryonic stem cells can repair and regenerate damaged organs, but harvesting them destroys the source embryo.2,3 Although the embryos are created outside of humans, there are objections to their use. What differentiates a mass of cells from a living person? Fortunately, adult stem cells can be used for treatment as well.2 Researchers have developed a new method that causes adult stem cells to return to a state similar to that of the embryonic stem cells, although the efficacy of the induced adult stem cells compared to the embryonic stem cells is still unclear.7
Regardless of the continuous controversy over the ethics of transplantation, the boundaries for organ transplants are being pushed further and further. Head transplants have been attempted for over a century in other animals, such as dogs,5 but several doctors want to move on to work with humans. To attach a head to a new body, the surgeon would need to connect the old and new nerves in the spinal cord so that the patient’s brain could interact with the host body. Progress is already being made in repairing severe spinal cord injuries. In China, Dr. Ren Xiaoping plans to attempt a complete body transplant, believed by some to be currently impossible.6 There is not much information about the amount of pain that the recipient of a body transplant must endure,5 so it may ultimately decrease, rather than increase, the patient’s quality of life. Overall, most agree that it would be unethical to continue, considering the limited success of such projects and the high chance of failure and death.
Organ transplants and new developments in the field have raised many interesting questions about the ethics of the organ transplantation process. As a society, we should determine how to address these problems and set boundaries to decide what is “right.”
- Jonsen, A. R. Virtual Mentor. 2012, 14, 264-268.
- Abouna, G. M. Med. Princ. Prac. 2002, 12, 54-69.
- Paul, B. et al. Ethics of Organ Transplantation. University of Minnesota Center for Bioethics [Online], February 2004 http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf (accessed Nov. 4, 2016)
- Organ Procurement and Transplantation Network. https://optn.transplant.hrsa.gov/ (accessed Nov. 4 2016)
- Lamba, N. et al. Acta Neurochirurgica. 2016.
- Tatlow, D. K. Doctor’s Plan for Full-Body Transplants Raises Doubts Even in Daring China. The New York Times. http://www.nytimes.com/2016/06/12/world/asia/china-body-transplant.html?_r=0 (accessed Nov. 4, 2016)
- National Institutes of Health. stemcells.nih.gov/info/basics/6.htm (accessed Jan. 23, 2017)