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Legal And Ethical Issues Of Organ Transplants

Legal And Ethical Issues Of Organ Transplants

The debate surrounding the ethical and legal issues of organ transplantation is as old as the process. No one takes the issues lightly as organ transplants are literally a matter of life and death. Medical and legal professionals must weigh the value of saving a life with an individual's right to decide what is done with their body.

Mostly Dead or Dead Dead?

A policy known as the dead donor rule is the main ethical and legal standard for organ transplants, except in the case of living donations. This rule states that a person must be declared dead before a doctor may harvest their organs for transplantation.

However, the debate lies in when a person is considered dead. There are two general definitions of death. These include the absence of breathing and pulse and the stopping of brain function.

The meaning of "brain death" comes from the Uniform Determination of Death Act. It is defined as "irreversible cessation of all functions of the brain," which includes the brainstem. The American Academy of Neurology requires three findings to diagnosis brain death, including unresponsiveness, apnea and the absence of brainstem reflexes.

The other legal concern for death is the lack of cardiopulmonary function, which is breathing and heart rate. A patient may be a candidate for organ transplantation if he is not brain dead but needs life support for cardiopulmonary function. Once life support is removed and several minutes pass, a patient can be deemed dead if there is no spontaneous cardiopulmonary function.

Consent: Opt-in or Opt-out

In most countries, the law states that people must opt-in for organ donation, meaning that people have to have expressed their wishes to be an organ donor. The exception is Singapore, which has the Human Organ Transplant Act. The Act states that people imply consent for organ transplantation unless they officially opt out. The Act excludes Muslims on religious grounds.

Although not a popular decision, Singapore's Act could arguably be the more ethical choice. Many people do not become organ donors because they never get around to it. They also may simply be unsure because they have not taken the time to think about it. Should people be allowed to deny their life-saving organs just because they did not take the time to fill out a consent form? Singapore's process makes it so that anyone who passionately does not want to donate their organs do not have to.

The Act has a clear directive on what to do if a patient dies and has not opted out of organ transplantation. In the United States, the directives are not as clear. Generally, deceased persons' next of kin are given the choice regarding organ transplantation. Some hospitals require family consent even if a patient has written down their permission for organ donation. Is it fair for family members to override a patient's wishes, especially considering that other people could die as a consequence of their decision?

Research shows that when given the option, families refuse consent around 40 to 50 percent of the time. Typically though, families do not actually have the power to overturn patient consent in most states. The Uniform Anatomical Gift Act was revised in 2006 states that a driver's license identifying a person as an organ donor is sufficient consent. Doctors do not need the next of kin to agree.

Organs for Sale?

Many people argue that a person should be allowed to sell their organs for living donations. People can donate a kidney, a portion of their liver, and a lobe from their lung to save another person's life with minimal risk to their own. People get paid to sell their hair, their eggs, their sperm, their blood, and their blood plasma, so why not organs if it would not endanger their life?

The argument is that allowing people to sell their organs could encourage is that poor people may sell their organs out of desperation. Organs sales could also encourage unethical organ trading. However, black market organ sales already exist and may even be reduced by legal organ sales. As far as poor people wanting to sell their organs, the truth is that poor people already do but the people they deal with are criminals and the risks they take are extreme. Legalized sales would offer better protection for the people donating and could save lives as people who are on the fence about donating their organs might do so for compensation.

There is no simple answer to what is right and wrong with regards to organ transplantation. Even the laws vary by hospital, state and country because people cannot agree on the best policies.