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Is Organ Donation More Of A Socio-Cultural Issue Than A Medico-Legal One?

Nowadays, organ or tissue transplantation is the only way to stay alive for those who have incurable illnesses of the kidneys, liver, heart and diseases such as leukemia, anemia, or genetic diseases. Transplantology is a such a widespread technique that it is used even as a cosmetological procedure where the body fat is used as a filler in an anti-aging therapy or hearing restoration. Organ transplantation embodies the eternal human desire to learn to “repair” the body.

The modern medical technological development level allows one to save hundreds of lives annually by using transplantation. However, this issue has a set of medical and ethical problems to face. The problems are associated with the key stages of transplantation technology such as research, withdrawal (fence) organs and/or tissues, distribution of organs and/or tissues between the recipients, the commercialization of transplantation, and ethics of xenotransplantation. This paper is to deal with socio-ethical problems of transplantology and define the most critical problems to be solved.

Debated Issues

First, organ transplant from a living donor may cause harm to his/ her health. On the one hand, an organ transplant (for example, a kidney) is saving the life of the person (the recipient) and is good for him/her. Also, the health of the living donor is severely impaired and transplantation violates the principle of “do no harm” (Lock, 2002). In addition, the problem of “black donation” is very acute in current transplantology since it creates additional ethical problems like the enrichment of illicit bodies trade.

Second, the problem of cadaveric organ donation is of current interest since the question of anonymity and the desire of donor’s family to honor the deceased remains unsolved. Additional mundane ethical issues to face are: the problem of ascertaining a person’s death and the problem of free will donation of their own organs after death for transplantation. Here, the issue of “the proper time of organ exhaust” is very acute.

Third, the contradictory issue is the idea of animals’ use as donors (xenotransplantation). It is based on the belief that the animal is a living organism less valuable than people, whereas both animal protection advocates and representatives of humanism are against this idea. In addition, the very use of this technology is debated since animals are said to be disease carriers and even the success of xenotransplantation is not the primary concern.

The Problem of Xenotransplantation (XTP)

XTP is currently one of the ways to address the shortage of donor organs. However, an issue arises in relation to the solution of scientific and medical problems associated with risk transfer of various infections and viruses to the human body and immunological incompatibility of animal organs and human tissues. In recent years, pigs became the most frequent animals for XTP since they are the closest to a human being by a set of chromosomes and the structure of the internal organs.

Recent studies in Mexico have shown that XTP indeed can reduce the insulin dependence of type I diabetic patients. However, as the researches were conducted in Mexico, the documentary for success was not enough to XTP authorities, and doubts about infection transfer from animal to human beings in these studies were not renounced. Unfortunately, the realization of XTP in Mexico was facilitated by different geopolitical, cultural and ethical contexts.

Cadaveric Donors

Obtaining the consent of the person or his/her relatives to use their organs for transplantation is associated with a number of ethical and psychological problems. In some countries, particularly in the U.S., it is a document of agreement for the subsequent transplantation people sign while being alive. Practice in vivo clearance consent to the removal of human organs after the person’s death is being implemented in Brazil, China, and Poland. However, in case of the donor card absence, obtaining consent from a person with a fatal disease is almost impossible for ethical and medical reasons since the person is physically found in such a state when one cannot make responsible decisions based on complete and accurate information provided in an accessible form.

Time for collection of different organs varies due to the specifics of human tissues and modern technology that is used for their preservation and transportation while allowing a stay that is suitable to the recipient. Therefore, when collecting donor organs from cadaver, the problem of establishing a possible moment of the body’s death arises. Is it “at the beating heart” or after the establishment of all criteria of biological death of the person?

Saving Lives or Economics?

When people hear about illegal organ transplantation, they imagine a dirty room, a doctor in bloody white coat holding rusty instruments. However, most of such transplantation procedures are held at the same operation rooms and using exactly the same techniques and safety precautions as the legal ones, but performed at night. Obviously, such illicit surgeries are more expensive than the legal ones, and this is the gold mine for those who want to make money from human health.

Illegal surgical facilities are able to make 400,000-500,000 euros for several operations only in one night (Dillard-Wright, 2012). Clinics and hospitals all over the world together with unofficial traders get their profit from illicit organs trade while donors may receive about 2,000 euros for the kidney or even less (Scheper-Hughes, 2000).

For example, in India a kidney can be purchased for 800 euros, which is the lowest price in the world (Dillard-Wright, 2012). Therefore, illegal organ trade is becoming stronger: the world’s “black market” of organs is formed on the economic principle “where there is demand, there will be supply.”

Unfortunately, people that are selling their bodies do not realize what awaits them.  Donor-sellers are in this case real people who, for various reasons (mostly financial), decide to sell one or parts of their organs. According to Scheper-Hughes, convey of bodies in the world happens by a scheme: from the south – to the north, from the east to the west, from the poorest regions – to the rich ones, from black – to the white-skinned (2004). In addition, she called transplant tourism an economic factor for the Third World countries. Indeed, the sum of 800-1000 euros is the real fortune for poor regions habitancy.

Thus, people do not see something discreditable in selling a kidney. However, most of such donors experience difficulties in their further life. According to the study conducted in order to determine the effects of “black” organ donation, in several years after the surgery families reported a worsened economical position in comparison to that one before the donation. In addition, the annual income of the donor decreased by one third, while they reported  back pain and weakness.

The practice of organ transplantation today is not a narrowly experimental framework, but a conventional medical industry. One can note that even such outstanding discoveries and inventions as a syringe and needle, the use of X-rays, the opening of microbiology and bacteriology, and even the formation of the “antibiotic era” are not accompanied by the creation and adoption of new legislation. This indicates that the yield of the transplantology onto a “physical” level of human death control is not a very specific and private medical issue, but a serious socio-cultural problem. Thus, organ donation may become a useful method to save lives of thousands of people, but only after ethical problems negotiation.

Author’s Note: From a very young age, I have been paying attention to any global problems, and I have always wanted to share my thoughts with others. I want people to not miss out on important issues, and this article is devoted to one more controversial topic, to which I would like to know your thoughts, so will I wait for your comments. 

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Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

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As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

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