Organ donation is when a person allows their organs to be removed, legally, either with consent when the donor is alive or after death with the consent of the immediate family.
Donations can be used for research, or healthier transplantable organs and tissues can be donated for transplantation to others.
Common transplants include: kidney, heart, liver, pancreas, intestines, lungs, bone, bone marrow, skin, and cornea. Some organs and tissues may be donated by living donors, such as the kidney or part of the liver, the pancreas, the lung or part of the intestine, but most donations occur after the donor dies.
On February 2, 2018, there were 115,085 people waiting for life-saving organ transplants in the US. Of these, 74,897 people are active candidates waiting for donors. While a positive organ donation view there is a large gap between the number of registered donors compared to those waiting for organ donations at the global level.
Video Organ donation
Process
Organ donors usually die at the time of donation, but may live. For live donors, organ donation usually involves extensive testing before the donation, including a psychological evaluation to determine if the potential donor understands and approves the contribution. On the day of the donation, donors and recipients arrive at the hospital, just as they will carry out other major operations.
For the donor to die, the process begins by verifying that the person is undoubtedly dead, determining whether organs can be donated, and obtaining approval for donations from any organs that can be used. Usually, nothing is done until the person has died, although if death is unavoidable, it is possible to check approval and to perform some simple medical tests just prior to, to help find suitable recipients. The verification of death is usually done by a neurologist (brain specialist) who is not involved in previous attempts to save the patient's life. This doctor has nothing to do with the transplant process. Verification of death is often done several times, to prevent doctors from ignoring the remaining life signs, however small. After death, the hospital can store the body with a mechanical ventilator and use other methods to keep the organs in good condition. Donors and their families are not charged for any donation-related expenses.
Surgery depends on donated organs. After the surgeon lifts the organs, they are transferred as quickly as possible to the recipient, for an immediate transplant. Most organs only survive outside the body for several hours, so receivers in the same area are usually chosen. In case the donor dies, after the organ is removed, the body is normally returned to its proper state, so the family can continue with the funeral and cremation or burial.
Maps Organ donation
History
The first living organ donor in a successful transplant was Ronald Lee Herrick (1931-2010), who donated a kidney to his identical twin brother in 1954. The primary surgeon, Joseph Murray, won the Nobel Prize in Physiology or Medicine in 1990 for progress in organ transplants.
The youngest organ donor is an infant with anencephaly, born in 2015, living only for 100 minutes and donating his kidneys to adults with kidney failure. The oldest known donor organ is a 107-year-old Scottish woman, whose cornea was donated after her death in 2016. The oldest organ donor known to the internal organs is a 92-year-old Texas man whose family chose to donate his heart after he died of a cerebral hemorrhage.
The oldest altruistic living organ donor is an 85-year-old woman in Britain, who donated her kidney to foreigners in 2014 after hearing how many people needed to receive a transplant.
The researchers were able to develop new ways to transplant human fetal kidneys to anephric rats to overcome significant obstacles in disrupting human fetal organ transplants. Human fetal kidneys show growth and function in mice.
Brain donation
Since there is no known cure for many brain disorders, a top priority is given to research designed to increase scientific understanding of healthy brain tissue to try to find new treatments. This is to ensure thorough research, as it is important to have access to brain tissue from people who do not have the disease being studied for comparison. These unaffected networks are known as 'control networks'. A short A BBC video app was published in early 2017
Global legislation and perspective
Laws from different countries allow potential donors to permit or deny donations, or to give these options to relatives. The frequency of donations varies across countries.
Approval process
The term consent is usually defined as a subject that complies with the principle and regulatory agreement; However, the definition becomes difficult to execute on the topic of organ donation, especially since the subject can not agree because of death or mental disorders. There are two types of consent under review; explicit consent and alleged consent. The explicit consent consists of donors who give direct approval through appropriate registration depending on the country. The second approval process is considered an agreement, which does not require the immediate approval of the donor or the immediate family. Estimated consent assumes that donations will be allowed by potential donors if permission is pursued. Of the possible donors, about twenty-five percent of families refuse to donate loved organs. Approval is defined as obeying the principal agreement. However, this definition is difficult to enforce according to organ donation because, in many cases, organs are donated from the deceased, and can no longer give consent to themselves.
Opt-in versus opt-out
As medical science progresses, the number of people who can be assisted by organ donation continues to increase. As the chance to save lives increases with new technologies and procedures, the number of people willing to donate organs also needs to be improved. To respect individual autonomy, voluntary consent must be determined for the individual's disposition of their remains after death. There are two main methods for determining voluntary consent: "taking part" (only those who have given explicit consent are donors) and "opt out" (anyone not refusing permission to donate is a donor). In the case of a system of allowance or alleged consent, it is assumed that individuals intend to donate their organs for medical use when they expire. The participation of the legislative system dramatically increases the effective level of approval for donations as a consequence of the default effects. For example, Germany, which uses an opt-in system, has an organ donation approval rate of 12% among its population, while Austria, a country with a very similar culture and economic development, but who uses opt-out systems, has 99 approval levels, 98%.
The opt-out permit, otherwise known as a "considered" consent, support refers to the presumption that the majority of people support organ donation, but only a small percentage of the population is actually registered, because they fail through the actual registration step. , even if they want to donate their organs at the time of death. This can be solved by opt-out system, where more people will be registered as donors when only those who refuse donations must register to be on the non-donation list. For this reason, countries, such as Wales, have adopted "free to vote" agreements, which means that if a citizen has not made a clear decision to register, they will be treated as registered citizens and participate in the organ donation process. Likewise, voting approval refers to the approval process of only those registered to participate in organ donation. Currently, the United States has an opt-in system, but research shows that countries with opt-out systems save more lives because of the greater availability of donated organs. The current opt-in approval policy assumes that individuals are not willing to be organ donors at the time of their deaths, unless they have documented otherwise through registration of organ donations. Applying for an organ donor depends heavily on the individual's attitude; those with a positive outlook may feel an altruism for organ donation, while others may have a more negative perspective, such as not trusting doctors to work hard to save the lives of registered organ donors. Some common concerns about an opt-out system are the sociological concerns of the new system, moral objections, sentimentalities, and concerns of registry management objecting to those who decide not to participate in donations. There are additional concerns with the view of sacrificing freedom of choice to contribute and conflict with existing religious beliefs. Despite concerns, the United States still has an organ donation approval rate of 95 percent. This national level of acceptance can foster an environment where moving to approval policies that may help solve some organ deficiency problems, in which individuals are assumed to be willing to donor organs unless they document the desire to "opt out", which must be respected.
Due to public policy, culture, infrastructure and other factors, the allegation of approval or non-participation models is not necessarily translated directly into effective contribution increases. The United Kingdom has several different laws and policies for organ donation processes, such as the consent of witnesses or guardians should be provided to participate in organ donations. This policy is currently being consulted by the Department of Health and Social Care. In the case of effective organ donations, in some systems such as Australia (14.9 donors per million, 337 donors in 2011), family members are required to give consent or rejection, or perhaps veto a potential recovery even if the donor has agreed. Some countries with opt-out systems such as Spain (36 effective donors per million inhabitants) or Austria (21 donors/million) have high donor rates and some countries with opt-in systems such as Germany (16 donors/million) or Greece (6 donor/million) has a lower effective contribution rate. President of the Spanish National Transplant Organization has acknowledged the Spanish legislative approach is likely not the main reason for the country's success in increasing donor levels, beginning in the 1990s. Looking at an example from Spain, which has successfully adopted an alleged donation approval system, the intensive care unit (ICU) must be equipped with sufficient physicians to maximize the recognition of potential donors and maintain organs while families are consulted for donations. The characteristics that allow the alleged Spanish approval model to be successful are the source of the transplant coordinator; It is advisable to have at least one in each hospital where setting aside donations is made to authorize organ procurement efficiently.
The public view is critical to the success of the exit permit or suspected donation system. In a study conducted to determine whether a health policy change with an alleged approval or opt-out system would help improve donors, a 20 to 30 percent increase was seen among countries that changed their policies from some type of opt-in system to an opt- out. Of course, this increase should be closely linked to changes in health policy, but it can also be influenced by other factors that could have an impact on donor enhancement.
Transplant Priorities for Donors Willing is a newer and first method of incorporating the "non-medical" criteria into the priority system to encourage higher donation rates in opt-in systems. Originally implemented in Israel, it allows individuals who need organs to get on the list of recipients. Moving a list depends on individual choice before organ donation needs. This policy applies non-medical criteria when allowing individuals previously listed as organ donors, or previous families have donated organs, priorities over other possible recipients. It should be determined that both recipients have the same medical needs before transferring the recipient to the list. While these incentives in opt-in systems do help to raise the level of donations, they are not as successful as doing the exit approval, the alleged default approval for donations. Argentina
On November 30, 2005, Congress introduced an opt-out policy on organ donation, in which all people over the age of 18 would become organ donors unless they or their family declared negative. The law was announced on December 22, 2005 as "National Law 26.066".
Brazil
The campaign by Sport Club Recife has led to a waiting list for organs in north-eastern Brazil down almost zero; while according to Brazilian law, families have the highest authority, the issuance of organ donation cards and subsequent discussions have alleviated the process.
Chile
On January 6, 2010, "Law 20,413" was announced, introducing a policy of opt-out on organ donations, in which all persons over 18 will become organ donors unless they express a negative.
Colombia
On August 4, 2016, Congress passed the "Act 1805", which introduced a policy of opt-out on organ donation where everyone would become an organ donor unless they expressed negative. The law came into force on 4 February 2017.
Europe
Within the EU, organ donations are regulated by member countries. In 2010, 24 European countries had some form of opt-out system, with the most prominent and limited neglect systems in Spain, Austria and Belgium that resulted in high donor levels. In the UK organ donations are voluntary and no consent is considered. Individuals who wish to donate their organs after death can use the Organ Donation Register, a national database. The Government of Wales became the first constituent state in the United Kingdom to adopt the alleged consent in July 2013. The organ donation scheme in Wales was aired on December 1, 2015 and is expected to increase donors by 25%. In 2008, the UK discussed whether to switch to opt-out systems due to its success in other countries and a severe shortage of British organ donors. In Italy, if the deceased person is not allowed or refuses the donation while alive, the relative will make a decision on his behalf despite a 1999 act that provides an appropriate abandonment system. In 2008, the European Parliament strongly chose the initiative to introduce EU organ donor cards to encourage organ donations in Europe.
Landstuhl Regional Medical Center (LRMC) has become one of the most active organ donor hospitals in all of Germany, which otherwise has one of the lowest organ donor participation rates in the Eurotransplant organ network. LRMC, the largest US military hospital outside the United States, is one of the best hospitals for organ donation in the German state of Rhineland-Palatinate, although it has relatively few beds compared to many German hospitals. According to the German organ transplant organization Deutsche Stiftung Organtransplantation (DSO), 34 American military personnel who died at LRMC (roughly half of the total who died there) contributed a total of 142 organs between 2005 and 2010. In 2010 alone, 10 of the 12 American service members who died at LRMC were donors, donating a total of 45 organs. Of the 205 hospitals in the central DSO area - which includes the major cities of Frankfurt and Mainz - only six have more organ donors than LRMC in 2010.
Scotland complies with the Code of Practice of the Human Network Authority, which gives the authority to donate organs, not individual consent. This helps to avoid conflicting implications and contains several requirements. To participate in an organ donation, a person must be registered in the Organ Donor Registry (ODR). If the subject is incapable of giving consent, and is not in the ODR, then a representative acting, such as a legal guardian or family member, may provide legal consent for the donation of the subject's organs, along with the chairman's witness, according to Human. Code of Conduct Tissue Authority. Approval or rejection of a spouse, family member, or relative is necessary because the subject is incapable.
Austria participates in the "opt-out" consent process, and has laws that make organ donation a default option at the time of death. In this case, citizens must explicitly "opt out" of organ donations. "In the so-called opt-out countries, more than 90% of people donate their organs, but in countries like the US and Germany, people should explicitly" vote "if they want to donate when they die.In these countries, less than 15% of people donate their organs at death. "
In May 2017, Ireland began the process of introducing a "opt-out" system for organ donation. The Health Minister, Simon Harris, outlined his hope to have a draft of the Human Rights Bill authorized by the end of 2017. The bill will place a system of "suspected consent".
The Mental Capacity Act is another legal policy applicable to organ donation in the UK. This action is used by medical professionals to state the patient's mental capacity. This action claims that medical professionals should "act in the best interests of the patient", when the patient is unable to do so.
India
India has a fairly developed corneal donation program; However, donations after brain death are relatively slow to take off. Most transplants performed in India are alive or not related to transplantation. To curb organ trafficking and promote donations after brain death, the government enacted a law called "Human Organ Transplant Law" in 1994 that brought significant changes in organ donations and transplant sites in India. Many Indian states have adopted the law and in 2011 a further amendment of the law took place. Regardless of the law, there are several examples of trading organs in India and this has been widely reported in the media. This resulted in further amendments to the law in 2011. The pending donations after brain death are slowly beginning to occur in India and 2012 is the best year for the program.
- Indian Transplant News Source from the MOHAN Foundation
The year 2013 has been the best for donations of dead organs in India. A total of 845 organs were drawn from 310 multi-organ donors that resulted in a national organ donation rate of 0.26 per million inhabitants (Table 2).
* ODR (pmp) - Organ Donation (per million population) rate
In 2000 through the efforts of an NGO called MOHAN state, Tamil Nadu started a network of organ sharing between several hospitals. The NGO also established the same sharing network in the state of Andhra Pradesh and both countries are at the forefront of the deceased donation and transplant program for many years. As a result, the collection of 1033 organs and networks was facilitated in these two states by NGOs. Similar sharing networks appear in the states of Maharashtra and Karnataka; However, the number of donations dying in these countries is not enough to make much of an impact. In 2008, the Tamil Nadu Government drafted government orders to lay down procedures and guidelines for organ donation and organ transplants that have died in the state. It carries nearly thirty hospitals in the program and has resulted in a significant increase in donation rates in the state. With an organ donation rate of 1.15 per million inhabitants, Tamil Nadu is the leader in organ donation that has died in the country. The small success of the Tamil Nadu model has been made possible by the merging of both public and private hospitals, NGOs and the State Health department. Most of the donation programs that have died have been developed in the southern Indian state. The various programs are as follows-
In 2012 besides Tamil Nadu other southern countries also transplant donations that have died more often. The registry shares online organs for the donation and transplantation of the deceased used by the states of Tamil Nadu and Kerala. Both of these registrants have been developed, implemented and managed by the MOHAN Foundation. However. Organizations and National Transplantation Networks (NOTTOs) are national level organizations established under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India and only official organizations.
Organ sales are legally prohibited in Asia. Numerous studies have documented that organ vendors have poor quality of life (QOL) after a kidney donor. However, a study conducted by Vemuru reddy et al showed a significant improvement in Quality of life as opposed to previous beliefs. A live kidney-related donor had a significant increase in QOL after kidney administration using WHO QOL BREF in a study conducted at the All India Institute of Medical Sciences from 2006 to 2008. The quality of donor life was poor when corruption was lost or the recipient died.
Iran
Only one country, Iran has eliminated the shortage of transplant organ - and only Iran has a working and legal payment system for organ donation. [54] It is also the only country in which organ trading is legal. The way their system works is, if a patient has no living relatives or who are not assigned organs from dead donors, apply to the Nonprofit Dialysis and Transplant Patient Association (Datpa). The association establishes a potential donor, the donor is assessed by a transplant doctor who is not affiliated with the Datpa association. The government provides $ 1,200 compensation to donors and helps them with a year of limited health insurance. In addition, working through Datpa, a kidney recipient pays donors between $ 2,300 and $ 4,500. Importantly, it is illegal for the medical and surgical teams involved or 'intermediaries' to receive payments. Charitable donations are made to donors whose recipients can not afford to pay. The Iranian system began in 1988 and eliminated kidney deficiency in 1999. In the first year of the establishment of this system, the number of transplants was almost double; nearly four-fifths came from sources unrelated to life. [50] Nobel Laureate economists, Gary Becker and Julio Elias estimate that a $ 15,000 payment to a living donor will reduce kidney deprivation in the US.
Israel
Since 2008, signing an organ donor card in Israel has provided potential medical benefits to the signatories. If two patients require organ donation and have the same medical needs, the preference will be given to the person who has signed the organ donation card. This policy is dubbed "do not give, do not get". Organ donation in Israel increased after 2008.
Japanese
The rate of organ donation in Japan is significantly lower than in Western countries. This was due to cultural reasons, some western drug disbelief, and controversial organ transplants in 1968 that sparked a ban on cadaver organ donation that would last for thirty years. Organ donation in Japan is governed by a 1997 organ transplant law, which defines "brain death" and the procurement of organs authorized from brain dead donors.
New Zealand
New Zealand laws allow live donors to participate in altruistic organ donations only. In 2013 there were 3 cases of liver donations by living donors and 58 cases of kidney donors by living donors. New Zealand has a low level of living donation, which can be caused by the fact that paying someone over their organs is illegal. The Human Tissue Act 2008 states that trafficking in human networks is prohibited, and punishable by a fine of up to $ 50,000 or imprisonment up to 1 year.
New Zealand law also allows for organ donation from deceased persons. In 2013, the organ is taken from 36 people who have died. Anyone applying for a driver's license in New Zealand indicates whether they want to become a donor if they die in a state that allows donations. The question needs to be answered for the application to be processed, which means that the individual has to answer yes or no, and has no option to leave it unanswered. However, the answers given on the SIM are not informed consent, because at the time of the driver's license application not all individuals are equipped to make decisions about whether to become a donor, and therefore not a determinant of whether donations are made or not. It's there to give only an indication of what that person wants. The family must approve the procedure for the donation.
A 2006 bill proposes regulation of organ donation registers in which people can provide informed consent to organ donations and clearly state their legally binding wishes. However, the bill did not pass, and there was criticism from bills from some doctors, who said that even if someone had given their consent openly to organ donations, they would not perform the procedure in front of any disputes. from grieving family members.
Native New Zealanders also have a strong view of organ donation. Many Maori people believe organ donation is morally unacceptable because the cultural needs for corpses remain intact. However, since there is no universally recognized cultural authority, there is not a single view of the universally accepted organ donation in the Maori population. They, however, tend to receive kidney transplants than other New Zealanders, although too many in the population receive dialysis.
Sri Lanka
Organ donation in Sri Lanka is ratified by the Human Transplant Human Trans. 48 years 1987. Sri Lanka Eye Donation Society, a non-governmental organization founded in 1961 has provided more than 60,000 corneas for corneal transplants, for patients in 57 countries. It is one of the main suppliers of the human eye to the world, with a supply of about 3,000 corneas per year.
United States
More than 121,000 people who need organs are on the US government's waiting list. The crisis in the United States is growing rapidly because on average there are only 30,000 transplants done each year. More than 8,000 people die each year from lack of donor organs, an average of 22 people per day. Between 1988 and 2006 the number of transplants doubled, but the number of patients waiting for the organ grew six times larger. It is estimated that the number of donated organs will multiply if everyone with the appropriate organ decides to donate. In the past allegedly the consent was urged to try to reduce organ needs. The Uniform Anatomical Gift Act of 1987 was adopted in several states, and allowed medical examiners to determine whether organs and corpses could be donated. In the 1980s, some states adopted different laws that only allowed certain tissues or organs to be extracted and donated, some allowed, and some were not possible without family consent. In 2006 when UAGA was revised, the idea of ​​approval allegedly abandoned. In the United States today, organ donations are made only with the consent of the family or the donor itself. According to economist Alex Tabarrok, organ deficiency has increased the use of an extended criterion organ, or an organ previously thought unsuitable for transplantation. Five patients who received a kidney transplant at the University of Maryland School of Medicine developed a cancerous or benign tumor that had to be removed. The chief surgeon, Dr. Michael Phelan, explains that "the ongoing organ deficiency of dead donors, and the high risk of dying while awaiting transplantation, prompted five donors and recipients to move forward with surgery." Some organizations such as Dana Kidney of America are pushing to exclude donation organs in the United States.
Donor Leave Law
In addition to their sick leave and annual, federal executive employees are entitled to 30 days paid leave for organ donation. Thirty-two countries (excluding Alabama, Connecticut, Florida, Kentucky, Maine, Michigan, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, Pennsylvania, Rhode Island, South Dakota, Tennessee, Vermont, and Wyoming) and The District of Columbia also offers paid leave for state employees. Five states (California, Hawaii, Louisiana, Minnesota, and Oregon) require certain private employers to give paid leave to employees for organ donations or bone marrow, and seven others (Arkansas, Connecticut, Maine, Nebraska, New York, Carolina South, and the United States). West Virginia) requires employers to give unpaid leave, or encourage employers to give leave, to organ donations or bone marrow.
A bill in the US House of Representatives, the Living Donor Protection Act (introduced in 2016, then reintroducted in 2017), will amend its Family Law and Medical Leave in 1993 to grant leave under legislation to organ donors. If successful, the new law will allow organ donors "eligible employees" to receive up to 12 weeks of leave work within a period of 12 months.
Tax incentives
Nineteen US states and the District of Columbia provide tax incentives for organ donations. The most generous state tax incentive is Utah's tax credit, which covers up to $ 10,000 of unpaid costs (travel, lodging, lost wages, and medical expenses) associated with organ or network donations. Idaho (up to $ 5,000 of non-renewed fees) and Louisiana (up to $ 7,500 from 72% of the non-renewed fee) also grant donor tax credits. Arkansas, District of Columbia, Louisiana and Pennsylvania provide tax credits to employers for wages paid to employees on leave for organ donation. Thirteen states (Arkansas, Georgia, Iowa, Massachusetts, Mississippi, New Mexico, New York, North Dakota, Ohio, Oklahoma, Rhode Island and Wisconsin) have tax breaks of up to $ 10,000 of unpaid costs, and Kansas and Virginia offer tax deduction of up to $ 5,000 of non-refundable fees.
Countries have focused their tax incentives on unpaid costs associated with organ donations to ensure compliance with the National Organ Transplant Act of 1984. NOTA prohibits, "anyone who consciously obtains, receives, or transfers any human organ for valuable considerations for human use, transplantation. " However, NOTA excludes, "the travel, housing, and wage costs incurred by human organ donors in relation to organ donations," from the definition of "valuable consideration."
While offering income tax deductions is the preferred method of providing tax incentives, some commentators have expressed concern that these incentives provide disproportionate benefits to richer donors. Tax credits, on the other hand, are considered fairer because the tax benefits after incentives are not tied to the marginal tax rates of the donors. The preferred tax-addition approach has been proposed for organ donations, including providing tax credits to families of deceased donors (seeking to encourage approval), refundable tax credits (similar to earned income credits) to provide greater equity in between potential donors, and charitable deductions for donations of blood or organs.
Other financial incentives
As stated above, under the National Organ Transplant Act of 1984, the granting of monetary incentives for organ donation is illegal in the United States. However, there is some discussion about providing fixed payments to prospective donors alive. In 1988, donated organ donations were instituted in Iran and, as a result, the kidney transplant waiting list was removed. Critics of paid organ donation argue that the poor and vulnerable become vulnerable to transplant travel. The journey for transplantation becomes a transplant tour if the movement of organs, donors, recipients or transplant professionals takes place on the border and involves organ trafficking or commercial transplantation. Poor and under-served populations in underdeveloped countries are particularly vulnerable to the negative consequences of transplantation tourism as they have become the main source of organs for 'transplant travelers' who are able to travel and buy organs.
In 1994 a law was passed in Pennsylvania proposing to pay $ 300 for room and meals and $ 3,000 for funeral expenses to family organ donors. Developing a program is an eight-year process; this is the first of its kind. Director and surgeon procurement all over the country awaiting results from the Pennsylvania program. There are at least nineteen families who have signed up for benefits. Because of the program inquiry, however, there are some concerns whether the money collected is used to help the family. Some organizations, such as the National Kidney Foundation, oppose financial incentives associated with organ donations that claim, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values ​​as a society." One argument is that it will disproportionately affect the poor. The $ 300-3000 reward can act as an incentive for the poor, compared to the rich who may not find a significant incentive on offer. The National Kidney Foundation has noted that financial incentives, such as this Pennsylvania law, diminish human dignity.
Bioethical issues
Deontological
A deontological issue is a matter of whether one has an ethical duty or responsibility to take action. Almost all scholars and societies around the world agree that voluntarily donating organs to the sick is ethically permissible. Although almost all scholars encourage organ donation, fewer scholars believe that everyone is ethically asked to donate their organs after death. Similarly, almost all religions support voluntary organ donation as a beneficial act of charity for society, although some small groups, such as Roma (gypsies), are opposed to organ donation for religious reasons. Problems about patient autonomy, life will, and guardianship make it almost impossible for donations of voluntary organs to occur.
From the standpoint of deontological ethics, the main problem surrounding organ donation morality is semantic. Debates about the definition of life, death, humans, and the body are in progress. For example, whether a brain-dead patient should be kept artificially in order to retain an organ for donation is an ongoing problem in clinical bioethics. In addition, some argue that organ donation is an act of self-harm, even when an organ is donated voluntarily.
Furthermore, the use of cloning to produce organs with genotypes that are identical to the recipients is a controversial topic, especially considering the possibility for the whole person to become there for the obvious purpose of being destroyed for organ procurement. While the benefits of such cloning organs would be a zero percent chance of transplant rejection, the ethical issues involved with creating and killing clones could outweigh these benefits. However, it may be in the future to use cloned stem cells to grow new organs without creating new humans.
The relatively new transplant field has revived the debate. Xenotransplantation, or animal transfer (usually pigs) of organs to the human body, promises to eliminate many ethical problems, while creating many of its own problems. While xenotransplantation promises to increase the supply of organs significantly, the threat of rejection of organ transplants and the risk of xenozoonosis, coupled with the general anathema to the idea, decreases the functionality of the technique. Some animal rights groups have opposed animal sacrifices for organ donations and have launched campaigns to ban them.
Teleologis
For teleological or utilitarian reasons, the moral status of "donations of black market organs" depends on purpose, not means. As long as those who donate organs are often impoverished and those who are able to buy black market organs are usually rich, it would seem that there is an imbalance in trade. In many cases, those who require organs are put on the waiting list for legal organs for an indefinite period of time - many are dying while on the waiting list.
Organ donation is quickly becoming an important bioethics issue from a social perspective as well. While most of the first world countries have a legal oversight system for organ transplants, the fact remains that demand far outstrips supply. As a result, there has been a dark market tendency often referred to as transplantation tourism. The problem is heavy and controversial. On the one hand are those who argue that those who can afford to buy organs exploit those who are desperate enough to sell their organs. Many argue that this results in growing status inequalities between the rich and the poor. On the other hand, are those who argue that desperation should be allowed to sell their organs and prevent them from doing so only contributing to their status as poor people. Furthermore, those who support trade argue that exploitation is morally better than death, and as far as that choice lies between the abstract notion of justice on the one hand and the dying whose lives can be saved on the other, the organ of commerce must be legalized. In contrast, surveys conducted among live post-operative donors and within five years after the procedure show extreme remorse to most donors, who say that given the opportunity to repeat the procedure, they will not do so. In addition, many study participants reported deteriorating economic conditions following procedures. These studies only see people selling kidneys in countries where organ sales are legal.
The consequences of black market for organs are a number of cases and alleged cases of organ theft, including murder for the purpose of organ theft. Legal market advocates for organs say that the black market nature of trade today allows such tragedies and market regulations to prevent them. Opponents say that such a market would encourage criminals by making it easier for them to claim that their stolen organs are legitimate.
Legalization of organ trade brings its own sense of justice [citation needed]. Continuing the black market trade creates further disparity on the demand side: only the rich can afford to buy these organs. Legalization of international organ trafficking may lead to increased supply, lower prices so that people outside the richest segment can afford such organs as well.
Exploitation of arguments generally comes from two main areas:
- Physical exploitation indicates that the operation is risky enough, and, occurring in a third world hospital or "back alley", is even more risky. However, if such operations can be made safe, there is little threat to donors.
- Financial exploitation shows that donors (especially in subcontinent and African India) are not paid enough. Generally, accounts from people who have sold good organs in legal and illegal market situations charge between $ 150 and $ 5,000, depending on local laws, ready donor supplies and the scope of transplant operations. In Chennai, India where one of the largest black markets for organs is known to exist, research has put the average selling price slightly above $ 1,000. Many accounts also have post-operative donors refusing the promised fee.
The New Cannibalism is a phrase coined by anthropologist Nancy Scheper-Hughes in 1998 for an article written for The New Internationalist. The argument is that actual exploitation is an ethical failure, human exploitation; the perception of the poor as a source of organs that can be used to prolong the lives of the rich.
The economic drivers that lead to increased donations are not limited to areas like India and Africa, but also appear in the United States. The increase in funeral costs combined with a decline in the real value of investments such as homes and pension savings that occurred in the 2000s has led to an increase in citizens who take advantage of arrangements where funeral costs are reduced or eliminated.
Brain death versus heart death
Brain death can result in legal death, but still with heart beating, and with mechanical ventilation, all other vital organs can remain alive and function for a certain period of time. Given long enough, patients who are not completely dead, in the full biological sense, but are otherwise brain dead usually, either after shorter or longer intervals, depending on the patient case and the type and level of trauma and their age and previous health, toxins and wastes in the body, and the organs (especially sensitive ones such as the brain, nerves, heart, blood vessels, lungs, liver, intestines, and kidneys) can eventually dysfunction, have coagulopathy or fluid and electrolyte and nutritional imbalances, or even fail - some, or all and can not be changed. Thus, organs will usually only be sustainable and feasible for acceptable use until a certain time period (most transplanted organs fortunately have been widely used and agreed upon parameters, which can be measured and reliable, when determining the well-being and level of their function ). It will depend on how well the patient is maintained, other comorbidities, medical team skills, nursing, and surgery, and quality of care and facilities-and once removed, time and mode of transport and how smoothly the transplant procedure (and treatment before, during, and after operation [s]), leave. With optimal care and supervision, and with such person (via warrant or driver's license) and/or guardian or immediate family or a lawyer's consent law, certain cases may provide optimal opportunities for organ transplantation. The main point of contention is whether a transplant should be allowed at all if the patient has not been completely dead (biologically), and if brain death is acceptable, whether the whole brain of a person must die, or if the death of a part of the brain (ie, the cerebrum - our intellectual, and indeed all, conscious capacity, or brainstem - which controls the essential organic functions necessary for life, such as breathing and proper heartbeat setting) is sufficient for law and ethics and moral purposes.
Most organ donation for organ transplants is done in the setting of brain death. However, in Japan this is a full point, and prospective donors can designate either brain death or heart death - see organ transplants in Japan. In some countries (eg Belgium, Poland, Portugal, Spain and France) everyone automatically becomes an organ donor, although some jurisdictions (such as Singapore, Portugal, Poland, New Zealand or the Netherlands) may opt out of the system. Elsewhere, the consent of a family member or immediate family is required for organ donation. Non-living donors are kept in support of the ventilator until the organs have been removed surgically. If an individual who is brain dead is not an organ donor, ventilator and drug support is stopped and cardiac death is permissible.
In the United States, where since the 1980s, the Uniform Determination of Death Act has defined death as an irreversible cessation of brain or heart and lung function, the 21st century has seen an increase in the order of the following donations. heart death. In 1995, only one of the 100 dead donors in the country gave their organs after the death of the heart. That number grew by almost 11 percent in 2008, according to the Scientific Transplant Recipient Registry. The increase has provoked ethical concerns about "irreversible" interpretations because "patients may still live five or even 10 minutes after a heart attack because, theoretically, their hearts can be restarted, [and thus] obviously not dead because their condition is reversible."
Political issues
There are also controversial issues about how organs are allocated to recipients. For example, some believe that the heart should not be given to alcoholics in danger of return, while others see alcoholism as a medical condition like diabetes. Faith in the medical system is critical to the success of organ donation. Brazil turned to an opt-out system and eventually had to withdraw it because it further alienated patients who had no faith in the country's medical system. Adequate funding, strong political will to see increased transplant outcomes, and the presence of specialized training, care and facilities also increase the level of donations. The definition of an expansionary law of death, such as the use of Spanish, also increases the number of eligible donors by allowing doctors to declare a patient to die early, when the organ is still in good physical condition. Ignoring or prohibiting payment for organs affects organ availability. Generally, where organs can not be bought or sold, quality and safety are high, but supply is inadequate for demand. Where organs can be bought, supply increases.
Iran adopted a kidney donor payment system in 1988 and in 11 years became the only country in the world to clear a waiting list for transplantation .
A healthy human has two kidneys, a redundancy that enables live donors ( inter vivos ) to give the kidneys to someone who needs them. The most common transplant is to close relatives, but people have given the kidneys to other friends. The most rare type of donation is a non-directed donation where donors provide kidneys to foreigners. Less than a few hundred kidney donations have been made. In recent years, searching for altruistic donors over the internet has also been a way to find life-saving organs. However, internet advertising for organs is a very controversial practice, as some experts believe it is destroying traditional list-based allocation systems.
The National Transplant Organization of Spain is one of the most successful in the world (Spain has been a world leader in organ donation for decades), but still can not keep up with demand, because 10% of those who need transplantation die while still on the transplant list. Donations from corpses are anonymous, and networks for communication and transportation allow rapid extraction and transplantation across the country. Under Spanish law, every corpse can provide the organ unless the deceased person expressly rejects it. Because family members can still prohibit donations, carefully trained doctors seek permission from the family, making it very similar in practice to the US system.
In most cases, organ donation is not possible due to safety of the recipient, failure of match, or organ condition. Even in Spain, which has the highest organ donation rate in the world, there are only 35.1 actual donors per million people, and there are hundreds of patients on the waiting list. This figure is comparable to 24.8 per million in Austria, where families are rarely asked to donate organs, and 22.2 per million in France, which - like Spain - has a suspected consent system.
Prison inmates
In the United States, detainees are not discriminated against as recipients of organs and are equally eligible for organ transplants together with the general population. A case of the US Supreme Court of 1976 ruled that restraining health care from prisoners was a "cruel and unusual punishment". United Network for Organ Sharing, the organization that coordinates the organs available with the recipients, does not factor the prison status of the patient when determining the suitability for transplantation. Organ transplants and advanced care can cost the prison system up to a million dollars. If a prisoner qualifies, a country may allow a compassionate early release to avoid the high costs associated with organ transplantation. However, organ transplants can save the cost of a large prison system associated with dialysis and other life-extension treatments required by inmates with failing organs. For example, the estimated cost of a kidney transplant is about $ 111,000. Treatment of dialysis prisoners is estimated to cost $ 120,000 per year.
Because donor organs are in short supply, there are more people waiting for transplants than the available organs. When a prisoner receives an organ, there is a high probability that another person will die waiting for the next available organ. The response to this ethical dilemma states that criminals who have a history of violent crime, who has violated the basic rights of others, have lost the right to receive organ transplants, although it is noted that it is necessary "to reform our judicial system to minimize the possibility of innocent people wrongly convicted of violent crime and thus denied organ transplants "
Prisons usually do not allow inmates to donate organs to anyone but close family members. There is no law against the donation of prisoners' organs; however, the transplant community has played down the use of detainee organs since the early 1990s because of concerns over the high-risk environment of imprisonment for infectious diseases. Doctors and ethicists also criticize the idea because detainees can not agree on procedures in a free and non-coercive environment, especially if given persuasion to participate. However, with the advancement of modern tests to be safer to get rid of infectious diseases and by ensuring that no incentive is offered for participation, some argue that detainees can now voluntarily approve organ donations just as they can now agree on general medical procedures. With careful protection, and with more than 2 million prisoners in the US, they reasoned that prisoners could provide solutions to reduce organ deficiency in the US.
While some argue that the participation of inmates may be too low to make a difference, an Arizona program started by former Maricopa County Sheriff Joe Arpaio encourages inmates to voluntarily register to donate heart and other organs. By mid-2012, more than 10,000 prisoners enrolled in one area alone.
Religious view
There are different religions that have different points of view. Islam has conflicting views on this issue, half believing it to be against religion. However, Muhammad claims his followers should seek medical attention when needing and saving lives is a very important factor of Islam. Buddhism is largely opposed to practice, because it does not respect the ancestral and natural bodies. Christianity is the most lenient on the topic of organ donation, and believes it is the ministry of life.
All major religions accept organ donation in at least some form on a utilitarian basis ( ie , for life-saving) or deontological reasons ( eg , the right of an individual who believes to make his decision own). Most religions, among them the Roman Catholic Church, support organ donation on the grounds that it is a charitable act and provide a means of saving lives, consequently Pope Francis is an organ donor. One religious group, The Jesus Christians, is known as "The Kidney Cult" because more than half of its members have donated their kidneys altruistically. Christians Jesus claiming altruistic kidney donations are a great way to "Do to others what they want you to do to them." Some religions impose certain restrictions on the types of organs that can be donated and/or on the means by which organs can be harvested and/or transplanted. For example, Jehovah's Witnesses require organs to be dried from any blood because of their interpretation of the Hebrew/Old Testament Christian Scriptures as prohibiting blood transfusion, and Muslims require that donors have given prior written approval. Some groups do not like organ transplants or donations; especially, these include Shinto and those who follow the gypsy custom.
Orthodox Judaism considers compulsory organ donation if it will save lives, as long as the donor is considered dead as defined by Jewish law. Neither in Orthodox Judaism nor non-Orthodox Judaism, the majority view holds that organ donation is permissible in cases of an irreversible heart rhythm. In some cases, rabbinic authorities believe that organ donation may be mandatory, whereas minority opinions perceive any live organ donation as forbidden.
Organ deficiency
Organ requests significantly outnumber donors anywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors. In particular, due to significant advances in dialysis techniques, patients with end-stage renal disease (ESRD) can survive longer than before. Because these patients do not die as fast as they used to, and when kidney failure increases with age and the prevalence of high blood pressure and diabetes in the community, the need for kidney increases every year.
In March 2014, about 121,600 people in the United States were on the waiting list, although about a third of these patients were inactive and could not receive donated organs. The waiting times and success rates for organs differ significantly between organs due to demand and procedure difficulties. In 2007, three-quarters of patients who needed organ transplants were waiting for the kidneys, and such kidneys had longer waiting times. As stated by the Gift of Life Donor Program website, median patients end up receiving 4 months waiting organs for the heart or lungs - but 18 months for the kidney, and 18-24 months for the pancreas as the demand for these organs substantially exceeds supply.
In Australia, there are 10.8 transplants per million people, about a third of the Spanish level. The Lions Eye Institute, in Western Australia, is home to the Eye Lions Eye Bank. The Bank was established in 1986 and coordinates the collection, processing, and distribution of eye tissue for transplantation. The Eye Eye Bank also maintains a waiting list of patients requiring corneal graft surgery. About 100 corneas are provided by the Bank for transplantation every year, but there is still a waiting list for the cornea. "For an economist, this is a basic supply and demand gap with tragic consequences." Approaches to overcome these shortcomings include:
- Donor enforcers and the "main approval" law, to remove the burden of donation decisions from the nearest legitimate family. Illinois adopted a policy of "mandate choice" in 2006, which required the SIM registrant to answer the question "Do you want to be an organ donor?" Illinois has a 60 percent registration rate compared to 38 percent nationally. Additional charges add questions to the minimum registration form.
- Monetary incentives to register as donors. Some economists advocate going as far as allowing the sale of organs. The New York Times reported that "Gary Becker and Julio Jorge Elias argue in a recent paper that 'monetary incentives will increase the supply of organs for sufficient transplants to eliminate the enormous queues in the organ market, and the suffering and death of many of them awaiting , without raising the total cost of transplant surgery by more than 12 percent. "" Iran permits the sale of the kidney, and does not have a waiting list.The main argument against this proposal is moral: like article records, many consider such a suggestion repulsive as the Foundation The National Kidney, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values ​​as a society. Any attempt to assign monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. "
- The opt-out system ("solution disagree"), where potential donors or their relatives must take certain actions to be excluded from organ donations, rather than special measures to be included. This model is used in several European countries, such as Austria, which has an eight-time registration rate from Germany, which uses an opt-in system.
- Social incentive program, in which members sign a legal agreement to direct their organs to other members on the transplant waiting list. One example of private organizations using this model is LifeSharers, who are free to join and whose members agree to sign documents that give preferred access to their organs. "The proposal [for organ-collective insurance collections] can easily be summarized: A person will receive priority for the transplant needed if the individual agrees that his organs will be available to other members of the insurance arm if he or her death... The main purpose [of this proposal] is to increase the supply of transplanted organs to save or increase more lives. "
At the hospital, organ tissue representatives routinely filter out patient records to identify potential donors shortly before their deaths. In many cases, organ-procurement representatives will require screening tests (such as blood typing) or organ preservative drugs (such as blood pressure medications) to keep potential donor organs safe until their appropriateness for transplantation can be determined and family consent ( if required) can be obtained. This practice increases the efficiency of transplantation, because unsuitable potential donors due to infection or other causes are removed from consideration before their death, and reduce the loss of avoidable organs. This can also benefit the family indirectly, as families of inappropriate donors are not approached to discuss organ donations.
The Center for Ethical Solutions, an American bioethics think tank, is currently working on a project called "Solving the Organ Deficiency", where he is studying Iran's kidney procurement system to better inform the debate about solving organ deficiencies in the United States.
Distribution
The United States has two institutions governing the procurement and distribution of organs within the country. The United Network for Organ Sharing and the Organ Procurement and Transplant Network (OPTN) regulate Organ Procurement Organizations (OPO) related to ethics and procurement and distribution standards. OPO is a nonprofit organization tasked with evaluation, procurement and allocation of organs within the Designated Service Area (DSA). Once the donor is evaluated and approval is obtained, the temporary organ allocation begins. UNOS me
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