THE ETHICS of ORGAN and TISSUE TRANSPLANTATION, PART I: LIVING HUMAN DONORS

Organ and tissue transplantation is a growing area of contemporary medical practice that raises a variety of ethical concerns. This article will consider the transplantation of organs or tissue from living human donors, examine some of the ethical questions these practices raise, and draw conclusions from the tradition of the Catholic Church.

In considering the ethics of organ donation by living human donors, we are particularly concerned with the practice of donating non-regenerative tissue, i.e. organs, parts of organs or other human tissue that the human body cannot regenerate but can, at least in principle, live without. A typical example would be the donation of a kidney by someone who has two healthy kidneys and can survive and maintain healthy functioning with only one. This kind of donation can be highly praiseworthy. Living donors can freely make a gift of their own bodies at considerable risk to themselves. These gifts can be acts of tremendous generosity. They can also be occasions for exploitation, injustice, and abuse, and thus can raise serious ethical concerns:

Safeguarding the Health of the Donor

The transplantation of organs or tissue from living donors involves caring for the health and well-being of the donor as well as the recipient. Perhaps the most obvious way the donor must be cared for regards her physical health. Donating a non-regenerative organ involves significant health risks, not only the risks involved in invasive surgery, especially when general anesthesia is required, but also the risks of living without the organ or tissue that has been donated. For example, a woman who has donated one of her two healthy kidneys would have increased risk of kidney failure now that she is living with one kidney instead of two.

In a sense, weighing the health risks of donation is like any other consideration of risks verses rewards (the expected risks or burdens are compared with the anticipated rewards or benefits). However, the risks and rewards that are involved are for two different people. The donor is rightly interested in preserving her bodily health and not mutilating herself without good reason. The recipient has to consider whether the good of receiving a transplanted organ justifies the risk, not only to himself, but to someone else as well.

Organ Donation vs. Organ Trafficking

Donating one’s own organ or body tissue is not like donating money or giving old clothes to The Salvation Army. The human body is an integral part of our God-given human nature. That means that, in the right circumstances, donating a part of one’s body can be an especially profound gift. It also means that it is especially perverse to exchange human organs and body tissue in a way that is more like buying and selling than giving and receiving, which would treat the human body as an object or commodity.

There are other, more concrete, reasons to oppose organ trafficking. When the motive for donating an organ is financial gain rather than benevolence, the quality of transplanted tissue is likely to decrease and a path is opened to all kinds of corruption and exploitation.

The Freedom of the Donor

Caring for the well-being of the donor means protecting her freedom as well as maintaining her bodily health. Donating an organ can be a great gift, but a gift is only a gift when freely given. Protecting and respecting the donor’s freedom involves more than providing complete information and receiving an expression of consent. Potential donors can be under great pressure, especially when the potential recipient is a close family member or friend. That pressure could come from the potential recipient or other family members, or it could come from the person’s own conscience or sense of obligation. These types of pressures have consequences for those administrating transplantation procedures and for those who receive transplanted organs. Care must be taken to ensure that the donor is truly competent to make a freely chosen gift.

“Savior Siblings”

A practice has recently arisen in which the parents of a child in need of a transplant conceive another child in the hope that he or she might be a fit donor for the older sibling. There are several ethical problems with this proposal. For one thing, potential for organ transplantation is not a good reason to conceive a child. The child, from the start, would be desired by her parents as a means to an end rather that as someone good and desirable in herself. Moreover, a newly conceived child cannot donate freely. The donor sibling would be subjected to significant risk, not for her own sake but for the sake of someone else. A potential donor sibling might reasonably and generously take such a risk once she can freely choose it. A parent might reasonably accept significant risk to a child in his care if the risk promises to benefit that child, but to put one child at risk solely for the benefit of another is not a gift. It is abuse.

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