How can we ethically increase organ donation - Essay Example

? “How can we ethically increase organ donation?” Introduction This research paper is devoted to the discussion of a critical modern issue: organ donation. On the basis of the article “Altruism + incentive = more organ donations” by Sally Satel, ethical concerns about organ donation is considered further on. Moreover, legal principles are discussed as the crucial principles of organ donation development in UK and USA. On the examples of legal regulations adapted in UK and USA organ donation it is clearly seen that organ transplantation is currently developed in such a way that organ donation is propagated in the society as a moral obligation of all citizens. Many people die every year in a queue for a transplant. Both dead and alive people can donate their organs. Some countries have regulations and laws, which allows organ transplantation from a dead relative without agreement of his relatives. Voluntarily donation of organs leaves much to be desired. Is there a lack of monetary reward or encouragement? Are ethical issues violated in organ donation? It is necessary to draw reveal a curtain from this modern problem, because thousands of lives are at stake1. Sally Satel in her article claims that organ donors should get a worthy monetary compensation. Mere altruism is not sufficient factor to increase organ donation. In her article Sally Satel discusses an experience of kidney transplantation. A donor sacrificed his kidney for the favor of a recipient and got no monetary compensation. A mere altruism was a basis of such an outstanding gesture of a donor’s generosity. Thus the author claims that organ donation requires a strong monetary support. Generosity of human soul is not an essential factor in organ donation. Satel’s ideas are considered from ethical perspective by doctors, bioethicists and scientists2. Thus, in accordance with UK professor, “We could try to increase the number of organ donors by providing stronger incentives, such as cash, paying funeral costs or priority for an organ in future, but would this be ethical?”3 Thus in order to find the solution to the problem of a lack of organs donations is doesn’t concern monetary compensation only.  UK policy prohibits monetary compensation for people who donate their organs. UK allows covering expenses connected with organ donation. Organ transplantation is more available in other countries and those who need organs often travel abroad to the countries where it is legal or possible to buy organs in the illegal market. Of course, organ donation covers ethical and legal issues. Ethical consideration of the problem is of high relevance currently. In accordance with Professor Strathern “We need to think about the morality of pressing people to donate their bodily material. Offering payment or other incentives may encourage people to take risks or go against their beliefs in a way they would not have otherwise done”4. Currently, in order to shift accents of immoral oppressing of “people who are able to donate their organs, people are encouraged to donate their organs in the name of their beloved salvation or the whole society”.5. In the Organ Donation Taskforce report of January 2008, in order to encourage people to donate, it is relevant to solve different issues in order to provide all clinics with necessary conditions to conduct operations of organ transplantation. Concerns about non-heartbeating donation require strict legal principles. Legal principles of organ donation of patients are discussed in the Department of Health considerations. In the UK, NHBD plays a role of legal regulations occurring in case a patient dies. Moreover, the Mental Capacity Act 2005 (MCA) regulates doctors’ actions to decide in the best interests of a dying person if his brain is badly injured. In accordance with UK courts, “best interests are wider than simply treating a person’s medical condition and include a person’s social, emotional, cultural and religious interests”6. Consequently, best interests of a person are discussed with family members. Organ Donation Taskforce (2008) is another regulative document of organ donation. This document also specifies that if a person is registered as a donor, then actions directed on facilitation of this process are conducted in the best interests of a person. Legal regulations of organ transplant are of crucial importance for UK because the situation with organ donation is rather complicated in UK. “Nearly 10,000 people are waiting for organ transplant”7. UK policy of organ donation is led with an emphasis on a moral obligation of all individuals. The NHS appreciates any possibility of organ/tissue/blood/skin donation both of alive and dead donors. From legal perspective, donations of organs from children are challenging issue8. USA has developed principles of potential donors: these are people who have injured their brains and lost their consciousness. Nevertheless in such a critical situation, injured persons are surrounded by families or relatives and doctors may ask for permission to transplant organ from their beloved. The MCA is the best clinical practice9. This practice involves considerations about person’s beliefs and wishes expressed when he was alive concerning a future of his body after death. In case if further life-sustaining therapies are futile or death is inevitable, or there is a possibility of organ donation after death, doctors after MNC consent with person’s wishes may transplant an organ10. Potential donor should be protected by confidentiality. HTA is another relevant policy to be implemented. Under the guidance of HTA blood may be tested or is a person is unconscious this decision can be made in his best interests. Department of heath issued “Legal issues relevant to non-heartbeating organ donation”; it is outlined in this document that “Guidance is provided below on the Department of Health’s view of how these legal principles can be applied in the context of NHBD, including how the MCA should be interpreted to establish best interests when considering organ donation”11. The UK government is concerned about popularization of organ donation among citizens and invests ?4.5 mln in this campaign. Maybe, it is more relevant to UK “to follow “presumed consent” or “opt out” system practiced in other European countries”12. This system implies that doctors have a right to remove organs from a dead person even in case his relatives are against. Thus if a person doesn’t want to become a donor after his death he has to opt out and register for being not operated after death13. In some countries relative of the deceased are asked for permission; some minority groups are against opt out system (e.g. Muslims in Singapore). Unfortunately, opt out system is not a way out for organ donation increase. For example, presumed consent was acclaimed in Spain, but it is essential to mention that this policy managed to improve people understanding of the necessity of organ donation and not the number of donated organs. In France, where policy of presumed consent is also adapted rises a lot of controversies, when, for example, organ is taken from a deceased, but this particular organ was not specified or documented. It is crucially important to keep organ donation in the plane of a freely given gift. The issue of a free donation of organs is important both for a donor and a recipient. Opt out system requires legalization and additional financing. Children and people who have no capacity to opt out should be provided with a correspondent legal provision14. Thus currently UK attempts to put stake at propagation and popularization of the organ donation. Following examples of Spain and US, UK may attract celebrities. NHS in England intends to make organ donation more public and propagate organ donation among families as a daily life routine issue. There is an intention to organize organ retrieval teams who will be responsible for in-time and qualified organ removal. Therefore NHS directs its efforts on increase of public awareness in the necessity of organ donation. USA has another perspective of organ donation. This country believes that having rewritten legislation regulations of organ donation they would solve a problem of kidney and other body parts shortage in the country. Therefore in America doctors claim that shortage of organ donation occurs because of misunderstandings in the legislation. In Virginia, Idaho, Utah and South Dakota legislation was updated with regard to “challenging issues occurring in the process of organ donation”15. For instance, doctors are puzzled how to treat patients who have been registered as donors but are currently unconscious but stated that they are against being kept on life-support. Another challenging issue occurs when a dying person has registered as organ donor, but his relatives are against organ donation from their relatives. Therefore we can see that legal regulations of organ donation are the crucial issue of organ donation around the world. There is a necessity to develop legal principles which will help to solve a ‘critical health problem of organ donation’16. In America nearly 17 states are on their way to adapt the policy of organ donation on legal principles and spread it all over the country. Supporters of organ transplantation claim that organ donation legalization is a best way to help thousands of people. On the contrary, the model law evokes a vivid discussion among bioethicists, doctors and critics17. Opponents of organ donation legislation claim that this will turn human society in a conveyer of human body parts selling in spite of the consent with their relatives or families. Moreover, doctors may be worried to hesitate when using drugs or other morphine to facilitate dying people suffering in order not to spoil organs to be donated18. According to the last data, now there are nearly 100,000 Americans waiting for donor’s organs. Doctors have no other choice and transplant organs of patients whose brain is still alive. In accordance with bioethicist from University of Pennsylvania, Arthur L. Caplan, "We have to be very careful that we don't make people think that we don't have their best interests in mind and are just going to use them to get their body parts"19. Consequently, America underlines necessity of legal regulation of organ donation. It is not the first of America to transform legalization of organ donation. The model law was updated from, the Revised Uniform Anatomical Gift Act, 1968 legislation accepted by every state. This law was updated in 1987 and 26 states signed that law20. It was clear, that it was necessary to review medical implication of the law and the National Conference of Commissioners on Uniform State Laws worked out the amendment. It was focused on donation misunderstandings or challenging issues. Government clearly realizes that there is a need to develop laws of organ donation in order to eliminate challenging ethical issues. For example, Sheldon F. Kurtz, a University of Iowa law professor claims that death of a donor is horrible, but he considers an opportunity to find something good from it. Another amendment in a new legal regulation of organ donation is person’s decision to be an organ donor can’t be changed by another person. Consequently there is a need to facilitate a process of organ donation. Another challenging issue concerns patients who have registered as donors but don’t want to be kept alive with the help of medical equipment. In this case doctors and bioethicists object that ‘the donor card trumps the living will’. Human nature is rather controversial and some people may claim that avoidance of machinery is more important to them than donating their organs. With regard to this situation, the commission appeals to families and relatives of donors and asks them how doctor would behave in such a complicated situation. Nevertheless, ethical challenge is not facilitated, but, vice versa it is sharpened as organ donation equals to end-of-life wishes. Thus, Caplan claims that “a person's instructions for end-of-life care should always take precedence over 'make me an organ donor”21 . Thus from ethical perspective, according to Gail A. Van Norman, a professor of anesthesiology and bioethics at the University of Washington in Seattle?, “a dying person is neglected for the benefit of another patient, as claims”22. Moreover, it is relevant to introduce computerized register of potential donors. Thus potential donors can be kept on life-support until transplant may be made. Sade and other supporters of the model law claim that this model is developed with regard to potential donators and those who are no indifferent to end-of-life care23. In accordance with the representative of the Association of Organ Procurement Organizations, Christina W. Strong, "What it does is make sure that to free up an ICU bed a hospital doesn't forget the patient may have wanted to be a donor or their family may want them to be a donor"24. Therefore American society tries to balance ethical issues of organ donation and value of human life. The Journal of American College of Cardiology considers organ donation as a great sacrifice. There is another challenge which is acclaimed by ethicists and doctors: a patient must be able to pay for surgical procedure and medical services, and only after that he can be registered as a potential recipient of organ. Out-of-pocket organ transplant financing is out of legislative regulation in USA. The issue of a recipient’s ability to pay for organ transplant is a striking ethical issue. It may be interpreted in the following way: “if a person is unable to pay for an organ transplant he is excluded from the UNOS list”25. We come across a problem of lack of financial ability of poor people or minorities. At this point we meet more serious ethical problem: organ donation turns into a process happening in a context of socio-economic and racial bias26. Consequently, it is relevant to conduct a research of an international scope directed on assessment and documentation of the number of American recipients waiting for a heart transplant but can’t get it because of undermined economic status. Medicare is on the way to provide financing to patients who unable to pay for patients who need kidney transplant27. There is a problem of transplant eligibility of different organs, such as hearts, lungs, kidneys etc. Nevertheless, Mayo claims that government would reject financing on their behalf of bill for organ transplants. In accordance with beforehand calculation, Medicare would spend $190 million in the nearest future (in 5 years approximately)28. Unfortunately, legalization of organ transplantation is often challenged by an alternative of free enterprise of organ donation. A free market of organ donation would intensify a possibility of organ theft. In case this market was legalized, there would be a lot of murder accidents. In spite of the fact whether free market would be legalized or not, currently exist facts witnessing that there is theft of organs. Conclusion Voluntarily donation of organs leaves much to be desired. Unfortunately, legalization of organ transplantation is often challenged by an alternative of free enterprise of organ donation. It is relevant to look for alternative sources of financing from healthcare institutions, pharmaceutical companies, and federal government etc. In case organ donation would have efficient financing, patients who lack ability to finance organ transplant would have a chance to remain alive. This is not only fair to attract different institutions to organ donation financing, but it is as well a moral obligation of every person in the world. Both UK and America should develop legislative principles of organ donation and make an emphasis on ethical specific of this crucial health problem. 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