The Organ Transplant System in the United States: Studying Health Behaviors - Research Paper Example

Abstract The organ transplant system in the United States has been designed so that need is the primary concern over those considerations of socio-economic status. However, because the transplant lists are so long and organ donation is a voluntary option which requires consent, the lists of those needing donations do not approach being fulfilled. There are a great number of ways in which organ transplant availability can be improved. Those improvements would increase the number of lives saved. Putting a social priority in place and imposing regulations that require donation when possible will help to increase the number of patients saved by organ donation. In addition, opening the avenue of commerce for body part sales from live donors will allow for more lives to be saved when the social concept that it is unethical is removed. The integrity of the medical community is one of the primary concerns in the idea of making medical care subject to commerce. However, the United States already limits health care to those who can afford it. Therefore, selling organs in an open, but controlled market is not against the ethics of the medical community and will allow for more patients to receive the treatment that they need in order to promote longer, healthier lives. Organ transplants: Selling body parts for profit Organ transplants depend upon donations from the loved ones of people who have died or the loved ones of those who need an organ that can be taken from a live donor with still preserving that life. Blood can be donated in bulk along with plasma. Sometimes blood banks pay for donations of blood. However, selling organs is strictly forbidden, thus contributing to a burdened system that has long lists of people in need of transplants. When discussing the sale of organs, the issues that prevent this from occurring are based upon ethical standards of practice. These ethics are put into place for a reason; however, framing the issue differently might provide an ethical way in which to encourage more available organs while still preserving the integrity of the medical industry. Examining the topic of organ donation requires studying health behaviors. Health is a social issue, the ways in which health issues managed part of a social construction of behaviors in which medical personnel and patients interact towards defining the experience of illness and disease (Siegel and Alvaro 4). While the medical science provides treatments for health issues, society creates structures for administering those treatments. The frustration that many patients have is that there is treatment available, but the necessary components needed, whether that be federal laws, money, or medical materials, are not available. At this point, the social system reveals one of its flaws. In the case of organ donation, the lists are much longer than the availability of the required organs. Thus, the drive for organ donation becomes vital in providing the quantity of organs needed to save those that are suffering from various diseases. When considering all types of transplants, including tissue transplants, the chances of a person needing some form is one in two people (Institute of Medicine Committee on Rates of Organ Donation, 2006, p. 293). According to UNOS (United Network for Organ Sharing) (2011), the total number of people who are active on the organ transplant list is 72,260 with 110,624 total on the list as of 2:07pm on April 1, 2011. The difference is caused by those who are on the list, but who are inactive because they have become medically ineligible, either temporarily or permanently. From January to December of 2010, there were 28,664 transplants from 14,506 donors (UNOS). This difference reveals a disparity between the number of available organs to the actual need. In Africa, Asia, Europe and South America, the commercialization of organ transplants occurs, with renal transplants being one of the more commonly sold form of transplant. Kidneys are sold in South Africa, China, Iran, Iraq, Lebanon, Pakistan, Philippines, Turkey, Bulgaria, Estonia, Georgia, Romania, Russia, and Brazil. The problem with much of the proposition of selling kidneys is that those who sell them are most often of a lower socio-economic status, thus allowing them to undergo the risk of the operation out of desperation for economic remuneration. In 1988, Iran developed a paid, non-related kidney donation program and since that time over 12,000 kidneys have been transplanted. The government funds the program and it has solved the problem of those who were wasting away on dialysis and dying long before a kidney could be found through cadaver donation (Gruessner and Benedetti, 2008, p. 13). The initial problem with this, of course, is that it exploits the socio-economic position of the poor. While the success of the program is undeniable, the moral and ethical issues that it raises have been the center of hesitation for the institution of such a program in the United States. According to Gruessner and Benedetti (2008), “Any attempt to assign a monetary value to the human body or its body parts, even in the course of increasing organ supply, diminishes human dignity and devaluates the very human life physicians have nobly dedicated their careers to saving” (p. 98). In arguing against the sale of human organs, Guessner and Benedetti (2008) go on to say that “It is an unethical approach to shift the tragedy from those awaiting for organs to those exploited into selling them” (p. 98). From this perspective, it is the dignity of the medical profession that is at stake when considering the sale of organs. Hinckley (2005) suggests four possible scenarios that can relieve the organ transplant issue so that more people can be helped by the technology of replacing body parts that are no longer functioning correctly. The first set of solutions provides that the current state of legal brain death be revised and that the harvesting of organs be a routine procedure that is expected upon the death of a viable patient. The need for consent, under this set of solutions would be eliminated. In addition, xenotransplant and stem cell research would be released from the current legal constraints so that these solutions could be more viable towards relieving those suffering from relevant medical issues (p. 156). The second set of solutions that Hinckley (2005) discusses concerns maintaining the status quo in regard to brain death definition, but increase the xenotransplant and cell stem research. The third set of solutions proposed concerns eliminating the need for consent where organ donation is concerned and allowing for any parts that are viable to automatically be taken. This set would also allow for the sale of a person’s own organs with permissions for taking organs after they die which could then be used by the buyer as needed. The final suggested set of solutions involves retaining the current level of lawful definitions concerning brain death, allow people to sell their own organs previous to death or to give consent before death. Preventative medicine is actively pursued in order to reduce the number of people on the organ transplant lists (p. 156). Xenotransplantation provides for the use of organs from different animal species in place of a human organ and tissue transplant. In this case, the animal is not always dead when the surgery takes place, thus taking a life in order to create the transplant. The predominant support for the use of animals for transplants is that it would increase the number of patients that can benefit from transplant surgery. The dire shortage of organs can find a solution through cross species transplants that provides for the use of animals in ways that is objected to for the use of human body parts (Saloman & Wilson, 2003, p. 2). Of course, those who support animal rights find this to be an objectionable form of medical treatment as it costs the lives of those who cannot provide consent nor understand the sacrifice that is imposed upon them. One of the intended uses of embryonic stem cells is in growing replacement organs for those who are in need of a transplant. The science involves creating a cloned embryo and when an organ, such as a kidney, begins to develop, those cells are taken from the embryo and then grown separately into a kidney. This brings many objections from religious leaders who believe that life starts when sperm and egg are joined. In that point of view, it is killing life in order to harvest cells. The objections are passionate and fierce, stemming from the original debate about abortion. The use of embryonic stem cell research is not supported by funding from the United States government, thus limiting the resources that go into investigating this solution (Forman, 2008, p. 27). The first set of solutions offered by Hinckley (2005) would be the best possible set for improving the overall prospects of those on organ transplant lists, but it also provides the largest level of controversy. None of his solutions allow for the concept of live donor sales of organs that can be taken without costing the life of the donor. The question about the ethical nature of buying organs from live donors appears to center on the needs of the medical profession without a consideration for the needs of those who would sell the organs and those who would benefit from receiving those organs. In the United States, there is a presumed moral status that is conferred upon the dead. However, reframing the way in which organ donation is approached will reduce the number of people who die needlessly when the technology exists for treatment. Before any other changes are made in the way in which organ donation is approached, the first change should be the expectation that organ donation upon death is non-optional. The idea of consent should have no influence on the harvesting of organs from those who have died. The state imposes its will in the case of murder or possible disease control issues where a dead body is concerned. Therefore, it is not unreasonable to create the legality of imposed organ donation on all viable deaths. The public need is sufficient enough to be considered a crisis and to warrant this action. The statistics from UNOS shows the great need that is present in regard to organ transplant. Enforcing the use of valuable body parts for the continuation of life for those who have a chance should not violate the morals of anyone’s life. However, this has not proven to be the case. While 90% of people surveyed indicate that they have “no moral objection” to organ transplant, only 45% say they would donate their own organs while 50% say they would agree to donate the organs of their loved ones (Trzepacz, & DiMartini, 2000, p. 289). The idea of organ transplant is more comfortable when it concerns an unknown set of people rather than the immediate social sphere of an individual. Therefore, this issue is an emotional issue that is tied to grief and attachment to the life of potential donors which is irrelevant to the use of their organs after death. Rational belief in the positive use of cadaver parts must be made through the legislation of those who are separate from the immediacy of the death of loved ones. When in the emotional state of grief, family members should not have to make the choice of whether or not to have their loved ones cut up and disposed of through organ donation. If the state makes this decision, then loved ones are no longer forced to make such a decision. It would become as expected as embalming or any of the other less than appealing aspects of preparing the body for burial or cremation. According to Laureys and Tononi (2009), brain death was not always accepted as a means of declaring death by a doctor. It was not until the year 2000 that the Roman Catholic Church sanctioned this form of declaration as valid. Judaism still debates the issue and has not agreed to the viable nature of declaring death when the brain is no longer functioning. There are many religious concerns for considering the concept of brain death, but it has been accepted through the legal system. Whole brain death is defined by “the irreversible cessation of the critical functions of the organism as a whole” (Laureys & Tononi, 2009, p. 152). Brain stem death is concerned with the irreversible state of never again being able to attain a conscious state. The concept of irreversibility is a fine line of judgment that is made by doctors after a series of tests to determine the probability of return. While the tests can define that it is improbable of any real meaningful recovery, saying that brain death is absolute is not truly possible. However, it has been determined that certain parameters meet a legal definition of death. The reason for allowing for a determination of brain death is specifically for the purposes of organ donation. According to Laureys and Tononi (2009), “The principle reasons for societies to allow physicians to practice brain death is to acknowledge biological reality, particularly with advances in ICU technology that permits increasingly prolonged physiological maintenance of a patient’s organ subsystems after the demise of the organism as a whole” (p. 159). In creating this purposeful scenario, the harvesting of organs can be done in a more meaningful way as the body is sustained after the consciousness has passed the point of being ever viable again. This is an example of the state imposing their impartial decrees of the state of a person’s viability in order to have a disimpassioned structure from which to define death. With ICU capacities to prolong the life of the body, the state has stepped in and given physicians the capability to recognize the loss of life through brain function. As it pertains to organ donation, this allows for a better situation from which to harvest organs. In this same manner, the state can step in and make the decision to take organs without the consent of the family, thus protecting the public from having to make the hard decision during a time of crisis, just as the declaration of brain death prevents prolonged costs in keeping a body that responds to stimulation alive past the biological reality of death, so too would state mandated harvesting of organs be socially excepted as the choice was taken out of the hands of the bereaved. In discussing the concept of the legalization of live donor organs sold for profit, it has first been important to create a circumstance in which the importance of organ donation has been separated from the cultural idea of morals that are conferred upon the body of the dead to the ideals of a state that mandates the importance of donation in order to serve the over 100,000 members of the transplant list as they still are alive. Their lives, if they receive a transplant near the beginning of their need, can better be served when there is enough of a stock of organs that can provide for sustaining their lives. If culture is trained to accept it as part of their responsibility in participating in society, then the moral objections will fade and eventually be outside of the majority of those who might initially object. The importance of this step in making the crisis of low organ donation figures in comparison to the number of people who need donation is in instilling within society the need for a shift in the way in which organ donation is approached. Once the importance of increasing the number of organs available to those who need a transplant has been instilled within culture, the moral and ethical problems revolving around the idea of paid participation in live organ donation can be shifted. While there are viable alternatives to the sale of organs from live donors, this option provides a great many opportunities to both the donors and to the potential recipients. The expectation of automatic organ harvesting from those who have died and have viable body parts for transplantation would decrease the public need for human organs. However, this would not completely take care of the issue. To further the opportunities for those on the list to get matching donations, the sale of organs from non-related donors would give others the opportunity for life through a controlled market of options. While the fear of exploitation is a viable concern, that fear can be alleviated by safeguards that allow for appropriate counseling that provides for a healthy participation. This is how surrogate motherhood is accomplished and could be extended towards live donor participants. The money that is made by the donor could allow for the use of those funds to help someone who has a goal or a need that would otherwise go unfulfilled. In addition, it is unreasonable that the ethics and integrity of the medical community would be compromised as long as high levels of adequate medical care was given to the donor and continued care for any later problems was ensured. Medical professionals make large sums of money off of their care of patients; therefore the idea of financial gain for donors should have no impact. In addition, people undergo elective surgeries in the form of cosmetic enhancements which make enormous sums of money for doctor’s who are cutting into perfectly healthy individuals for the purposes of beauty. There is no reason that organ donation should not be done under a financial arrangement in order to prolong someone’s life. Organ donation is a serious issue whereby those who are suffering from illnesses that require a human transplant go on long lists that currently cannot be fully serviced. Organ donation depends on the gift of organs from either the expressed wishes of a will or through the consent of loved ones who must make that decision during the first moments of experiencing the grief of having just lost their loved ones. While there are a series of ways in which organ transplant needs can be greatly improved, having the opportunity to sell an organ for a financial gain will help to provide organs from healthy individuals so that others can survive. In addition those funds can be used to increase the position in life that a person may face. It is only exploitation if society considers it exploitive rather than deciding that it is a positive act by the donor that helps both the donor and the recipient. Organ donations must be improved by the various methods that exist and through the advancements of medical research . In addition, recipients must be given the opportunity to purchase organs from those willing to make the sacrifice for financial gain. References Anderson, P. V. (2011). Technical communication: A reader-centered approach. Boston, MA: Wadsworth. Forman, L. (2008). Stem cell research. Edina, Minn: ABDO Pub. Gruessner, R. W. G., & Benedetti, E. (2008). Living donor organ transplantation. New York: McGraw-Hill Medical. Hinkley, C. C. (2005). Moral conflicts of organ retrieval. Amsterdam: Rodopi. Institute of Medicine Committee on Rates of Organ Donation. (2006). Organ donation: Opportunities for action. Washington D.C.: National Academy of Sciences. Laureys, S., & Tononi, G. (2009). The neurology of consciousness: Cognitive neuroscience and neuropathology. Amsterdam: Elsevier Academic Press. Salomon, D. R., & Wilson, C. (2003). Xenotransplantation. Berlin: Springer. Siegel, J. T., Alvaro, E. M., & Claremont Symposium on Applied Social Psychology. (2010). Understanding organ donation: Applied behavioral science perspectives. Chichester, U.K: Wiley-Blackwell. Trzepacz, P. T., & DiMartini, A. F. (2000). The transplant patient: Biological, psychiatric, and ethical issues in organ transplantation. Cambridge: Cambridge University Press. UNOS. (2011). Working together saving lives. Accessed from http://www.unos.org/ Read More