Distributive Justice: About Organ Transplant

Earliest Forms of Organ Transplant

The revelation of organ transplant varies with the earliest records available in the regional medical practice. For instance, while the oldest account of heart transplantation acknowledges Pien Chi’ao and Hua T’o work in 200 BC, Sushruta writings outline the ancient Indian surgery where ears, lips and noses were amputated from criminals. Similar accounts in the West include the classical stories of religious symbolism illustrating Adam as the first donor in the Genesis account of creation (Kanniyakonil, 2005). Besides, the New Testament captures several accounts, including re-implanting breasts performed by Saint Peter to Saint Agatha, restoration of the servant’s ear by Jesus of Nazareth and the hand by Saint Mark (Howard & Cochran, 2012).

In addition, Cosmos and Damain referred as the twin saints of medicine who lived in AD 285-305, successfully transplanted a leg recovered from a dead sheep to a patient. Equally, the School of Salerno emerged a center of new surgery from the eleventh to the fifteenth century. Moreover, John Hunter experimental surgery, autologous skin grafting by Giuseppe Baronio, and C. Bunger nose transplant from a free thigh graft, reveals the pioneer work that sets the pace towards the century of transplantation (Kanniyakonil, 2005). The gradual progress revealed in earlier forms of experiments reveals a cycle of staged development that shed light and set ground upon which modern surgery have improved to eliminate the reported errors.

Using Organs from the Deceased Patients

The process of harvesting organs from dead patients requires the initial ascertainment that the donors expected to die after the completion of the process is dead before the undertaking the recovery of the organ. This ensures that the patients are declared dead of irreversible cessation of brain functions and cardiopulmonary function. Additionally, the closest relatives of the donor must provide an informed consent permitting the recovery of life-sustaining organs.

The declaration of brain death as the qualification of recovering organs from deceased donors, presents several ethical quandaries. Firstly, using the brain death as the ideal standard legitimizes the recovery of bodies revealing respiratory and circulatory response. This suggests that nurses should not violate the integrative functions of the patient by upholding respect for the integrity of life and bodily functions. Similarly, all parties must embrace the principles of autonomy, beneficence and non-maleficence, alongside distributive justice, to avoid acts of killing their patients (Hippen, Ross, & Sade, 2010). The latter requires accounting for fairness in the process through value for human rights and the sanctity of life. To the contrary, there are instances revealing violations of the dead donor rule, including the removal of kidneys from a patient in the 1962 incident prior to terminating the cardiopulmonary bypass (Howard & Cochran, 2012).

Organ Procurement Organizations (OPO)

The increasing figures of patients succumbing to death related to organ failure prompted the promulgation of OPOs. Their primary role involved running an organized platform of recovering organs from donors and facilitating sharing across various centers. Secondly, they streamline the ethical concern surrounding the experience of physicians pronouncing death, thus the need of uniformity in serving more transplant programs. Moreover, they guarantee better survival of sharing organs through an organized system to improve outcomes and matching basic information between the donors and prospective recipients (Howard & Cochran, 2012). Although appreciated as a breakthrough to the un-organized recovery and procurement of organs, OPOs draw an ethical concern from cases of wrongful declaration of death amongst potential donors. Secondly, it raises questions in the accuracy of declaring brain death in their prior involvement in the donor care. This implies that since the primary interest of coordinators is obtaining consent, prior linkage may influence the process of declaring brain death (Verheijde, Rady, & McGregor, 2008).

Unlike in the period of their formation, OPOs are governed by several federal laws and regulations, alongside states, federal agencies and joint commissions. Besides the guidance offered by the Social Security Act and the End Stage Renal Disease Act, the federal agencies through the Code of Federal Regulations provide overall oversight to their operations. In particular, the Public Health Service Act requires them to obtain a designated area of service, meet outlined performance measures, while participating in the systematic efforts involved in the acquisition of all usable organs from donors (Howard & Cochran, 2012).

Collective Contribution in Organ Transplant

Despite the recent development in the medical technology revolves around meeting the increasing demand of organs, the public health agency has two vital roles to play. The agency must scrutinize the implementation of the inquiry laws and avoid malice among participants in an attempt to increase the supply of organs for organ transplant. The agency must also provide oversight by revealing the extent of effectiveness, equitability, and efficiency attained in the recent policy changes. This will avoid the enactment of stringent requirements that are rarely integrated within the organ transplant system.

References

  • Hippen, B., Ross, L. F., & Sade, R. M. (2010). Saving Lives Is More Important Than Abstract Moral Concerns: Financial Incentives Should Be Used to Increase Organ Donation. Forty-fifth Annual Meeting of The Society of Thoracic Surgeons.
  • Howard, R. J., & Cochran, L. (2012, March). History of Deceased Organ Donation, Transplantation, and Organ Procurement Organizations. Progress in Transplantation, 22(1), 6-17.
  • Kanniyakonil, S. (2005). Living Organ Donation and Transplantation: a Medical, Legal, and Moral Theological Appraisal. Kottayam : Oriental Institute of Religious Studies.
  • Verheijde, J. l., Rady, M. Y., & McGregor, J. L. (2008, November). Growing Concern about Brain Death and Organ Donation. The Indian Pediatrics, 45(17), 883-888.
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