24 procuring organs 1 (1)

Procuring OrgansProcuring Organs

Human organs for transplantation Human organs for transplantation are a scarce resource.are a scarce resource.

Human organs come from (a) Human organs come from (a) cadavers or (b) living donors.cadavers or (b) living donors.

Among living donors, (a) the donor’s Among living donors, (a) the donor’s loss may be loss may be temporarytemporary (blood, bone (blood, bone marrow) or marrow) or permanentpermanent (kidney). (kidney).

In the US (as of April 13, 2012), the In the US (as of April 13, 2012), the waiting list for an organ was 113,866waiting list for an organ was 113,866

Waiting for Waiting for kidneykidney: 98,000: 98,000 Waiting for Waiting for liverliver: 16,856: 16,856 Waiting for Waiting for heartheart: 3,178: 3,178 Approximately 6,500 people per year Approximately 6,500 people per year

die waiting for organsdie waiting for organs

In the US, there are approximately In the US, there are approximately 2.5 million deaths per year. So why 2.5 million deaths per year. So why a shortage of cadaver organs?a shortage of cadaver organs?

In part, the answer is that the “pool” In part, the answer is that the “pool” of potential donors is much smaller of potential donors is much smaller than 2.5 million.than 2.5 million.

The accepted definition specifies that The accepted definition specifies that an individual is an individual is deaddead who has who has sustained “irreversible cessation of sustained “irreversible cessation of circulatory and respiratory functions” circulatory and respiratory functions” [cardiac death] [cardiac death] oror who has sustained who has sustained “irreversible cessation of all functions “irreversible cessation of all functions of the entire brain, including the of the entire brain, including the brain stem” [whole brain death].brain stem” [whole brain death].

The “higher” brain consists of the The “higher” brain consists of the cerebral hemispheres; it enables us cerebral hemispheres; it enables us to see, hear, feel, etc.to see, hear, feel, etc.

The “lower” brain consists of the The “lower” brain consists of the brain stem; it controls things we do brain stem; it controls things we do unconsciously, such as breathing, unconsciously, such as breathing, heartbeat, and reflex action.heartbeat, and reflex action.

If the higher brain is destroyed, there If the higher brain is destroyed, there can be breathing, heartbeat, etc. (as can be breathing, heartbeat, etc. (as in PVS pts such as Quinlan, Cruzan, in PVS pts such as Quinlan, Cruzan, Schiavo, or in an anencephalic Schiavo, or in an anencephalic infant).infant).

Individuals who are in a PVS or are Individuals who are in a PVS or are anencephalic are anencephalic are notnot brain dead. brain dead.

Why a shortage of cadaver Why a shortage of cadaver organsorgans

1.1. Organs are taken from persons Organs are taken from persons declared whole brain dead.declared whole brain dead.

2.2. No “contraindications” [e.g., AIDS, No “contraindications” [e.g., AIDS, hepatitis, cancer, etc.].hepatitis, cancer, etc.].

3.3. Next-of-kin [family] must agree.Next-of-kin [family] must agree.

4.4. Some who are transplanted “reject” Some who are transplanted “reject” the organs.the organs.

Concerning (1): Most who die Concerning (1): Most who die experience “cardiac death”; only a experience “cardiac death”; only a small number are brain dead and small number are brain dead and whose circulation can be sustained whose circulation can be sustained on machinery.on machinery.

Concerning (3): Even if a person has Concerning (3): Even if a person has signed an organ donor card, usually signed an organ donor card, usually organs will not be procured unless organs will not be procured unless the family agrees.the family agrees.

Concerning (4): Recipients of organs Concerning (4): Recipients of organs must take immunosuppressive drugs must take immunosuppressive drugs for the rest of their lives. They are for the rest of their lives. They are more susceptible to infections and more susceptible to infections and may “reject” the organ.may “reject” the organ.

Given the Given the valuevalue of organs for of organs for transplantation (save lives) and transplantation (save lives) and given the given the shortageshortage, society should , society should have as a goal increasing the have as a goal increasing the supplysupply of available cadaver organs.of available cadaver organs.

But how can society deal with this But how can society deal with this problem?problem?

There are There are threethree ways of approaching ways of approaching the problem:the problem:

1.1. Expand the “pool” by including more Expand the “pool” by including more than the brain dead.than the brain dead.

2.2. Adopt a different Adopt a different policypolicy for procuring for procuring organs.organs.

3.3. Retain the current policy, but make it Retain the current policy, but make it work better.work better.

Concerning strategy (1), some have Concerning strategy (1), some have suggested including as donors:suggested including as donors:

Individuals in a PVS.Individuals in a PVS. Anencephalic infants.Anencephalic infants. Some who have died “cardiac death” Some who have died “cardiac death”

[where the time of death can be [where the time of death can be predicted as when someone is predicted as when someone is removed from life-support].removed from life-support].

Question about strategy (1): Will Question about strategy (1): Will including any or all of these including any or all of these additional categories significantly additional categories significantly increase available organs? It seems increase available organs? It seems doubtful.doubtful.

If not, one of the other two strategies If not, one of the other two strategies needs to be employed (needs to be employed (ifif the the problem can be solved).problem can be solved).

Strategy (2): Look at the different Strategy (2): Look at the different policies that might be used for policies that might be used for obtaining cadaver organs and see if obtaining cadaver organs and see if some seem more promising than the some seem more promising than the status quo.status quo.

To implement strategy (2), we must To implement strategy (2), we must look at the look at the policypolicy optionsoptions, including , including the status quo.the status quo.

Of each option, we must ask:Of each option, we must ask:

1.1.Is the policy likely to increase the Is the policy likely to increase the supply of organs available? Will it supply of organs available? Will it produce enough without being too produce enough without being too costly?costly?

2.2.Are there any moral objections to the Are there any moral objections to the policy?policy?

We will examine several policies that We will examine several policies that might be adopted:might be adopted:Giving Policy (status quo)Giving Policy (status quo)Trading PolicyTrading PolicyPolicy of Presumed ConsentPolicy of Presumed ConsentModifications of the Giving PolicyModifications of the Giving Policy