ORGAN DONATION AND ETHICAL DILEMMA

Organ Donation: How it has created an Ethical Dilemma in Healthcare



Organ Donation: How it has created an Ethical Dilemma in Healthcare

Introduction

Organ donation has become the treatment of choice for end-stage renal disease (ESRD) in addition to other types of organ failure, notably heart, liver, and lung. Boulware, et al (2002) mention by all accounts, the shortage of transplantable organs is a public health crisis with one person on the United Network of Organ sharing (UNOS) transplant waiting list dying approximately every 17 min (Boulware, et al, 2002). In 2005, there were more than 90,000 individuals awaiting transplantation.

There are two possible sources of organs for transplant: deceased organ donation that has provided the major source of transplantable organs and living donation usually, but not always, from the families of waiting recipients (Siminoff, et al, 2003). Deceased donors are the only feasible source of heart donation and are by far the single most important source of livers, lungs, intestinal organs, and pancreata. Most living donation involves kidneys (92%) or liver segments (8%).

The number of deceased and living donors for all organs was 14,491 in 2004, with 7,593 deceased and 6,898 living donors. The number of all organ donors has increased at an average rate of 7% per year. Although the increase in living donors has been a major contributor in helping ameliorate the organ donor shortage in the United States, the numbers of persons on the waiting list is growing faster, with a net increase in the waiting list of 11% per year. This paper discusses organ donation in the context of how it has created an ethical dilemma in healthcare in a concise and comprehensive way.

Organ Donation: How it has created an Ethical Dilemma in Healthcare

Most organs for transplantation come from cadavers, but as these have failed to meet the growing need for organs, attention has turned to organs from living donors. Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient. Transplantation surgeons have therefore been cautious in tapping this source. As surgical techniques and outcomes have improved, however, this practice has slowly expanded. Today, according to the United Network for Organ Sharing (UNOS), almost half of all kidney donors in the United States are living. In 2004, living organ donors also provided a lobe of the liver in approximately 320 cases and a lobe of a lung in approximately 15 cases.

Three categories of donation by living persons can be distinguished: directed donation to a loved one or friend; non-directed donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; and directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection (Siminoff, et al, 2003).

Each type of donation prompts distinct ethical ...