Organ Donation
The need for organ donation worldwide, in particular in the USA, is an urgent issue that requires solution that is important for the transplant community and the society on the whole. The process of allocating human organs for transplantation claims to follow a specific application of ethical principles and norms to the matters of social rights and justice. The involved principles are the same in different spheres of human behavior as all of them reflect the inferences of the U.S. public bodies that have examined general norms and principles of ethics. This paper discusses the ethical dilemma of organ allocation and creates a set of guidelines (three major ethical principles) that manage the model of the Golden Rule essay store
The Value of the Ethical Issue and Organ Donation Statistics
More and more people need organ donation not only in the United States but also across the globe. The result of this ongoing struggle for the transplant community is daily human deaths because of the lack of organs. According to the U.S. Department of Health and Human Services (HHS), about 22 people die every day awaiting a life-saving organ transplant (2015b). As for 2015, there were119 thousand people on the U.S. transplant waiting list (where 2 thousand of them are children under 18 years old), and this number has increased fivefold from 1991. Only 30, 970 transplants were performed that year. Moreover, every ten minutes the list is updated with a new person. Concerning the ethnicity of the waiting list, 58% of the registered people are ethnic minorities, where Caucasians take almost 42%, African Americans – 29.7%, Hispanics – 19%, Asians – 7.5%, and other – 2.2%. With regard to the organs which people need urgently, kidney takes the first place there (81.8%), liver goes second (11.4%), then heart (3.2%), lung (1.1%), and other organs (2.5%). Thus, the question of organ allocation is really significant for the whole country and the world in general.
The History of Organ Allocation
The first human organ that was transplanted successfully is the kidney (in 1954). By the late 1960s, transplant surgeries on such organs as heart, liver, and pancreas were also performed well. The procedures of lung and intestinal organ transplantation were started in the 1980s. Medical advances in areas of treatment and prevention of rejection resulted in more successful transplantations and increase in demand for them.
In 1984, an independent and non-profit organization was incorporated – United Network for Organ Sharing (UNOS). It saved human lives by supporting the donation efforts and transplantation professionals. The same year, the National Organ Transplant Act (NOTA) called to create a private and non-profit organization that is under the federal contract called an Organ Procurement and Transplantation Network (OPTN). As a result, in 1986, United Network for Organ Sharing became first to be awarded the American OPTN contract by the U.S. Department of Health and Human Services. Moreover, it continues to exist as a single organization (operated by the OPTN) that created an organ sharing system which maximizes the efficient applying of deceased donor’s organs by fair and timely allocation. It also informs patients, provides various consultations, and helps individuals as well as organizations concerned with organ transplantation to enlarge the number of organs that are available for transplants.
Guiding Ethical Principles of Organ Allocation
In summer 2015, the combined ethics committee of ONOS and OPTN released a white paper that outlines the major ethical principles which may guide organ allocation process and are general prescriptive norms that identify the basic features of human practices which tend to make such principles morally right. The white paper has some practical considerations such as the need to maximize quality-adjusted years of life as well as to minimize complications, morbidities, and mortality that are in the balance with the attention to justice issues. According to this document, there are three ethical principles of primary importance in the human organ allocation process. They are utility, justice, and respect for people.
The Principle of Utility
The principle of utility guides a practice or an action to be right in case it promotes more benefits than any other alternative action. Being applied to the allocation of organs, this principle defines that allocation needs to maximize the expected overall good, thereby including the principle of beneficence that means “make good” and the principle of non-maleficence that warns “do no harm”. Establishing a current principle, it is important to have evidence that the particular person has a medical condition which causes a prediction of poorer result.
The Principle of Justice
The principle of justice deserves careful consideration as a basis of the ethics of organ allocation. Justice refers to fairness in the structure of distribution of the advantages and obligations referred to organ procurement and an allocation program. Thus, it deals with the general amount of produced medical goods and the method of distributing those goods amid potential beneficiaries. Hence, all patients are not treated the same way but should be equally respected. Organ allocation focuses on such social characteristics as race, gender, and socioeconomic class will conflict with the principle of justice as there can be specific cases. One of such cases is matching a skin tone to a hand transplant that requires exclusions in allocation of vascularized composite allografts. It is possible to involve many factors to the allocation policy as they all promote utility; however, it is also important to treat potential patients fairly by providing everyone with the same opportunities to get an organ when it is needed. The essential factors in the application of the principle of justice are a likelihood of finding an appropriate organ in the nearest future, medical urgency, waiting list time, age, geographical justice, and first versus repeat transplants. Occasionally, the principle of justice can be in a conflict with the principle of utility. In this case, both of them deserve equal consideration as they play a significant role in a decision-making process regarding the morally just allocation.
The Principle of Respect for Persons
The principle of respect for people involves the ethics requirements of honesty and faithfulness to commitments made. The bottom line here is that respect for individuals includes the concept of respect for autonomy, considering that practices or actions tend to be right as they reflect self-determination. Thus, if appreciation of autonomy contradicts other ethical principles, in some cases autonomy deserves respect while sometimes it must yield to it. For instance, the current system of organ allocation gives priority to justice over respect, so the autonomy to sell forbidden organs is granted. In case when realizing an organ is a donor’s decision, producing a market system that enlarges healthcare disparities among various socioeconomic groups contravenes the underlying principle of justice.
Implementing a Model of the Golden Rule in Solving Ethical Issues
To start with, a model of golden rule appears at the top of moral principles as it is the most universal and precise among them. The rule according to which you must treat others in the way you would like to be treated in turn, serves as an ethical stepping stone for any person when making decisions related to the morals. The model implies that each individual has his/her own value and worth. It indicates that a person on the other side deserves the same justice and respect. Thus, this model is perfect when it comes to solving an ethical issue of organ allocation that requires following three major principles of ethics, namely utility, justice, and respect for people, which is also reflected in the golden rule. The model oversteps the divisions of class, race, or status. Every patient registered on a waiting list for a needed organ merits respect for his/her individuality, fairness, and usefulness. The golden rule means that being honest in treating others is essential to show respect for people. Reflections on a patient’s age and the controversy about individuals on the waiting list for multiple organs, when other people die while awaiting the only one life-saving organ, is related to the matters of utility and justice. Therefore, there should be a balance in applying the major ethical principles to a problem that makes the golden rule such a global and powerful tool.
The need for the increased amount of organ donation in the USA and worldwide is an ongoing struggle in the transplant community, since about 22 individuals die every day awaiting life-saving organ transplantation. Ethical issues of organ allocation should be considered by with regard to the model of the golden rule that is also based upon adhering to such three ethical principles: utility, justice, and respect for people. The balance between all of them creates a framework needed for the equitable allocation of human organs for transplantation. The policies of allocation should aspire to include an appropriate combination of basic principles by giving equal consideration to justice and utility, while combining the fundamental aspects of respect for people. Thus, finding a solution to an ethical dilemma is possible through treating others in the way a person wants to be treated in turn and by keeping a balanced relationship centered on the ethical principles.
