Organ transplantation is a gift

“...nobody (that is, no potential recipient) has a claim on organs or tissue of any person, living or dead. The sick should thus accept the tissue and organs freely offered by others as a gift” – German Bishops.

This position is widely accepted.

The transplantation of organs carries with it many complex ethical issues that are not solely medical. What is medically possible is not necessarily ethically correct.

Organ transplantation from live donors, whether they are from kin or from a live Samaritan donor, must be considered within the framework of a multi-disciplinary team who evaluate each individual case on its own merits.

The Ministry of Health said that a decision about organ donation will be made after the cases are evaluated by the Live Donor Transplant Advisory Committee. I think that this advisory committee needs to have all the facts that will lead it to come to a decision.

The debate that arose when Sarah Borg decided to advertise that she was looking for a healthy kidney for the father of her son and was offerring financial compensation created an environment of misinformation, even though she stated that this compensation is only to offset the loss of work that the person will have to endure.

The moment monetary com­pensation was mentioned this muddied the waters.

As soon as a patient suffering from end-stage kidney failure starts haemodialysis, s/he is put on a list for transplantation. The kidneys used for the transplants are usually from a cadaver. This is not a straight and plain next-on-the-list process. Other parameters are justly taken into account. Is this patient the best match? Is the overall condition of his body ready to take the impact of this major operation? Are there younger and healthier patients who will benefit far more from this transplant without falling into the issue of discrimination because of age, race or religion?

Because the number of patients undergoing dialysis is about 250, this means that the supply of available organs is much lower than the demand. This is not only a Maltese scenario but a worldwide fact. In view of this, it has become far more commonplace that live donors have come on to the scene. It is a most laudable act of generosity, selflessness and vital solidarity, which has seen many patients like myself regain a new life and hope in the face of nearly certain death.

The fact that another person who is heathy is brought into the picture requires serious attention to the fact that the dignity and health of this live donor must be fully respected.

In major centres of trans­plantation, where the number of tranplants are well over 100 annually, such as Cisanello in Pisa, where I underwent a simultaneous kidney and pancreas trans­plantation, besides the thorough medical testing, both the donor and the recipient have to undergo separate pschological and psy­chiatric testing.

The assesment involves examin­ing whether the donor and recepient are mentally balanced. Will the donor be able to survive the donation and live a future healthy lifestyle? Is this recipient the best recipient for the organ?

Some argue in favor of allowing human organs and tissues to be bought and sold to increase the supply and to respect people’s autonomy. Others argue against such a practice saying that to treat the human body and its parts as commodities violates human dignity.

Human tissues and organs are, in fact, being sold in some places. In Bombay, for example, there have also been some cases of kidnapping where victims regain consciousness to find that one of their kidneys was removed while they were drugged.

Paying for organs can constitute unjust moral pressure on the donor. It could invalidate any free consent or a contract.

Some also fear that the buying and selling of organs and tissues would undermine the altruism (giving motivated by love) and social bonding now associated with transplants. It could also lead to organs going to the highest bidder. Equity would be violated with ability to pay rather than medical need determining the distribution of organs.

A World Health Organisation resolution in 1989, which was eventually supported by more than 151 nations in part, “calls upon member states to take appropriate measures to prevent the purchase and sale of human organs for transplantation...”

Concerning the Christian vision, which sees human life and the body as “a gift of the Creator, which persons cannot dispose of as they please”, the German Bishops’ Conference and the Council of the German Evangelical Church say: “This does not exclude compensation for the expenses incurred by the donation of tissue and organs but it does forbid deriving profit from it.”

The Catholic Health Association of Canada holds that the buying and selling of human organs, tissues and blood “contradicts the principle of charity, which is part of the necessary justification for such transplantations”.

Sometimes an organ or tissue is procured for a person by publicising their need through the media. This could bypass the regular transplant channels and their selecting recipients for an available organ on the basis of greatest need and greatest likelihood of benefit and first come first serve.

On the other hand, media pleas frequently bring in more volunteers than those required for the case being publicised. Media publicity also increases public awareness of the need for transplants and, so, in the long run should increase the supply of donated tissues and organs.

The author is director of the Centre for Ignatian Spirituality and a member of the Transplant Support Group.