Organ Donation and Transplantation Ethics: New Developments
By: Daniel Z. Buchman1 and Linda Wright2
1MSW, RSW, PhD, Bioethicist, University Health Network, Multi-Organ Transplant Program
2Director of Bioethics, University Health Network
Member, Joint Centre for Bioethics & Assistant Professor, Dept. of Surgery, University of Toronto
The ethical issues in organ and tissue donation and transplantation are often in the news, as we debate fair, reasonable, and respectful ways to find and distribute this scarce life-saving resource. Global developments in donation and transplantation technology, policy, and law have raised new ethical issues, including the use of social media, transplant tourism, incentives for donation, vascular composite allografts (VCA), and innovations in organ donation from living donors. Transplant centres, which strive to enable life-extending and -saving transplants, are often on the front line in deciding how to respond to these new situations. Two very topical issues are VCA–which is not done in Canada yet but has been performed elsewhere–and social media, which have become an integral part of daily life and force us to address new situations in our healthcare.
VCA Donation and Transplantation
VCA include face, limb, and keratolimbal transplantation. They differ from other organ transplants in two important ways. First, the transplanted body part is external, visible, and touchable, which may raise issues of personal identity and bodily integrity for the recipient. Ethical issues associated with identity have also been observed in solid organ transplant recipients also. Second, the body part is not needed to save a life, unlike heart, lung, or liver transplants. However, a person who is missing two hands could find much greater utility with a hand transplant. Consequently, the risk-benefit ratio for the recipient is different (e.g. limb recipients need to balance the risks of immunotherapy against the option of a prosthesis). Limb and face transplants can reduce suffering, enhance quality of life, and improve sensation and functionality. Ethical issues to consider include the possibility of a recipient becoming known to the deceased donor family, who may wish to revisit a part of the donor’s body (e.g. a parent could hold their child’s hand again). Ethical issues include balancing the potential benefit of the VCA to the recipient against asking donors and their families to donate these body parts.
Social media provide several opportunities for people, including finding living donors through Internet websites, and raising awareness of the need for organs. Some initiatives have been very appropriate and successful, such as Hélène Campbell’s campaign to encourage people to consider organ donation, which garnered attention from celebrities Justin Bieber and Ellen DeGeneres. This drew a lot of media space and led a large number of people to sign their donor cards. At the same time, social media enable people to find each other by sharing stories. Anonymity of deceased donor families and transplant recipients may be threatened when people share news, bringing either positive or unwelcome outcomes. Websites where those who need organs can post their stories in the hope of finding a living kidney donor offer important opportunities for people who do not have a living donor among family members or friends. However, problems may arise for both the recipient and the potential donor. People who respond by offering a kidney may not have a good understanding of what is involved in donation and can find themselves drawn into an arrangement that they ultimately do not like. Recipients need to be wary of accepting a kidney from a stranger whose expectations of the newfound relationship may not match their own. Transplant centres perform vigorous evaluations of potential living donors and their recipients to ensure that ethical standards are met. In particular, they aim to ensure that all living donors are acting voluntarily and are making donation decisions based on accurate information.
Transplantation enables life. Ethical issues challenge us to find acceptable ways to enable responsible innovation through thoughtful analysis and creativity.