The Ethics of Cadaveric Organs for Transplantation
Advancements in medicine have allowed for the ability to transplant organs from a cadaver to a living patient. Immunosuppressive drugs have been developed to block the bodily rejection of organs from the deceased making transplantation possible. When an individual dies The Uniform Anatomical Gift Act allows for tissue and organs of the cadaver to be used for transplantation (Garrett, Baillie, & Garrett, 2001). This document is a set model or regulations and laws concerning organ donation that all 50 states have passed in some measure.
Organs such as the kidneys, heart, liver, lungs, pancreas, intestines and spleen can be transplanted if the timing is close after death. Tissues such as skin, corneas and bone however, can be donated hours after death. One cadaveric donor can provide organs for several different individuals. What organs and tissues which can be recovered may depend on the cause of death or damage to an organ but usually several are harvested. Transplantation has become an effective treatment of human disease.
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Death is legally defined by the Uniform Determination of Death Act (UDDA) as either the irreversible stoppage of circulatory and respiratory functions (non-heart-beating) or cessation of all functions of the brain including the stem (brain death). “A non-heart-beating cadaver is pronounced dead according to traditional cardiopulmonary standards” (Fox & Christakis, 1995) Brain death is a method to determine death when a person is on a ventilator but still has a pulse, blood pressure and other signs of life. It is critical to harvest and transplant the donated organ(s) as quickly as possible close to the moment of death.
If vital organs could be removed while still functioning they would be more likely be successfully transplanted. Patients who are on ventilators but not brain dead are removed from the respirator and organs are quickly removed when cardiac death is pronounced. Controlled non-heart-beating death (NHBD) refers to situations where a decision is made to withdraw a ventilator, wait for the heart to stop (cardiac death) and then rapidly remove the person’s organs before he or she deteriorates. Uncontrolled NHBD refers to situations where a person suddenly dies and cannot be resuscitated.
In uncontrolled NHBD, tubes may be inserted into the donor and cold preservation fluid is instilled to preserve the organs until transplantation. This gives time to notify the family members and obtain consent for the donation. This preservation is legal in some states, but not often done due to cost and public resistance to starting preservation of organs before family consent is obtained. In the harvesting of organs on an individual who is brain dead, the ventilator is continued until the organs are removed (Valko, 2002).
Organ donation upon death is considered praiseworthy by many. A functioning transplant aides the sick and suffering and is less expensive than keeping ill patients on long term treatments such as dialysis. “Dead bodies decay very quickly and cannot remain intact” (Spital & Taylor, 2007). Having completed life, the best way for the body to be used is to promote the well-being of a living individual. Because a cadaver can not feel pain or be harmed and no longer needs organs necessary for life, the risk to the dead body is zero and the benefits of donation are life saving.
Grieving relatives have also been comforted by donating a loved one’s organs after a tragic death by changing the life of someone in need of a transplant. Although it is believed that a cadaver cannot and does not suffer pain, acceptance of death takes time and the respect which the cadaver is treated is in many ways linked to a still-living family member (Emson, 1987). An act done on the deceased immediately following the death are emotionally felt by the remaining members of the family.
Although the person no longer exists the body is a remaining part of the beloved deceased person. In the majority of the religious groups, as long as due respect is shown to the body, cadaver organ transplants are not forbidden (Garrett, Baillie, & Garrett, 2001). But in some cultures death is not the end of the soul and that the life of the body can be restored. “Most families still refuse to donate the organs of their dying relatives” despite all efforts made to increase donations. Harvesting may be thought of as violating the sanctity of the body.
Donation may involve “unwarranted mutilation of the body and so disrespect for the dignity of the human body” (Garrett, Baillie, & Garrett, 2001). Individuals are urged to sign an organ donor card with little or no awareness of what that action can mean. How the death is determined may weigh in on the decision to donate. The potential recipient is rarely known, because tissue and compatibility tests must be done. There is always less ethical force in an unnamed potential person that a living identifiable one. The horror stories that make the headlines also deter consent for donation.
The few illegal harvesting accusations which are published in newspapers and documented on television deter individuals from donating and allow them to see denial of consent as the barrier to exploitation and harm. There is also a fear that the organ donor may not actually be dead but declared dead prematurely so that the vital organs can be taken to benefit another human being. The Uniform Anatomical Gift Act stipulated that the “time of death be determined by a physician who attends the donor at his death, or, if none, the physician who certifies the death.
This physician shall not participate in the procedure for removing or transplanting a part” (Uniform Anatomical Gift Act, Section 7 (b)). The shortage of available organs creates a dilemma surrounding organ transplantation. Due to the fact that one cadaveric donor can provide multiple organs, it is an area that attracts focus to increase the number of available organs. The drive for more organs may be leading to behaviors that are increasingly drastic. Illegal trades of organs via the internet and organ brokers have emerged because of the high demand.
The American Society of Transplant Surgeons gathered to determine whether an ethically acceptable pilot trial could be proposed to provide a financial incentive for families to consent to the donation or organs from a deceased relative (e. g. a contribution to a charity chosen by the family or a reimbursement for funeral expenses, direct payment or tax incentive). They were opposed to the exchange of money for cadaver donor incentive which commercializes the value of human life by commodifying donated organs.
They did find that organs as a gift could be sustained by a funeral reimbursement or charitable contribution that conveyed the appreciation of society to the family for their donation (Surgeons, 2007). The idea of routine recovery which is designated to stimulate consent would be simpler and cheaper. There would be no need for donor registries, no need to train requestors and no need for government regulations. It would assist to eliminate the stresses that are experienced by some families and staff who are forced to make the decision to consent for harvesting (Valko, 2002).
Adapting presumed consent as a policy would allow for cadaveric organs to be procured for transplantation unless the decedent or the family has expressed and objection to the recovery. If nothing is said, than the organs can be harvested. A human person is never to be violated nor is the cadaver regarded as an object to be consumed or sold. Free and informed consent for transplants from the potential donor prior to death is needed, or in the absence of those expressed wishes, from the next of kin.
Families should not be deceived about where and how the donated organs will be used. Insisting on consent shows respect for the person’s autonomy. A society which places value on autonomy cannot make a law which makes people donate. The wishes of the deceased regarding the postmortem disposition of his or her body should be respected (Valko, 2002). Organs from cadavers are currently distributed by the United Network for Organ Sharing (UNOS), a private group that contracts with the federal government in a regulated setting.
The donor organs are matched with transplant patients by gathering information such as organ type, blood type and size, distance from the donor to the recipient, level of medical urgency and time on the organ waiting list. The UNOS maintains a comprehensive, up-to-date website that gives the status of people awaiting organ transplants. Wishes for the body of the individual should be documented in a living will and made clear to the next of kin. In New York, the Department of Health can be contacted and an individual can register for the intent to be an organ donor.
Registration can also be done through the Department of Motor Vehicle as part of a license, permit or non-driver identification. Intent does not necessarily mean consent. A persons consent to donate their organs is made while still living or in an advanced directive. An individual can enroll in the Donate Life registry. If the deceased’s organ donation wishes are not known upon death, the hospital, physician or organ procurement organization will approach a family member to obtain consent to remove organs.
A family member with the authority to grant consent for the harvesting of the deceased persons organs is generally determined by a hierarchy. First if there is a spouse, that person is asked. If no spouse, an adult child is to make the decision. Next is a parent, if no parent’s then and adult sibling and at last a legal guardian. The most effective way to have an individual’s wishes carried out is to make family aware of what you want so the immediate decision can be made on refusal or consent of organ donation after death.