ORGAN TRANSPLANT It is a surgical operation where a failing or damaged organ in the human body is removed and replaced with

h a new one. Organ donation - giving of tissue/organ by a person to another person or to an institution Donor The giver who may be a cadaver or a living person A donor who exchanges the organ for money is a vendor.

Recipient The receiver who may receive directly from the donor or from an institution. A recipient who pays for the organ is a buyer. 1. Autotransplantation the donor and the recipient of are one and the same individual 2. Heterologous transplantation the donor and the recipient of transplantation are 2 different individuals. Animal to human transplantation Human to human transplantation (cadaver-donor; living-donor) Transplanting organs from one living person to another is also ethically acceptable provided that the following criteria are met: 1. There is a serious need on the part of the recipient that cannot be fulfilled in any other way. 2. The functional integrity of the donor as a human person will not be impaired, even though anatomical integrity may suffer. ANATOMICAL INTEGRITY -refers to the material or physical integrity of the human body. -when all the parts of the human body that are supposed to be there are all accounted for. FUNCTIONAL INTEGRITY - refers to systematic efficiency of the human body. - When all the anatomical parts are normally functioning for the good of the whole bodily system. Example: If one kidney were missing from a persons body, there would be lack of anatomical integrity, but if one healthy kidney were present and working, there would be functional integrity because one healhty kidney is more than able to provide systemic efficiency. 3. The risk taken by the donor as an act of charity is proportionate to the good resulting for the recipient. -It is a manifestation of generosity and love -It should be done first and foremost , to save and improve the quality of life of another Principle of common good -Both donor and recipient should benefit from the process -A donor shall be reimbursed for the expenses related to the donation and transplantation (medical, loss of income, inconvenience), but not for the organ itself. 4. The donors consent is free and informed -No deception in the information given, no coercion in obtaining of consent, and volunteerism on the part of the donor and recipient 5. The recipients for the scarce organs are selected justly.i Principle of Justice and Equity -Benefits and burdens must be equally distributed -A gratuity should be given to the donor -There shall be transparency in the whole process -Non-directed donated organs shall be allocated equitably among patients with priority based on the objective criteria for medical need and probability of success as specified by the Donation Allocation Guidelines Live vs. Cadaveric Organ transplant is the moving of an organ from one body to another (or from a donor site on the patient's own body) purpose of replacing the recipient's damaged or failing organ with a working one from the donor site. Living or deceased Transplantable from living donor: Lung/Kidney/Liver/Intestine/Bone/Bone Marrow Deceased Donor: Lung/Kidney/Liver/Intestine/Bone/Heart/Pancreas/Cornea Living Transplant involves an organ taken from one living person and given to another living person Deceased/Cadaveric Transplant involves an organ or tissue taken from a dead person and given to a living person Living Organ Donation: 1. Related Donation between genetically related persons They can be: Parents brothers and sisters (over 18 years of age) other blood relatives (aunts, uncles, cousins, half brothers and sisters, nieces and nephews) 2. Non-related Unrelated living donors are healthy individuals emotionally close to, but not related by blood They can be: spouses in-law relatives close friends

 co-workers, neighbors or other acquaintances 3. Non-directed living donors who are not related to or known by the recipient, but make their donation purely out of selfless motives. This type of donation is also referred to as anonymous, altruistic, altruistic stranger, and stranger-to-stranger living donation. 4. Paired Donation consists of two donor/recipient pairs whose blood types are not compatible The two recipients trade donors so that each recipient can receive a kidney with a compatible blood type. Once the evaluations of all donors and recipients are completed, the two kidney transplant operations are scheduled to occur simultaneously. 5. Kidney Donor Waiting List Exchange donor who is not compatible with their intended recipient offers to donate to a stranger on the waiting list the intended recipient advances on the waiting list for a deceased donor kidney This type of living donation is also referred to as list-paired exchange and living donor/deceased exchange. 6. Blood Type Incompatible - allows candidates to receive a kidney from a living donor who has an incompatible blood type. - to prevent immediate rejection of the kidney, recipients undergo plasmapheresis treatments before and after the transplant to remove harmful antibodies from the blood, as well as the removal of the spleen at the time of transplant. Acceptable Living Donors: Physically fit and in good general health 18-60 years old Compatible blood type with intended recipient Written living donor informed consent form Benefits of Living Donation: Superior results for the recipients Eliminate the long wait for a deceased-donor organ Allow transplant surgery to be scheduled when both the organ donor and recipient are in top physical and mental health The sooner a failing organ is replaced, the quicker and easier it is to recover. The longer a person must wait, the more likely further health complications are to happen. Informed Consent: All aspects of the donation process, the potential risks and benefits of it, as well as center-specific factors must all be understood by the potential donor. Only a competent adult can agree or disagree to be a living donor through free and informed consent. In an incompetent person (severely mentally disabled adult or a minor living donor), it is unethical for the guardian to consent for an organ donation. Most living donors are family members which provide a better donor-recipient tissue match, thus there will be reduced risk of rejection. Cadaveric Transpant: is when a person declared brain dead and their immediate family has given consent for their organs to be donated for transplantation transplanting an organ or tissue from a dead person to a living person presents no ethical problem 1. Heart Beating Cadaver Donors/ Neomorts (HBCDs) Patients who have been declared dead on neurological grounds or brain dead - irreversibly lost all brain function - also called as a Neomort Organs removed while the donors are still on respirator and their hearts are still beating Ideal no delay between cessation of heartbeat and removal of organs

2. Non Heart Beating Cadaver Donors (NHBCDs) Patients who have been declared dead on the grounds of cardiopulmonary criteria. Their hearts are no longer beating at time of organ procurement. Not Ideal there is a delay between the death of the donor/patient and the harvesting of the organs Consent of Deceased Donor: "organs and tissues may be removed from a deceased person who has bequeathed them verbally or in writing or, in the absence such clear expression of the deceased person's will, with permission of the family. the wishes of those grieving for the person's death should be taken into account Ethical Considerations: harm and risk of human must be minimal or proportionate to the benefits to be derived the dying cannot be killed organ must not be necessary for life (brain), organ must not be for personal or procreational identity (penis) the donor must be cared for before, during, and after the donation. proper screening standard healthcare (insurance) reimbursement for medical expenses disability and livelihood lost prevention of discrimination

 community acceptance the intrinsic worth and dignity of the donor must be respected free and informed consent information about the process of matching, the chance of success, and permission to refuse must be provided in case of cadaver donors, consideration must be given to the family familys consent must be obtained if organ donation card was signed by the patient, consent of the family is not needed when a dead body is unclaimed within 48 hours, the state now owns the body and allows the organ to be harvested Medical Decisions: especially that of the donor should be: free (voluntary) not coerced based on a sound understanding of what is at stake Donating Within Families: Unavoidable Pressures intended recipient will die without the transplantation, which of course makes any decision highly charged only one person in the family is a suitable donor and so the spot-light falls on him or her alone Avoidable Pressures pressure put on a family member to donate in exchange for certain favors - whether specified or left more vagus there may be threats of disapproval, perhaps implied or unspoken, if a person refuses to donate lasting harm to relationships in the family Sources of Donor Organs: Living Donor/Cadaveric Donor/Anencephalic Infants/Human Fetuses/Stem Cells/Animal Organs Living Organ Donor: when a living person donates an organ or part of an organ to someone in need of a transplant functional integrity of the donor as a human person will not be impaired, even though anatomical integrity may suffer risk taken by the donor as an act of charity is proportionate to the good resulting in the recipient Transplanting organs from one living person to another is also ethically acceptable provided that the following criteria are met: Act of Charity It is a manifestation of generosity and love It should be done first and foremost, to save and improve the quality of life of another whatever justification a person accepts, there is one consideration which should inform all decisions about living donation - Informed Consent Cadaveric Organ Donor: harvesting from a dead person will do no harm once a person dies, his or her organs may be donated if the person consented to do so before they passed away a persons consent to donate their organs is made while still living, appears on a drivers license or in an advance directive if the deceased persons organ donation wishes are unknown, the hospital, physician, or organ procurement organization will approach a family member to obtain consent to remove the organs the family members with the authority to do so is generally determined by this hierarchy: spouse adult child parent adult sibling legal guardian Anencephalic Infants: infants born with a major portion of their brain absent and without cognitive function organ donation may only be considered if the anencephalic infant has satisfied the criteria for brain death or somatic death as applied to other human beings. studies showed that use of anencephalic childs organs leads to unsuccessful transplants because of the ff reasons: AI will not usually satisfy the standard brain death criteria because of adequate brainstem function that maintains spontaneous respiration and heart rate after birth. by the time brain death or somatic death has been declared, the organs will have undergone ischemic damage, making them unsuitable for transplantation use of life support does not improve the chance of successful organ donation from anencephalic infants Human Fetus: if the fetus has died of natural causes, the ethical issues would be similar to other transplants from the deceased but if the fetus died from abortion, the organ should not be used for donation because it will justify the use of abortion Stem Cells: unspecialized cells that can self-renew indefinitely and differentiate into more mature cells with specialized functions

 these super cells have a magic clinical potential in tissue repair and they represent the future relief of a wide range of incurable diseases, or replacement of defective organs and tissues, by restoring their normal functions With all its controversiality, due to its origin, the question is: can these cells be isolated and used? If so, under what conditions and restrictions In order to discuss the moral aspect of isolation and use of HuSC, it is essential that we first understand exactly what these cells are, where they come from, their intended application, and the ethical questions regarding its different sources. "Stem cells will cure everything" "Stem cells kill embryos" Where Do They Come from? early embryonic stages embryos fetal tissues umbilical cord bone marrow embryonic stem cells were the only pluripotent stem cells capable of differentiating into cells of ectodermal, mesodermal, and endodermal origin. embryos are destroyed in the process of extracting the stem cells the Vatican condemned research using human embryos as "gravely immoral," because removing cells kills an unborn child the Roman Catholic church teaches that life begins at conception and must be safeguarded from that point. It encouraged the use of cells from adults instead of embryos, which it called `the more reasonable and humane step. Animal Organs: Xenotransplantation transplants of animal organs into humans experiments have been performed on transplants of bone marrow, hearts, neurons and other tissues from baboons, chimpanzees and pigs, with limited success in terms of patient survival or organ functionality rejection issues and the risk of transmission of animal diseases to humans human immune system reacts violently to pig organs and pigs contain ubiquitous retroviruses which may adversely affect humans Ethical issues surrounding the use of animal organs for human transplants appear to be threefold issue of animal rights and the breeding of animals simply for human consumption and medical benefit xenotransplant technology is just another way for biotech companies to make money, and they are not concerned with the welfare of the animals or truly concerned with the welfare of mankind new infection be introduced for which we have no cure Selection of Recipient Donor/Matching: Patients on the waiting list are in end-stage organ failure and have been evaluated by a transplant physician at hospitals Subjected to intense scrutiny by the government, and the medical profession. Organ transplantation is built upon altruism and public trust. If anything shakes that trust, then everyone loses. Implicit rationing doctors, HMO's, and the individual's ability to pay, control who gets limited resources Explicit rationing government, through public health authorities, controls the allocation of limited resources Entry into Transplantation Programs: First stage - deals with the considerations w/c should be taken into account in deciding on the identity of the individual patients to whom offers of transplants are to be made. Entry to a program - assessment of patients Exclusion criteria - age restrictions, abnormalities in other organ systems, previous history of malignant disease and other medical considerations. A medical practitioner whose patients become candidates for admission would have a conflict of interest if he or she had the sole responsibility for selection. Second stage - It relates to whether an individual chooses to become a transplant recipient. - It is a decision to be made by the patients in the light of advice form their medical attendants and consultation with their families. - Patient should receive a full description of what is entailed in the program, what procedure can be expected and their possible risk and benefits. Organ Procurement and Transplant Network (OPTN): All patients accepted onto a transplant hospital's waiting list are registered with the UNOS Organ Center. When donor organs are identified, the procuring organization typically accesses the UNOS computerized organ matching system, enters information about the donor organs, and runs the match program. For each organ that becomes available, the computer program generates a list of potential recipients ranked according to objective criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient, time on the waiting list, and distance between donor and recipient). [UNOS United Network for Organ Sharing - where a centralized computer network links all organ procurement organizations (OPOs) and transplant centers.] After printing the list of potential recipients, the procurement coordinator contacts the transplant surgeon caring for the top-ranked patient Depending on various factors (e.g. donor's medical history and the current health of the potential recipient), transplant surgeon determines if the organ is suitable for the patient. If the organ is turned down, the next listed individual's transplant center is contacted, and so on, until the organ is placed. Once the organ is accepted for a potential recipient, transportation arrangements are made for the surgical teams to come to the donor hospital and surgery is scheduled. From the moral standpoint of view, an obvious principle of justice requires that the criteria for assigning donated organs should in no way be

discriminatory (ie, based on age, sex, race, religion) or utilitarian (ie, based on work capacity, social usefulness) Instead, in determining who should have precedence in receiving an organ, judgment should be made on the basis of immunological and clinical factors. Any other criterion would prove wholly arbitrary and subjective, and would fail to recognize the intrinsic value of each human person as such, a value that is independent of any external circumstances. Pope John Paul II Selection of Recipient: Disabled & suffering Waiting & wondering Selection of the patient Serious need on the part of the recipient that cannot be fulfilled in any other way. Selection of the sickest patient An offer to the patient who is most likely to die without it might appear the most reasonable basis. However, this is not necessarily the best use of a limited resource. Selection of the patient most likely to benefit based on medical or other criteria - preference should be for the best possible tissue match in the patient with the best outlook (optimal medical condition at the time of the operation, least risk of recurrence of the diseases occasioning transplantation, younger age, etc) Selection of the patient on the waiting list for the longest period Priority on the basis of length waiting period has administrative advantages of ready identifiability and defensibility Argument: the fact that a patient has survived for a long period after meeting the requirement for entry to waiting list might indicate that he or she was in better condition than others on that list. The question might then be put whether for this reason, his or her NEED was less. * All patients on the waiting list should have an equal chance of selection * Recipient selection of patients are done justly (on the basis of their importance for the well-being of others) * Preference in selection of patients who have previously had one or more transplants Principle of free and informed consent adequately informed regarding the expected benefits, risks, burdens and costs of the transplant and aftercare, and of other possible alternatives Principle of human dignity All are equally persons, have the same human rights, and have the same claim to justice and dignity. The same criteria is applied to everyone who is referred for a transplant Because donated organs are such a limited resource, the probability of a good outcome is emphasized (the utility principle). At the same time, patients have complex medical conditions so each individual patient is evaluated within these broad criteria (the beneficence principle). The expected length of survival and the possibilities regarding rehabilitation should be considered Care must be taken not only that they extend life biologically, but that they also offer the patient a real chance for a healthy life The new organs should add new years to life, and help to provide a new and better life

Give priority to those who have great need and who are expected to benefit greatly. Organ selling/buying: Organs are precious GIFTS. Organs are NOT resources. In the face of scarcity, these gifts of life are turned into market commodities. 1996-2006 the number of kidney transplants locally, increased Transplant from living and related donor flattened while the number of non-related transplant donors ballooned out from 52 in 1999 to 473 in 2006. The number of foreign recepients in 2004 and 2005 increased by 62%. In 2007, 50% of transplant operation involved foreign recipient despite of law which restrict the number of transplant to foreign to 10% of the total. Selling or exporting human organs carries a 20-year jail term and stiff finesbut presecutions are rare.

In Baseco, on Manila Bay, about 3000 of the slums 50,000 inhabitants are reported to have sold a kidney These donors are all male, with an ave. age of 29. A third of them have not even reached high school Most are farmers or tricycle drivers with a 4000 PhP average household monthly income They received just 150,000 PhP for a kidney 3/4 did not improve their lives economically 4/5 felt their capacity to work was reduced None would recommend that others sell their kindney Elements of Tragedy: Patient whose life hangs in the balance Desperately poor whose organs now have monetary value, and who are vulnerable to exploitation in a growing industry known as transplant tourism Churchs Stand: Organ Selling is IMMORAL It is contrary to the dignity of the human body. Those who NEED such a gift should receive it, rather than only those who can PAY. Ethics of Health Care, 3rd edition, Ashley and ORourke Issues: Proponents of the market Primary focus and purpose has been to propose financial incentives due to decreased organ donation. There is an increasing interest in addressing the shortage of transplantable organs by using monetary payments to obtain them.

Their primary focus ad purpose has been to propose financial incentives for decreased donation. The source of these commentaries has been from those who do not have direct care responsibility for transplant patient or organ donors. Practice Itself use of organ sales as remedy for the poor to life themselves out of destitution. There is an increase in exploitation by creating incentives, ignoring other alternatives for helping the poor. The Buyer Persons who vitally need an organ so as to live a full life are under considerable pressure. Buyer: Buying an organ from a poverty-striken person enables chance for a better life for that person and his family. The Seller Organ sales have brought little benefit to those selling them. Number of participants living below the poverty line has even increased. Reports from India reveal: kidney donors are worse off than they were before their nephrectomy. Deterioration in health status also occurs. Economic conditions There is exploitation of the weak countries by rich and powerful nations. The victims are usually the very poor. Professional Consequences A program of ORGAN SELLING creates conflict between the Physician-Patient relationship. Patients are not clients, nor commodities. This approach threatens the core values of the profession of medicine. Physicians become market providers Patients become consumers / clients Any attempt to assign a monetary value to the human body or its body parts diminishes human dignity and devalues human life. Scientific Justifications Nor Cost-Effectiveness Analyses does not overcome Ethical Concerns. Donate with LOVE in our hearts and for the sole purpose of giving and helping those in need without monetary enrichment as the primary motivation. Virtues: It is a good operative habit. St. Thomas Aquinas Traits of character or habits of disposition to think and act in ways that are morally good. - Alora, Angeles. Bioethics for students. Fidelity faithfulness to trust and promise keeping patients best interest first in mind Respect for Persons: They are human beings, made in the image of God and made in the image of Christ. They have inner worth, unique and equal dignity and rights. They stand above all things and have rights which are universal and inviolable. Scientific Competence: - Diligence in research - Updating and consultation with peers - Patience - Perseverance Great Heart: - Integrity/Public Spiritedness/Humility/Love/Faith/Hope/ Honesty - refers to both truthfulness and integrity Truthfulness - the good faith intent to convey the truth to others as best one knows Integrity - being true to oneself or wholeness Justice - constant will to give another his due - adjusting what is owed to the specific needs of the person even if those needs do not strictly fit what is owed Compassion - feeling for the loss/suffering of another with an attempt beyond obligation to help or avoid that loss/suffering - self sacrifice : for the benefit of another whose needs are greater, expecting no gain, recognition or payment in return Humility - recognizing ones capabilities and limitations - accepting deserved praise graciously and denying undeserved praise Prayerfulness seeking Gods help in everything one does The health worker becomes a mediator of something which is particularly meaningful, the gift of self by a person even after death so that another might live.

Transcribed by Aubrey Del Rosario B2012