ORGAN DONATION AND
ALLOTRANSPLANTATION
HEALTH LAW AND BIOETICS
Helena Pereira de Melo
23 April, 2014
Szilvia Szabó - 003903
ORGAN DONATION AND ALLOTRANSPLANTATION
Introduction
• Organs and tissues for donation
- heart, kidneys, liver, lungs,
- pancreas, intestine, thymus
- Bones, cornea, skin, heart valves
- Nerves and veins …
Most of kidneys > liver > heart
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Culture in relation to transplant
Human rights in relation
Justice rights
Benefice rights
ORGAN DONATION AND ALLOTRANSPLANTATION
Introduction – Human rights
• Mr. George Olds is a 76-year-old nonsmoking retired business executive
with end-stage heart failure. He has good pulmonary and renal function and
is not diabetic;thus he is medically a good candidate for a heart transplant.
His life expectancy without a transplant is 1 mouth. He has a loving family,
with the resources to pay the $100,000 cost of procedure.
• Mr. Matt Younger is a 46-year-old divorced man who is unemployed,
having lost his job as an auto worker 3 years ago. He has a history of
smoking and alcohol use. He suffers a heart attack, develops intractable
heart failure, and will die within 1 mouth without a heart transplant. He has
good pulmonary and renal function and is not diabetic, making him a good
candidate for the procedure.
Who should receive it?
1984 National Organ Transplaltation Act designed the United Network for
Organ Sharing (UNOS)
ORGAN DONATION AND ALLOTRANSPLANTATION
History – before modern society
ORGAN DONATION AND ALLOTRANSPLANTATION
History – 19 century
• 1818 first human – to – human blood transfusion
• 1831 Mary Shelley publishes Frankenstein
• 1878 first successful human – to – human bone transplant
• 1881 first reported use of skin graft
• 1896 first attempts at bone marrow transplant
ORGAN DONATION AND ALLOTRANSPLANTATION
History – 20 century
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1900-1902 blood groups discovered
1902-1908 Carrel Develops Technique for connecting blood
1905 first successful cornea transplant
1908 first transplant of a knee
1909 first recorded kidney transplant, animal to human
1913 researches create the first artificial kidney
ORGAN DONATION AND ALLOTRANSPLANTATION
History – 21 century
2000-2002
• Population of kidney failure patiens grows
• Tissue and blood banks respond to terror attack
• Number of living donors passes cadaveric donors
• Patients living with organ and tissue transplants numbers in the Millions
2003
• Eighteen people die each day on the waiting list
2004
• 50th anniversary of the first kidney transplant
2004 and beyond
• The future of transplantation
Death by medical sience
1. Clinical death:
The circulation, breathing and brain function temporarily suspended.
Reversible!
2. Biological death:
The body’s viability is irreversibly terminated.
3. Brain death:
The brain – including the brainstem – complete and irreversible
cessation. The same as the traditional sense of invidual’s death
Legal
Death – A statutory definition of death?
The Criminal Law Revision Committee (1980): acknowledge the existence of
the brain death. To take place in a statue would be too restrictive.
In the other side would promote distrust.
Main questions: What is human death? How can we determine that is has
occured?
1. The current mainstream view – the whole-brain approach (irreversible
cecassion of brain and brain stream)
2. The progressive alternative – the higher-brain approach (irreversible
cecassion of consciousness)
2.1. essence of human persons
2.2. personal identity
2.3. the definition of death is a moral issue
Brain death
Death or alive? The case of anencephalic newborns
95 % of which die within the first
postnatal week
‚Organs obtained from these
anencephalic newborns could make a
substantial contribution to the supply of
infant organs’
‚They would provide a significant
proportion of transplantable organs’
US Uniform Determination of Death Act
(1980) also requires that anencephalics
like all organ donors meet estabilished
criteria for brain death, icluding
cessation of brainstem activity, before
they are used as donors.
Transplantation’s interspecies
1. Allotransplantation is the transplantation of cells, tissues, or organs
to a recipient from a genetically non-identical donor on the same
species.
2. Autotransplantation is the transplantation of organs, tissues or
proteins from one part of the body to an other in the same invidual.
3. Xenotransplantation is the transplantation of living cells, tissues or
organs from one species to another (pigs – human)
4. Isograft is a graft of tissue between two inviduals who are
genetically identical. (i.e. Monozygotic twins where the transplant
rejection never occur)
Transplantation
1. Live donor transplants
2. Cadaver transplantation
3. Foetal Tissue Transplantation
2.1 Opting/Contracting in countries: USA, UK, Canada, Germany, The
Netherlands, Switzerland, New Zeland, Australia, Japan, South Korea,
Thailand, Ireland, South-America, and in most Arab countries
2.2 Opting/Contracting out countries: Austria, Czeh Republic, Poland,
Denmark, Portugal, Finland. Some countries can choose to give
opportunity to ask the family (France, Italy, Spain)
Transplantation from Live Donors
• Whole organs (kidneys)
• Organ materials (liver or bone marrow)
2 cases
• Parents conceived a child in the hope that the baby’s bone marrow
cells would save the life of a teenage daughter dying of leukemia.
• 3 years old one of twin’s bone marrow requestd by the father of their
half-brother in the face of their mother’s objection
‚the law alone cannot provide all of the answers to matters of human
relation’ (Curran 1991)
Foetal Tissue Transplantation
• From aborted foetus (may be infected or defective)
• ‚second patient’
• ?Independent from the woman?
Usefulness:
• It seems to have the greatest therapeutic potential such as
- Parkinsonism,
- Treatment of diabetes and
- immunodeficiency disorders,
- Anaemia patients,
- Immune system research.
In the US research sould continue, on political grounds too (=win the antiabortion movement). Modification: allow research on spontaneously aborted
foetuses and embryos, and will probably be overturned in time.
Foetal Tissue Transplantation
The Council of Europe (1986)
‚even when dead the embryo
of foetus retains its human
character and … respect for
human dignity requires that
any commercial or industrial
use must be prohibited’
Benefice Rights in Foetal Transactions (US National Organ Transplant
Act 1983; United States niform Anatomical Gift Act 1983)
Foetal Tissue Transplantation
• How to provide equitable acess to these scare tissues?
• How to protect the right of couples or women to produce foetal
tissue to help loved ones?
• How to avoid the possible exploitation of poor woman?
https://www.youtube.com/watch?v=uXulTMrNI4M
Organ theft in Kosovo