When I was asked “Would you like to be an organ donor?” as I was filling out my license registration, I had no second thoughts as I checked off the “Yes” option. Granted, I was only half-awake after a tireless 5-hour wait in front of the DMV on what should have been another lazy summer day. But that’s beside the point. Contrary to my initial expectation, some people do not feel the same way as me. In the United States, fewer than 15% of individuals donate their organs whereas, in Austria, more than 90% of people donate their organs (Krishnan). Opponents believe that it’s ethically wrong to harvest organs from a person who’s still breathing even if they have been declared brain dead. But before we get on with this debate, where and how did this medicine miracle actually come to be?
It all started on December 23, 1954, when Dr. Joseph Murray and John Merrill of Peter Bent Brigham Hospital transplanted a kidney from one twin to another, allowing for the other to live for an additional 8 years (Jonsen). All the different types of transplantations we see today all began with a kidney transplant — an important one nevertheless — as it helps maintain homeostasis of the body's extracellular fluids.
This practice was most definitely a huge leap in the medical field and initially was even looked upon as a direct blessing from God. However, it comes with its ethical downsides, especially when transplantation puts the healthy person at risk. Obviously, a physician’s intentions are not to put one out of harm’s way at the cost of another. As compared to kidney transplantation, liver transplantation has been found to carry many risks for both the donor and recipient such as wound infections, hernia, abdominal bleeding, bile leakage, narrowing of the bile duct, and intestinal problems including blockages and tears (“Benefits and Risks of Becoming a Living Organ Donor”). At the same time, research also does suggest that it is better to take these risks than to wait.
Most of the time, ethical questions about organ donation or transplantation primarily stem from the ambiguity in the process of organ donation. Specifically, looking at donors who are proclaimed “dead”, how can one conclude that someone is truly in an unreversible situation just because a brain stops functioning? Does being brain-dead equate to death? This leads to my next question: what exactly is death? What conditions qualify someone as dead? And surprisingly enough, the definition of “death” is one of the most controversial topics in healthcare. This debate has been attempted to be cleared up by the Uniform Determination of Death Act, which states that a patient is pronounced dead if they have “sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem” (National Conference of Commissioners on Uniform State Laws). So essentially even if someone is not declared brain dead, but their circulatory and respiratory systems have stopped functioning, the patient could be a candidate for organ donation. But not everyone agrees with this practice. Some believe that removing organs is not the same thing as “letting nature take its course” and that instead, the removal of organs is equivalent to murder (Potts & Evans). But this all goes back to how one defines the state of being dead.
Now for potential living donors, how can you ask them for donation consent without forcing? Where is the line drawn between it being consensual versus forceful?
In the United States, healthcare has established two principles to ensure that there is full consent being bestowed to both the recipient and donor. These principles claim that “no financial compensation could be given for organs or to organ donors (except for medical costs)” and that the organs can only be donated if “explicitly granted by the donor, either living or before death.” A primary way consent is asked is through license registrations - something that I went through myself, which is sufficient consensual evidence for an organ donation (Bridget).
But what if a potential donor who passed away hasn’t provided any official consent prior to their death? In this situation, medical personnel are required to ask the patient’s relatives or surrogates whether they would like to donate their organs in a practice called “required request” (Bridget). In a last resort type of situation, medical personnel do not even need explicit consent from a potential donor or a relative to remove organs as long as there is no objection expressed by the donor or their family (Bridget). So in these ways, the United States tries their best to strictly follow laws in order to narrow the discrepancy in terms of the aspects involving donors’ consent.
This is not to say, however, that the principles stated above are internationally observed as different nations tend to have their own procedures. For example, Chinese authorities were discovered to have allowed 95% of organ harvesting “from executed prisoners without prior consent from them or their families” and this had been going on until they were caught in 2014 (Singh). On the other hand, Iran is the only country that has legalized buying organs (Singh). As long as you have money, you don’t have to worry about waitlists. These donors have many additional perks as well, including extended health coverage, monetary compensation of approximately $1,200 from the government, all on top of the money - between $2,300 to $4,500 - that the recipient provides (Singh). Now, in a country like this, it wouldn’t be much of a surprise if families forced (without consent) living members to harvest their organs. And this is where concern tends to rise especially with organ trafficking.
There is a significant shortage of organs and consequently, they are in huge demand worldwide. Given the money received from selling organs and the legalizing of organ buying/selling, the poor population of Iran has been specifically targeted for their organs. Essentially the country of Iran is normalizing a system that permits the poor to be victimized while broadening the line between the rich and the poor (Krishnan). Iraq is not the only country that has been guilty of this disgusting practice. The list includes nations including Israel, India, China, Pakistan, Turkey, Brazil, Nepal, the Philippines, Kosovo, and former Soviet states in eastern Europe (Arsenault). In such countries, the poor are forced to choose between selling their organs or starving. A possible way to put down some of these issues is through the “opt-out system,” in which “everyone is already included as an organ donor if organs are viable after death,” but they have the choice to opt-out from donating (Krishnan). More than ever, this existing system needs to be made more widespread to combat the organ shortage without also jeopardizing the lives of the poor population.
Organ donation, without a doubt, is truly a medical miracle, but another’s person’s life or wishes should not be sacrificed for the sake of saving another. Instead, stricter laws should be considered or more focus can be diverted towards a more viable alternative like stem cell research. As a society, we should not test the forces of nature and instead seek to do our best to grant everyone’s wishes.
**The information on this article should not be used as medical advice. Always consult your doctor first!
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Works Cited
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