The Ethical Way Forward for Procurement of Organs - Dissertation Example

? The Ethical Way Forward for Procurement of Organs Task: 0 Chapter 1 Introduction This dissertation aims at dissectingthe pertinent topic on the ethical way in procurement of organs. Organ procurement has been a consummately chief practice in the medical industry since it profoundly aids in saving lives of numerous scores of people who have defective organs that are vital for survival. It is a good thing to save lives of people whenever means are available to save them. Without proper procurement of organs, these people would surely be disadvantaged. Therefore, procurement is an extremely important process taken seriously, for the welfare of all humankind. Contemporarily, concerns regarding the underbelly of organ procurement have risen, bringing the issue into light. I have modelled this dissertation professionally to fill the loopholes left behind by previous scholars and researchers who have tried to address this matter. Therefore, this chapter sheds light on the history, background and the issues dealt with in the chapters that follow. It will therefore usher the reader into the stark knowledge that awaits him/her regarding the topic under study. 1.2 Background According to the Medical Conditions Dictionary 2010, organ procurement is the set of procedures that includes administrative, authoritative and ethical processes observed in the acquisition of organs for transplant via affiliations, systems or programs. The entire organ procurement procedure includes by consent seeking from the donors or donors’ relatives or acquaintances and the transportation of the organs so obtained from the donor through tissue harvesting to the respective health centres for further medical processing and eventual transplant into the recipient. Organ procurement began as a basic endeavour when affiliations that specialized in kidney transplantation obtained organs and used them to save other lives in the same facility. As the demand for organs and speciality in the transplantation of other solid organs as the heart, small intestines, pancreas liver and lungs among others augmented in the society, the dire need of developing enhanced and ethical organ procurement, distribution and sharing agreements was acknowledged (Mary et al. 2010). Because of the high demand for organs for transplant in contemporary times, numerous organizations, through the efforts of physicians, scholars and medical personnel, are operating to counteract the looming shortage to avoid deaths. I would wish to expound on this aspect by drawing an instance of organizations that are pertinent to enhance the entire organ procurement procedures. This addresses the dire need for organizations to come up to ensure that organ procurement continues as it should. For instance, affiliations and networks such as the SEROPP, SEOPF and OPTN in the US were formed that operated within the constitution to introduce efficient organ procurement enhancements that resulted into the betterment of the entire process. Some of the enhancements include tissue typing, computerized kidney-matching, educational programs regarding organ procurement and government controlled systems that improved and controlled identification of organ donors (Mary et al. 2010). The procurement procedure is a procedural process that involves initial identification of brain-dead givers. The concerned physician conducts this practice. Hospital guidelines and the laws of the state are extremely imperative in the determination of the brain-dead patients. The patients stay under ventilator machines as physicians conduct further procedures on them. On completion of verification of brain death of the patient, the procurement body gives the guidelines and details of what needs to occur before transplantation. The core purpose of contacting the procurement plant is to allow discussion with the family of the deceased regarding procurement of the donor tissues or organs for further transplantation. Procurement body consultation is consummately augments consent by the concerned families regarding willingness to authorize the donation of their relatives’ organs and tissues. What follows is organ matching, diagnosis and procedures that validate successful transplantation of organs from the donor to the needy recipient. Careful dissection and removal of the organs is imperative in the surgical units as the patient receives treatment as other brain-alive people. Another debatable issue is the eventual step in organ procurement, before transplantation to the terminal patient. Since numerous needy patients are waiting for the transplantation with the procured organ, various schemas apply in the determination of the suitable recipient. Mary et al. (2010), postulates that factors such as pending list time, illness severity and proximity to the donor centre calculate the patient score, whereby the one with the highest qualifies for the transplantation. The allocation system is, however, different from organ to organ, regarding the ischemic time for that given organ. Ethical concerns arise in various organ procurement procedures, principally regarding their appropriateness and validity. Religions are the most observant of the organ procurement and regularly critic it, founded on their beliefs. This religious aspect has affected the number of organ donors in the world either positively or negatively. Secondly, procurement of organs from live donors to benefit others is another cropping issue in organ procurement. I would like to touch on legal and ethical aspects surrounding this issue. According to Wilkinson (2003), most of the legal and ethical concerns that connect to the process of organ procurement are in the light of several factors as informed consent, benevolence, common good and fairness, reverence of human integrity and dignity and non-maliciousness. Sale of human organs and tissue is regarded respect for the autonomy but is disrespect for human dignity as it confers the human body parts as commodities that sell at a price. Apparently, sale amplifies the organ supply as people want to make money in exchange. Wilkinson (2003) argues that media publicity in organ procurement brings about effectiveness in the field as more donors present themselves. However, other scholars as garret et al. argue that the practice of publicizing organ procurement ought to end immediately because it is unethical, in terms of respect for the cadaver and the bereaved family among other reasons. Various kinds of consent apply in organ procurement. Voluntary consent is the whereby the individual donor makes their liberal will to offer their organs for transplantation to needy patients after passing away or when alive. Other kinds of consent include routine inquiry, family consent and presumed consent and RRC. The first and latter consents serve to counteract organ loss when the individual had not expressed presumed consent and when the family was not consulted for consent after the demise of the individual. This is a correctional measure for acute organ shortage in this epoch when there is augmenting demand for organ transplants (Wilkinson 2003). The issue of physicians as requestors for organs from the donors or the family of the donor is under discussion. Physicians should serve to prepare the family for organ donation while taking care of their imminent loss. The physicians should act as a bridge between the organizations that procure organs and the families since they are win close acquaintance with the family of the donor than they themselves. However, issues regarding the unfamiliarity on the part of the physicians to discuss organ donation with the prospective donors or the donor’s family in pursuit of consent prior to the procurement. Additionally, some physicians find themselves unsuitable to be organ requestors, regardless of their close association with the donor or the donor’s family. According to Department of Health, Organs for Transplants (2008), a conflict arises in the course of the physician-applied requests. On one instance, the physician acts as the principal advocate of the patient, taking care of their medical requirements and uttermost care as life ends. On the other instance, the physician acts as the selected organ procurement representative, acting on behalf of the recipients. The physicians’ ethical and legal commitment to benefit their patients is undermined as the physician is stuck between the dichotomous roles. With regard to the ethical concerns sounded by the physicians’ involvement in the organ procurement procedure, Department of Health, Organs for Transplants (2008), postulates that elimination from the organ procurement procedure may be counterproductive in organ procurement. This is because designation of other potential organ procurement representatives would be unproductive due to their massive distance from the donor’s family or rather the donors themselves. According to Nuffield Council for Bioethics (2011), Procurement of organs from other species has brought about ethical issues with regard to the effects and implications that those organs have on the human recipient. This process is Xenotransplantation, which carries several quandaries and risks with it. A perfect example of xenotransplantation is the case where a physician transplanted a baboon heart into a dying young girl’s body. She later died due to tissue rejection by the body. It is evident, therefore, that the human body can reject tissues and organs from other animal species. However, in order to enhance the procurement procedure, the physicians have inculcated human grafts into animals such as pigs to accustom the pigs’ bodies to the humans’ such that the human bodies will not reject the grafts from pigs. Additionally, xenotransplants bring about concerns of introduction of animal diseases into the human species, by making virus species harmless to the animals to mutate into the human bodies in deadly forms, such as the HIV virus. Additionally, there is dire need for education of the entire public and the health practitioners, without exclusion of the physicians regarding the entire organ procurement procedure, and its importance in saving needy recipients. Wilkinson (2003) postulates that people have numerous fears regarding organ donation since they are under-informed on the benefits of voluntary expressed consent among other superstitions that hinder them from signing donor cards, despite their willingness to donate their organs to the needy recipients on demise. This brings about a shortage in the organs needed for donation. 1.3 Conceptual Underpinnings for the Study 1.3.0 The dead Donor Rule In this dissertation on the ethical way forward for procurement, the dead donor rule is stressed on with regard to the tenets and ethical norms that it stipulates. One of the stipulations define that the most vital human body organs such as the heart, liver and kidney among other should only be procured from dead patients and not live human beings. This is because this can lead to organ shortage or instil further complications on the donating individual. Additionally, it states that the process of organ procurement should not result into the death of a living individual or donor and the living donors. According to Erin and Harris (2003), deliberate violation of any of the above stated stipulations would confer legal repercussions since it is a violation of the laws of the government and constitutes euthanasia. According to Truog and Miller (2011), death is as the complete termination of the entire functioning of the organism as a whole. However, contemporarily, death is the termination of the integrative functioning of the brain and its entire parts. They argue that brain death is not a credible standard for establishing death of a patient and confirming them as prospective donors. This is because most of these individuals still portend neurological traits and processes that manifest through sexual maturation, metabolism and secretion of the hypothalamic hormones among others. 1.3.1 Consent Seeking Procurement affiliations experience a huge task in the procurement procedure since they are actively involved in the communication with physicians in the health facilities concerning deaths in their premises to initiate the process of consent seeking from the family of the dead. In this particular case, the physicians are organ requesters and mediate between the families and the procurement affiliations. This fact introduces an immense clash in ethical standards that govern the working of the physician as stated by Department of Health, Organs for Transplants (2008). This clash comes up by the professional obligation of the physician to take care of their patients and, similarly, the role of the physician as the selected organ requestor in the procurement procedure for the sake of the needy recipient patients. However, the consent process ought to be voluntary and informed as Truog (2008) states. Statistically, it has been proven that at least 50% of those willing to donate have discussed their decision with their families (Sheelagh and Margaret 2008). Additionally, in the UK, approximately 28% of the adults have registered in the ODR, with the youths forming a majority of the registered, with a toll of approximately 58%. Generally, the awareness of the presumed consent is very low. This occurs due to lack of opportunity, awareness and information regarding the importance of the practice. Additionally, families may fail to give consent for organ donation in the event of death of their own. The cause of this may be emotional overwhelming, religious and cultural reasons, negative notions on organ donation among numerous other causes. These quandaries have resulted into less effective organ procurement procedure. 1.3.2 Presumed Consent and Mandated Choice Presumed consent is the prior declaration by individuals to have their organs donated to needy recipients at death. Lawson (2008) postulates: numerous people have succumbed to lack of organs for transplantation when such a problem is preventable. The core reason behind this quandary is because most of the people shore up organ donation but they barely make an effort to register and obtain organ giver cards. This way, most of the bodies containing useful transplantable body organs that can save lives end up buried. Presumed consent is an informed and voluntary process that should be educated to the masses for the people to authorize procurement of organs from their bodies once they demise. Presumed consent, therefore, will lessen the burden of seeking consent from the families. It also confers respect to the decision of the individual to donate their organs. However, some medical plants violate the so-called consent by application of automatic organ donation. Additionally, according to Lawson (2008) the consent does not manifest when the medical plants and affiliations have to preserve the part of the body required for transplantation. Patients without the mental ability to make consent in this context have their interests violated. A major issue that the jurisdiction is overriding autonomy, though for the benefit of needy people, is debatable. The subsequent sections dissect these issues in a clear way. 1.3.3 Organ donation ethics Organ donation is a worthy issue as it leads to saving of human lives in a big way. Issues that undermine the willingness of the prospective donors to donate their organs after death with respect to the dead donor rule and through the presumed consent affect organ donation. Because of this quandary, the organ donation ethics have to transform with immediate effect to save more lives. The ethics should go to the masses to inform them of the significance of organ donation with respect to saving lives (Harris 2002). Additionally, numerous other enhancement processes that make organ donation successful ought to apply. These include proper donor identification, proper screening and matching before transplantation, encouragement and respect of individual consent, creation of transplantation hotlines, offering professional support to surrogates and overall organizational support for organ transplantation. Additionally, it is imperative for people to join the ODR to save live after death. These initiatives will build up the ethics of organ donation with proper procurement as explicitly discussed in the subsequent sections in this dissertation. 1.3.4 Controversies and the Ethical Way Forward The issues revolving the entire process of organ donation, procurement and transplantation are critical with regard to the critics’ viewpoints on the ethical validity and quality of the respective processes. In this case, I shall highlight the contemporary occurrences in the entire medical arena. For Instance, there is consummate evidence behind contemporary practices in the field of organ procurement. For example, modern physicians have delved into unethical practices that make the procurement procedure questionable. In this case, I would give an instance of a physician who gives excess morphine and anti-anxiety medicine to hasten his death. The physician bears the guilt of abuse of a dependent patient. Therefore, as much as the physician’s actions are understandable, they are controversial too, since the physician is supposed to take care of the interests of the patient. In accordance with my studies, I found out that the dead donor rule is controversial in the actual determination of demise. The neurological standard of death establishment is unclear. The demarcation between brain death, through termination of brain functionality and cardiac failure, through termination of the functionality of the brain is perturbing. The brain death mode of death determination, currently utilized is unjust since brain death does not lead to termination of metabolism and functionality of the heart and the whole body. Unlawful issues of organ trafficking and sale still surrounds the organ procurement procedure. All of these issues come out well in depth in the chapters that follow. The core purpose of this study aims to investigate, describe and develop the wide topic of organ procurement starting from the processes of procurement and the donation, involving the government and the citizens, who are the donors. The study espouses the ethical concerns relating to organ procurement and donation. Considering that, these practices are extremely imperative, consummately important and worthwhile in saving lives in the modern population where the organ demand exceeds supply, posing a threat to the people who have terminal illnesses affecting some of their vital organs that are necessary for life sustenance. Procurement of these organs that are required in transplantation is, therefore, a profoundly fundamental activity that ought to be carried out ethically to enhance saving of lives and avoid controversies that dwindle the faith of the donors, undermining organ donation. Ethics, being an extremely important quality in human beings, needs to apply in this field to make sure that the looming organ shortage declines for the betterment of humankind. Numerous aspects of this study fills the loopholes that previous researchers have not managed to address properly, with regard to the ethical ways forward in the organ procurement procedure. The dissertation succinctly lays bare the underbelly of the unlawful practices employed in organ procurement by people, health practitioners, physicians and the administrative affiliation. With the exposition accomplished, what follows is a detailed recommendation of the best ways to counter and dealt with the quandaries related with the processes of organ procurement. Also espoused are the different aspects of consent seeking and death determination among other important processes. 1.3.5 The collection of information for a number of trade has slightly affected the study-offs, though, I have countered. Most of these quandaries are due to independent factors that are merely controlled. Additionally, various assumptions come up in the study since information available may not be credible or are undermined. However, the information available in all the sources fuses to develop good and adequate findings. Some of the assumptions are that the statistics merely change by a wide index over time since the quandary is not fully resolved or due to introduction of new setbacks in the field of organ procurement at almost the same rate as there are counter controls.. With adequate controls for the deficit in information, the study is up to standard and is credibly applicable in future researches by upcoming and existing researchers. The wide array of information sources from which most of the content of the study is derived makes a perfect design control that truncates shortage of information and consummate evidence required for an ingenious study. 1.4 Definition of Key Terms I have used numerous terminologies throughout the study. The advantage is that most of the terminologies are globally recognized. Some of them are common to most readers while some are more technical for the common reader to understand. However, I have expounded on both terms, since, they are consummately important for the reader to comprehend the core concepts and underpinnings of the study. Most of the organ procurement terminologies are biological while others are medical. Others are abbreviations distributed throughout the entire dissertation study. The key terms include: Actual Organ Donor: Deceased or alive person from which one or more solid organ or tissue has been recovered for transplantation (WHO 2009). Allocation: Assignment of an organ for transplantation to a candidate (WHO 2009). Allogeneic: Tissues or organs transplanted from the donor to the recipient (WHO 2009). Brain Death: Irreversible standstill of brain stem activity. A brain dead individual is considered dead, though, can have their cardiopulmonary functioning active through ventilator system (WHO 2009). Cardiac Death: Irreversible termination of respiratory and circulatory activity. A cardiac dead individual can give their vital organs (WHO 2009). Certification of death: Standardized documentation for demise (WHO 2009). Consent to donation: Valid legal authorization for removal of organs or tissues for transplantation (WHO 2009). Deceased Donor: An individual who is declared valid for donation of organs for transplantation through neurological and cardio-pulmonary decisive factors (WHO 2009). Donor: An individual who is source of organs for transplantation (WHO 2009). Living donor: A living human being from which organs or tissue can be recovered for transplantation (WHO 2009). Presumed consent: Legally lawful presumption of authorization to recover organs for transplantation in the event of absence of individual refusal of the same (WHO 2009). Procurement: Procedural identification of a prospective donor, analysis, consent seeking, maintenance and the actual recovery of organs and tissues for transplantation (WHO 2009). Recipient: An individual in which organs or tissues have been transplanted into (WHO 2009). Recovery: Obtaining of organs from donors for the purpose of transplantation (WHO 2009). Time on waiting list: The time from placement of a recipient on the waiting list until the time of organ reporting when the recipient is removed from the list (WHO 2009). Transplantation: The process of grafting organs or donated tissue in a recipient to restore body functionality (WHO 2009). Waiting list: A list of recipient candidates waiting to receive organs or tissues for transplantation (WHO 2009). SEROPP: South Eastern Organ Procurement Foundation. SEOPF: South Eastern Organ Procurement Foundation. OPTN: Organ Procurement and Transplantation Network. RRC: Required Request Consent. 1.5 Summary The chapter one of this dissertation succinctly expounds on the key aspects of the entire study about the ethics in organ procurement to be taken into consideration for the purpose of preparation of the actual study in the subsequent chapters. This chapter mainly describes the main topic for the reader to comprehend and understand since the next chapters will get into deeper details of the study about the ethics in organ procurement. The study will discuss practically everything regarding the topic of study amid several limitations explained for under the limitations and design controls section. Chapter three outlines the methodology and research design where actual data gathering is performed. After the information is collected, chapter four constitutes the detailed analysis of that particular data to derive useful facts and viable information. The final chapter, chapter five which closes the entire dissertation, deals with the findings or results, conclusions and implications derived from the study. It provides a complete summary regarding the study topic, the ethical way forward for organ procurement. 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