LD
Exercises adapted from Yael Adler
By: Robert D. Truog, M.D.
Adapted from: New England Journal of Medicine 2005; 353:444-446, August 4, 2005
1.
Most organs for transplantation come from cadavers, but as these have failed to meet the growing need for organs, attention has turned to organs from living donors.
Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient.
Transplantation surgeons have therefore been cautious in using this source. As surgical techniques and outcomes have improved, however, this practice has slowly expanded.
Today, according to the United Network for Organ Sharing (UNOS), almost half of all kidney donors in the United States are living.
In 2004, living organ donors also provided a lobe of the liver in approximately 320 cases and a lobe of a lung in approximately 15 cases.
2.
Three categories of donation by living persons can be distinguished: directed donation to a loved one or friend; nondirected donation, in which the donor gives an organ to the general pool to be transplanted into the recipient at the top of the waiting list; and directed donation to a stranger, whereby donors choose to give to a specific person with whom they have no prior emotional connection.
3.
Each type of donation prompts distinct ethical concerns. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so to feel coerced. In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the donor has a legitimate reason to refuse.
Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves.
In one instance, both parents of a child who was dying of respiratory failure insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life. Such a sense of compulsion is not unusual. In cases like these, simply obtaining the informed consent of the relative is insufficient
— physicians are obligated to prevent people from making potentially life-threatening sacrifices unless the chance of success is proportionately large.
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Questions
1. a. What moral problem do doctors face when dealing with cases of organ donations by living donors?
________________________________________________________________
________________________________________________________________ b. Has this problem prevented them from continuing with living organ donations?
YES / NO
Support your answer by quoting from the text.
________________________________________________________________
2. What are the three types of donation by living donors?
1. ________________________________________
2. ________________________________________
3. ________________________________________
3. a. According to paragraph 3, what are the two concerns connected to directed donation to a loved one/friend?
1._______________________________________________________________
2._______________________________________________________________ b. What solution does the writer offer for each of these concerns?
1. Doctors should __________________________________________________
2. Doctors should __________________________________________________
4. Is the case of the parents mentioned in paragraph 3 typical?
YES / NO
Support your answer by quoting from the text.
___________________________________________________________________
4.
Nondirected donation raises different ethical concerns. The radical altruism that motivates a person to make a potentially life-threatening sacrifice for a stranger calls for careful scrutiny. One recent case involved a man who seemed pathologically obsessed with giving away everything, from his money to his organs, saying that doing so was "as much a necessity as food, water, and air." After donating one
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kidney to a stranger, he wondered how he might give away all his other organs in a dramatic suicide. Other psychologically suspect motivations need to be excluded as well. Is the person trying to compensate for depression or low self-esteem, seeking media attention, or hoping to become involved in the life of the recipient?
Transplantation teams have an obligation to assess potential donors in all these dimensions and prohibit donations that arouse serious concern.
5.
Directed donation to a stranger raises similar ethical questions with a few additional aspects. This type of donation usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising is not illegal, but it has been strongly discouraged by the transplantation community.
Two central objections are that the practice is unfair and that it threatens the view that an organ is a "gift of life," not a commodity to be bought and sold.
6.
Some argue that just as we have a right to donate to the political parties and charities of our choice, so should we be able to choose to whom to give our organs.
In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs — rather than those most in need. This strikes some ethicists as unfair. Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals.
Hence, the argument goes, these donations are legitimately subject to societal requirements of fairness, and transplantation centers should refuse to permit the allocation of organs on the basis of anything but morally relevant criteria.
Questions
5. What ethical concerns are involved in nondirected donation? a. Nondirected donation may threaten the health of the donor. b. Donors are reluctant to donate their organs to strangers. c. Nondirected donation may lead to depression or low self-esteem. d. The motives for nondirected donation may be unacceptable.
6. What possible motives for donating an organ to a stranger are mentioned in paragraph 4? a. ______________________________________________________________ b. ______________________________________________________________ c. ______________________________________________________________ d. ______________________________________________________________
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7. What are the two major arguments against directed donation to a stranger? a. ______________________________________________________________ b. ______________________________________________________________
8. a. How do supporters of directed donation to strangers justify their position?
( Complete the sentence .)
They claim that this kind of donation is similar to __________________________
____________________________________ and therefore, ________________
_________________________________________________________. b. Does the author agree with this argument? YES / NO c. Why or why not? ( Complete the sentence .)
Because instead of people who _______________________________________ getting organs, people who __________________________________________
_____________________________________________________ will get them.
___________________________________________________________________
7.
The most ethically problematic cases are those in which the recipient is chosen on basis of race, religion, or ethnic group. In one case, for example, the family of a braindead Florida man agreed to donate his organs — but insisted that because of the man's racist beliefs, the recipients must be white. Although the organs were allocated accordingly, Florida subsequently passed a law prohibiting patients or the families from placing such restrictions on donation.
8.
Even when the motives for choosing a recipient may be unethical, however, there might be reasons for allowing the donation to proceed. Consider a case that was discussed at a recent public forum hosted by Harvard Medical School's Division of
Medical Ethics: a Jewish man in New York learned of a Jewish child in Los Angeles who needed a kidney transplant. The man wanted to help someone of his own faith and decided he was willing to donate a kidney to help this particular child. Despite his discriminatory preference, one might view the donation as permissible, since at least some patients would benefit (the child would receive a kidney, and those below her on the waiting list would move up) and no one would be harmed (those above the girl on the waiting list would not receive the kidney under any circumstances, because the man would not give it to them). Whether directed donation to strangers violates standards of fairness is thus controversial. But if it is permitted, it will be very difficult
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to prohibit discriminatory preferences, since donors can simply specify that the organ must go to a particular person, without saying why.
9.
The other substantial cause for concern about this type of donation is its potential for making possible the buying and selling of organs. These practices are strictly prohibited by law, yet they seem to be an inherent risk in directed donations to strangers.
Wealthy patients in need and healthy donors looking for a quick fix to their financial problems will always be able to find ways around even the most serious attempts to prevent money from changing hands.
Questions
9. What is the topic of paragraphs 7-8? ( Complete the sentence .)
They both discuss cases of organ donation that are influenced by
____________________________________________________________.
10. a. What does the story about the Jewish man in New York (par. 8) illustrate?
________________________________________________________________ b. What reasons are given for allowing this type of case?
________________________________________________________________
________________________________________________________________
11. In paragraph 9, what do the words "this type of donation" refer to?
________________________________________________________________
12. Which groups will be interested in finding ways to sell organs? a. ______________________________________________________________ b. ______________________________________________________________
___________________________________________________________________
10.
Despite these concerns, efforts to direct organ donations to strangers are not new, dating back at least to the celebrated 1982 case of Jamie Fiske, whose father successfully mounted a nationwide appeal for someone to donate a liver to her.
Today, many such solicitations are transmitted over the Internet, where, when the practice was relatively limited, organ solicitation was managed quietly, on a case-bycase basis, by individual transplantation centers. All this changed, however, with the emergence in 2004 of MatchingDonors.com. This Web site currently claims to have
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more than 2100 registered potential donors and to have brokered 12 transplantations, with about 20 more recipient –donor pairs matched and awaiting surgery.
11.
The business conducted on this organization's – MatchingDonors.com -- Web site introduces a new degree of visibility that increases the magnitude of the issue.
Will competing commercial Web sites begin to emerge? How will these sites be held accountable? Dr. Jeremiah Lowney, the medical director of MatchingDonors.com, recently argued that just as a dating service could not be held responsible for a bad date, his Web site has no responsibility for the outcomes of its matches.
Furthermore, the Web site has no mechanism for ensuring the quality of the information it provides about transplantation and donation by living persons or for checking the accuracy of information submitted by potential donors and recipients.
12.
Given the life-or-death consequences of the procedure, the solicitation of organs over the Internet requires higher standards of responsibility and accountability than are currently in place. UNOS should standardize the process for evaluating potential donors, ensure that independent advocates are assigned to help donors make an informed choice, develop mechanisms to deal with potential injury or death to the donor, set standards for both directed and nondirected donation, and prohibit transplantation when the chance of success is insufficient to justify the risks. A comprehensive approach is necessary if the ethical dilemmas are to be adequately
Questions
13. What are some of the problems with Internet sites that match donors and recipients? a. ______________________________________________________________ b. ______________________________________________________________ c. ______________________________________________________________
14. What is the main purpose of this article? a. To argue that organ donation by living donors should be limited b. To convince people that they should donate their organs to strangers c. To discuss the moral concerns related to living organ donation d. To discuss how the Internet has affected the issue of organ donations
___________________________________________________________________
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Exercises adapted from Yael Adler
I. Pre-Reading
1. Look at the picture below. a. What kind of card is it? ____________________________________________ b. Who might carry this card in his/her wallet? Why?
________________________________________________________________
2. What organs can be donated?
________________________________________________________________
3. What kind of people may become donors of organs?
________________________________________________________________
4. What are the possible motives for donating to a stranger?
________________________________________________________________
5. Look at the ad below. What kinds of ethical issues might be involved in organ donation?
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II. Global Questions
Read paragraphs 1-2, which are the introduction of the text. Then answer the following questions.
1. a. What moral problem do doctors face when dealing with cases of organ donations by living donors?
________________________________________________________________
________________________________________________________________ b. Has this problem prevented them from continuing with living organ donations?
YES / NO
Support your answer by quoting from the text.
________________________________________________________________
2. What are the three types of donation by living donors?
1. ________________________________________
2. ________________________________________
3. ________________________________________
3. Skim the rest of the text to find which paragraph(s) discuss each type of donation.
Write the correct paragraph number(s) next to each type above.
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IV. References
I. Read the following excerpts from the text. In each one, some reference words have been marked. Answer the questions below about the excerpts. Note that in order to answer the questions, you must understand the reference words.
Paragraph 1
Most organs for transplantation come from cadavers, but as these (1 ) have failed to meet the growing need for organs, attention has turned to organs from living donors.
Organ donation by living donors presents a unique ethical dilemma, in that physicians must risk the life of a healthy person to save or improve the life of a patient.
Transplantation surgeons have therefore been cautious in using this source (2) . As surgical techniques and outcomes have improved, however, this practice (3) has slowly expanded.
1. What have not met the growing need for organs?
________________________________________________________________
2. What source are surgeons hesitant to use?
________________________________________________________________
3. What practice has grown?
________________________________________________________________
Paragraph 3
Each type of donation prompts distinct ethical concerns. With directed donation to loved ones or friends, worries arise about the intense pressure that can be put on people to donate, leading those who are reluctant to do so (4) to feel coerced. In these cases (5) , transplantation programs are typically willing to identify a plausible medical excuse, so that the donor has a legitimate reason to refuse.
Equally important, however, are situations in which people feel compelled to donate regardless of the consequences to themselves.
In one instance, both parents of a child who was dying of respiratory failure insisted on donating lobes of their lungs in a desperate but unsuccessful attempt to save her life. Such a sense of compulsion is not unusual. In cases like these (6) , simply obtaining the informed consent of the relative is insufficient ….
4. What are some people unwilling to do?
________________________________________________________________
5. In which cases do transplantation teams identify a plausible medical excuse?
Cases in which the __________________________ does not want
______________________________.
6. When is obtaining the informed consent of the relative not sufficient?
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________________________________________________________________
Paragraph 5
Directed donation to a stranger raises similar ethical questions with a few additional aspects. This type of donation (7) usually occurs when a patient advertises for an organ publicly, on television or billboards or over the Internet. Such advertising (8) is not illegal, but it has been strongly discouraged by the transplantation community.
Two central objections are that the practice (9) is unfair and that it threatens the view that an organ is a "gift of life," not a commodity to be bought and sold.
7. What kind of donation happens when a patient advertises of an organ publicly?
________________________________________________________________
8. Which type of advertising has the transplant community opposed?
________________________________________________________________
9. Which practice is unfair?
________________________________________________________________
II. Read paragraph 10, and find 5 reference words and expressions. Choose 2 of them and write a reference question about them.
V. Connectives
Below are sentences from the text. Each sentence contains 1-2 connectives that indicate relationships between ideas in the text.
Circle the connective in each sentence. Then, write which type of relationship is indicated by each connective on the line after each sentence.
The different types of connectives are:
Addition
Time / Order
Illustration
Cause
Effect
Comparison
Contrast
1. (par. 1) Transplantation surgeons have therefore been cautious in tapping this source. __________________________
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2. (par. 1) As surgical techniques and outcomes have improved, however, this practice has slowly expanded.
__________________________ __________________________
3. (par. 3) In these cases, transplantation programs are typically willing to identify a plausible medical excuse, so that the donor has a legitimate reason to refuse.
__________________________
4. (par. 4) Other psychologically suspect motivations need to be excluded as well.
__________________________ __________________________
5. (par. 6) Some argue that just as we have a right to donate to the political parties and charities of our choice, so should we be able to choose to whom to give our organs. __________________________
6. (par. 6) Unlike monetary gifts, they argue, organ transplantation requires the involvement of social structures and institutions, such as transplantation teams and hospitals.
__________________________ __________________________
7. (par.
6) Hence, the argument goes, these donations are legitimately subject to socie tal requirements of fairness…. __________________________
8. (par. 7) In one case, for example, the family of a brain-dead Florida man agreed to donate his organs — but insisted that because of the man's racist beliefs, the recipients must be white. __________________________
__________________________ __________________________
9. (par. 8) Despite his discriminatory preference, one might view the donation as permissible, since at least some patients would benefit …and no one would be harmed. __________________________ __________________________
10. (par. 8) Whether directed donation to strangers violates standards of fairness is thus controversial. __________________________
11. (par. 9) These practices are strictly prohibited by law, yet they seem to be an inherent risk in directed donations to strangers.
__________________________
12. (par. 11) Furthermore, the Web site has no mechanism for ensuring the quality of the information it provides about transplantation and donation by living persons….
__________________________
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The Ethics of Organ Donation by Living Donors – Vocabulary
Find and underline the following words in the text.
Word Word
Paragraph 1
1. organ (n.)
Also in par. #
Paragraph 4
12. motivate (v.) motivation (n.) / motive (n.)
13. scrutiny (n.) / scrutinize (v.) 2. transplantation (n.) transplant (n./ v.)
3. donation (n.) / donor (n.) donate (v.) cf. recipient (n.)
4.
physician (n.)
5. cautious (adj.) / caution (n./ v.)
6. outcome (n.)
2
4
14. seek (v.)
Paragraph 5
15. advertise (v.) / advertising advertisement (n.) / advertiser (n.)
/
Also in par. #
8
Paragraph 2
7. directed/ non-directed
Paragraph 3
8.
concern
9.
(n., v.) coerce (v.)
10. compel (v.) compelling (adj.)
11. regardless (of)
(adj.)
/ coercion (n.)
5
16. discourage (v.) cf. encourage (v.)
Paragraph 6
17. means (n.)
Paragraph 7
18. race (n.)/ racist (n.)
Paragraph 8
19. discriminatory (adj.) discrimination (n.)
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Exercise 1: Finding Synonyms
Find words in the article that mean the same as the following words:
Paragraph 1: medical doctor ____________________________ careful ____________________________ result ____________________________
Paragraph 3: force ____________________________; ____________________________
Paragraph 4: stimulate ____________________________ look for ____________________________ close examination ____________________________
Exercise 2: Noun Groups
Circle the head nouns in the following word groups; then, translate the whole phrase. organ donation ____________________________ organ transplantation ____________________________ living donor ____________________________ informed consent ____________________________ life-threatening sacrifices ____________________________
Exercise 3: Affixes
Circle the affixes (prefixes and suffixes) in the following words. Write the meaning and the function (part of speech) of each word on the lines. discourage _________________ discrimination ________________ transplantation _________________ racist __________________ cautious __________________ nondirected __________________
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Exercise 4: Word Variations
I. regard / regarding / with regard to / regardless
The sentences below demonstrate different uses of the root "regard." Study the sentences and then match the definitions of the word "regard" / "regardless" with the appropriate sentence.
1. School children should hold their teachers in high regard . _____
2. The teenagers regarded the police officer with suspicion. _______
3. According to recent studies, people can always acquire new skills, regardless of age. ______
4. Researches have offered several explanations with regard to the rise of violence in modern society. ______
5. People have opposing views regarding the political situation in this country. ____ a. in spite of, not considering b. concerning, on the subject of, about c. respect d.
consider, look upon
II. mean / means a. Read the following sentence (taken from paragraph 6).
"In practice, however, this means that those who have the most compelling stories and the means to advertise their plight tend to be the ones who get the organs – rather than those most in need."
What are the two meanings of the word "means"? Explain the difference.
_____________________________ _____________________________ b. Write a sentence that demonstrates each meaning of the word.
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
III.
Choose concern / concerning to complete the sentences below:
-The students read an article ____________________________ the issue of organ transplantation.
-This news is of great ____________________________ to us all
-David's irresponsible behavior has greatly ____________________________ his parents.
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