Are your kidneys available to me? - Eighth in a series
In theory kidney transplantation, begun in 1954, is being perfected as a medical procedure to save lives and and to improve healthcare; the future looks bright. In practice it is a boondoggle of financial wreckage for taxpayers, questionable truth in advertising to prospective donors, a cauldron brewing up a black market for human organs, a quandary of legal matters, a patchwork of medical and government coordination, and an ethical minefield.
Various approaches have developed to try to resolve these dilemmas.
Public relations efforts are ongoing to recruit living donors. Numerous medical communities hire the best people to achieve results in all program aspects. (example) More living donors will save taxpayers money. (See previous post.)
Changing the law to permit selling ones kidneys is possible, to address the black market mess (previous post). Iran alone among the nations legalized kidney sales, but some countries are very well known for trafficking so much so that selling seems accepted; an internet search will return these perpetrators.
Churches set guidelines to try to enforce an ethic of life that nevertheless upholds transplants, to help clear the ethical minefield (previous posts). Clearing minefields is slow and dangerous work. For example, the Catholic church catechism states:
Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons. (#2296)
The tricky word in this teaching is death. The Catholic hierarchy accepts the neurological definition, or brain death, as true death, but a sizable number of parishioners do not. (example)
They hold to the “the time proven, generally accepted criteria for death — the cessation of circulation, respiration, and reflexes.” This controversy is delineated on the Truth about Organ Donation website.
At a Vatican conference to explore the differing definitions, one doctor provided background information for the controversy:
Dr. Hill recalled that the earliest attempts at transplanting vital organs often failed because the organs, taken from cadavers, did not recover from the period of ischemia following the donor's death. The adoption of brain-death criteria solved that problem, he reported, "by allowing the removal of vital organs before life support was turned off--without the legal consequences that might otherwise have attended the practice.”
While it is remarkable that the public has accepted these new criteria, Dr. Hill remarked, he attributed that acceptance in large part to the favorable publicity for organ transplants, and in part to public ignorance about the procedures.
“It is not generally realized,” he said, “that life support is not withdrawn before organs are taken; nor that some form of anaesthesia is needed to control the donor whilst the operation is performed. As knowledge of the procedure increases,” he observed, “it is not surprising that — as reported in a 2004 British study – ‘the refusal rate by relatives for organ removal has risen from 30 percent in 1992 to 44 percent.’” Dr. Hill also suggested that when relatives see with their own eyes the evidence that a potential organ donor is still alive, they harbor enough doubts so that they are not ready to consent to the organ removal. (ref)
Dr. Paul A. Byrne may be the best known physician in this camp. His articles have been so helpful to me. He is in agreement with Catholic classical doctrine, but not with the Vatican’s acceptance of the definition of death.
I have gotten off on a rabbit trail exploring the definition of death controversy. We will pause here and take up a few more approaches to resolving dilemmas arising from the practice of transplantation in the next post.