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Organ Transplantation

I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Is it true that “everyone’s a winner”, as Julian Savulescu suggested recently on this blog , if we price life and body parts? Let’s accept that if there is a valid objection to buying and selling body parts, it must be grounded in the recognition of a harm that would come to some person or group of people. Consider, then, Savulescu’s suggestion that we should price body parts, and engage in buying and selling of them. We could categorize the potential harms that it might generate under the following headings:

(1) Harm to the participants in the transactions: donors, recipients, or facilitators

(2) Harm to specific third parties

(3) Harm to society at large

Read More »I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Second-hand and second-class organs. Should the patient know?

In a urology journal this month American
surgeons describe transplanting kidneys that would previously have been
rejected as unsuitable. In each case the donor kidneys had been found to
contain a solitary mass during the transplant work-up that was potentially
cancerous. Rather than cancelling the donation the surgeons removed the kidney,
cut out the tumour, and then transplanted the tumour-free organ. This follows
reports from a couple of weeks ago that surgeons are increasingly using ‘risky’
organs from donors who are elderly or who have other serious illnesses.

Read More »Second-hand and second-class organs. Should the patient know?

Feetility – should we pay egg and sperm donors?

Lisa Jardine, the head of the UK Human Fertilisation and Embryology Authority, has called for public debate about paying egg or sperm donors. Currently donors are given a maximum of £250 in reimbursement for expenses. But donation rates have fallen in recent years, at least in part related to changes in rules in 2005 preventing donor anonymity. As a consequence a significant number of patients seeking donor egg or sperm for in-vitro fertilisation have been forced to travel overseas. In essence Jardine suggests that a regulated local market in donor eggs and sperm may be better than unregulated fertility tourism.

Read More »Feetility – should we pay egg and sperm donors?

Umbilical cord blood donation: opt out or work on Sundays?

Umbilical
cord blood (UCB) contains haematopoietic stem cells, which can be used for the
treatment of several lethal disorders, including leukaemia
and several types of anaemia. Other sources of haematopoietic stem cells are bone marrow and ordinary peripheral
blood. Unlike bone marrow donation, which requires general anaesthesia, UCB
donation does not cause any inconvenience or significant risks for the donor. Peripheral
blood contains very few stem cells. Another major advantage of using UCB stem
cells is that less genetic similarity is required between donor and recipient.
This increases the chance of finding a ‘match’ and thus of the transplantation
being successful.

Read More »Umbilical cord blood donation: opt out or work on Sundays?

The Future of Making Organs for Self-Transplantation

Scientists have been able to create a new windpipe using stem cells. They took a windpipe from a dead patient, removed all the cells, and placed stem cells from a patient onto the remaining scaffolding to create what was in effect a new windpipe, with the patient’s own cells. The patient had an irreparably damaged her windpipe from TB.

The significance of this is that it opens the door to creating whole organs, like kidneys, livers and perhaps even hearts and lungs. This is a radical advance because up until now, stem cells have only really been useful to replace tissue, or bits of the body without a complex organized structure. But this means we could potentially replace any part of the body with a person’s own stem cells. New livers for people with liver failure, new kidneys from those with kidney failure – and because the cells would come from the patient, there would be no rejection. Indeed, this patient has shown no signs of rejection.

Does this raise any ethical issues?

Read More »The Future of Making Organs for Self-Transplantation

Status quo bias and presumed consent for organ donation

Yesterday the UK organ donation taskforce released its report on a
presumed consent (opt-out) system for organ donation. To the
consternation of the chief medical officer and the Prime Minister the
taskforce advised against the introduction into the UK of such a system.

In an editorial in today’s Guardian, it was observed that both the low
rates of consent in the UK – and the taskforce’s response to the
question of presumed consent may represent an irrational preference for
the default position. They may both be examples of the status quo bias.

Read More »Status quo bias and presumed consent for organ donation

Death Fiction and Taking Organs from the Living

By Julian Savulescu and Dominic Wilkinson

Imagine you could save 6 lives with a drop of your blood. Would you have a moral obligation to donate a drop of blood to save six people’s lives? It seems that if any sort of moral obligation exists, you have a moral obligation to save six lives with just a pinprick of your blood.

But every day people do far worse than failing to give a drop of blood to save 6 lives. They choose to bury or burn their organs after their death, rather than save 6 lives with these organs. And it would cost them nothing to give those organs after their death. Our failure to give our organs to those who need them is among the greatest moral failures of our lives. At zero cost to themselves, not even having to endure a pinprick, many people choose to destroy their lifesaving organs after their death.

Read More »Death Fiction and Taking Organs from the Living

The paradox of organ donation consent

In Australian newspapers today a Melbourne intensive care physician,
Jim Tibballs is reported as criticising current organ donation
guidelines on the grounds that donors are not actually dead at the time
that organs are removed. Other doctors have called Professor Tibballs’
comments “irresponsible” on the grounds that they might cause a
significant fall in organ donation rates.

Read More »The paradox of organ donation consent

Radical organ retrieval procedures

I wrote recently
about the controversial news that surgeons in Denver had taken organs,
including the hearts, from newborn infants who had died in intensive
care.
In recent years the retrieval of organs from patients whose hearts have
stopped (so-called donation after cardiac death, DCD) has become more
popular. In part this is because of the problem that there is a
shortage of organ donors who are brain dead. It is also because of the
recognition that when patients die after removal of life support, their
organs may still be viable for transplantation.

Read More »Radical organ retrieval procedures