Organ transplantation is one of the most controversial issues in the modern medicine. In fact, sharing own blood, tissues or organs with other people is a precious gift that cannot be underestimated. The shortage of organs for transplantation causes numerous deaths of people who could be saved. “In 2003, there were 86,355 U.S. adults, children, and infants on transplant waiting lists, and, for lack of enough donors, 7,147 died....3915 kidney patients, 2071 liver patients, 582 heart patients, and 487 lung patients died while waiting for life-saving organ transplants”( Tong, 2007, p. 291). Nevertheless, advocates of imposing veto on transplantation raise the question about the moral aspect of the issue (Tong, 2007, p.292). Exploring the problem, this paper will focus on two aspects of organ transplantation, such as the organ-supply problem and artificial organs issue. The study regards these challenges in the context of key ethical theoretical models.
The Background of Transplantation
People obtained the hope to be saved from certain severe incurable diseases in the 1950s, when Dr. Joseph Murray made a successful transplantation of the kidney from the donor to his patient. According to the statistics, modern surgeons transplant approximately 1,800 hearts and nearly 3,900 livers from donors to suffering individuals every year (Tong, 2007, p. 292). Nowadays, kidneys, hearts, livers, pancreas, lungs, intestines, and other organs can be transplanted, saving numerous people (Tong, 2007, p. 292).
Key Practical Challenges of Transplantation
Organ supply and creation of artificial organs are the key challenges of transplantation.
Organ Supply Problem
The amount of available organs for transplantation is not enough to safe lives of all patients who urgently need them. Suffering individuals and their relatives engage in all the possible activities to obtain the necessary organ, including buying body parts from the representatives of developing nations (Tong, 2007, p. 291).
The organs for transplantation can be taken from both cadaver and living donors. In the USA, the great majority of donors belonged to the cadaver group during the first decades. Nevertheless, rapid increase in the number of living donors is a new tendency. To illustrate, the amount of living donors was equal to 6,821, while cadaver donors made 6,457 cases in 2003 (Tong, 2007, p. 293).
Living donors can be related and nonrelated. Relatives may donate their organs to individuals who are in family relations with them. To illustrate, Renada Damiel-Patterson’s father gave his daughter both his kidneys (Tong, 2007, p. 299). Nonrelated donors not always offer their parts of the body for the financial reward. They may save the life of a person they love or admire, such as a friend, a lover or any other individual they want to help (Tong, 2007, p. 300). In case of cadaver donors, the end-of-life teams are to follow certain ethical procedures. After explaining relatives of a donor that their dear person died, they remind about the opportunity to donate certain organs to save other individuals’ lives. The end-of-life team turns to the local Organ Procurement Organization, or the hospital transplant team.
However, the risk of commercialization of organs is extremely high. It may cause commodification of human bodies. Moreover, criminals might take the opportunity to make profit on other people’s grief. To illustrate, in 2004, a 48-year-old American illegally obtained a donor’s kidney, using the information on the Internet. She paid $60,000 for the organ. The poor donor from Brazil received only $6,000, while $54,000 were directed to organ traffickers (Tong, 2007, p. 300).
The other way to get a necessary organ is to get on the Organ Waiting List. In 1972, the U.S. Congress accepted the End-Stage Disease Act, directing money for renal dialysis and renal transplantation to suffering individuals (Tong, 2007, p.301). In 1984, the National Organ Transplant Act was adopted that founded the Organ Procurement and Transportation Network. The United Network for Organ Sharing, a private non-profit organization, runs the OPTN (Tong, 2007, p. 301).
Transplant legislation differs within the USA. For example, drivers have to confirm whether they are willing to donate their organs, when receiving driver licenses. (Meln, 2014, p. 6). In some US states, the dead person’s relatives inform about their permission to donate that individuals’ organs, if he/she did not mention the decision in the will (Meln, 2014, p. 6).
Medical resources for transplantation are limited. Therefore, the challenge of the obligatory sharing own organs with other individuals appears (Tong, 2007, p. 291). This fact raises ethical and philosophical problems.
Artificial organs are body implants or interfaces produced from biomaterials (Sharma, 2005, p. 148). These devices perform the functions of the missing or damaged organs. Numerous artificial organs can be used. The most developed and widely transplanted organ is heart (Yoon, 2012, p. 1). Surgeons often transplant artifical legs, arms, kidneys, and others. Synthetic body parts are widely used. To illustrate, synthetic windpipes are successfully transplanted to suffering people (“Growing artificial organs,” n. d.). Artificial kidney is extremely important, since it participates in kidney dialysis. Individuals, who recieved artificial organs, can join the waiting list for donors’ organs (Bridgewater, 2013, p. 500).
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On the one hand, creating artificial organs seems to be the best solution for the problem of organ-supply. To obtain necessary life-saving tools, patients and their relatives do not need to spend years in waiting lists, save huge sums of money and search for potential donors. Surgeons do not have to create complicated conditions for taking necessary parts out of the donor’s body and saving these organs. Moreover, many patients’ relatives and friends would not have to harm their own health to save the dear person. Artificial organs seem to be the panacea.
Nevertheless, two key problems, such as medical and ethical issues, cross all the benefits suggested by the artificial organs. First, patients’ immune system often rejects organs made of biomaterials. Hyperacute rejection may occur within several minutes to several hours from the moment of transplantation. Then acute vascular rejection and cellular rejection can take place. Finally, chronic rejection can ruin all the attempts to save patients’ lives. Artificially grown stem cells often cause cancer in the nearest after the transplantation period. The second problem deals with ethics, criticizing the involvement of alien constructions in human bodies. Religious beliefs do not support the intrusion (Yoon, 2012, p. 1).
Organ-Supply and Artificial Organs in the Context of Key Ethical Theoretical Models
The issues of supplying organs and creating artificial ones can be regarded with the use of core principles of such main ethical theories as utilitarianism, universal ethics, the Golden Rule, and virtue ethics. Suggesting beneficial and negative ways for solving the issue, the above-mentioned theories reflect various ethical theoretical models of the surrounding world.
The development and implementation of ethical principles in dealing with relevant problems of the modern medicine would contribute to a vivid and wide dialogue between the advocates of opposing viewpoints. To illustrate, organ supply problem and creation of artificial organs can raise the questions: if it is ethical to take organs from one person to give them to the other one; if it is ethical to create and put synthetic devices into human bodies? Public community, representatives of religious confessions, doctors, philosophers, and ordinary people have different viewpoints on these problems. In fact, philosophical principles are instruments for decision-making. The issues can be regarded as a dilemma that requires certain ethical frameworks for successful solving. Basic philosophical approaches are different in their nature and strongly oppose each other. Nevertheless, considering their core ideas is necessary for making wise decisions (Colero).
This paper regards the organ-supply problem and the issue of creating artificial organs in the context of major ethical philosophies, such as utilitarianism, universal ethics, the Golden Rule, and virtue ethics.
According to the postulates of utilitarianism, the real values are “not rules but results” (Mayer, Warner, Siedel, & Lieberman, 2013, p. 5). The outcome of an action or a number of actions is calculated and evaluated according to the sum of received benefits for the great majority of stakeholders. In fact, utilitarianism is a pattern striving to ensure the greatest advantage for all the parties of the issue. Decision-makers are to choose the proper solution only after detailed consideration of all the challenge and evaluating its total benefits and drawbacks. Utilitarianism considers things right if the total sum of benefits from consequences of the activity exceeds the sum of disadvantages (Mayer et al., 2013, p. 55).
On the one hand, human bodies are sacred and should be protected from all detrimental intrusion. Moreover, many individuals do not desire to have their organs taken for any purpose. On the other hand, thousands of people can be saved, receiving donors’ organs as the chance to survive. Taking into account the beneficial outcome, both transplantation and creation of artificial organs are to exist and be encouraged. Dead people do not need their organs, while numerous human lives can be saved if those organs are donated. Utilitarianism can be widely implemented in dealing with organ supply issue. The total advantage of the introduction of the wise transplant legislation is obvious.
Utilitarianism cannot be a moral approach because it may approve immoral activities and things, claiming that they bring the overall welfare. For example, compulsory organ harvesting from bodies of dead individuals and implantation of ugly synthetic devices into human bodies can be considered appropriate, according to utilitarianism. These activities would bring more utility, saving lives. On the other hand, there are numerous objections against these activities, positioning them unethical.
Deontology (Universal Ethics)
Deontology or universal ethics is a philosophical approach offered by Immanuel Kant. The German philosopher highlighted that “a moral intent and following the right rules ...a better path to ethical conduct than achieving the right results” (Mayer et al., 2013, p. 32). Focusing on duties, Kant appreciated equality among all the individuals and their universal duties (Mayer et al., 2013, p. 31).
Implementation of the postulates of universal ethics in organ-supply problem and the issue of artificial organs seem to be the wisest. People should find common interests and achieve proper results. Both donors and suffering people are equal. The necessary organs can be harvested only if the potential donor permits such actions. Governments, social and health care institutions should take an active part in initiating and developing transplant programs, convincing people to help individuals in need. Mass media is an effective tool to involve citizens in charity programs. Journalists, film directors, writers are encouraged to spread the idea about the strong necessity to participate in transplant programs. According to the universal ethics, any obligations in such cases are offensive. Universal ethics concerns about creating artificial organs in the indirect way. In cases, when donors’ organs are unavailable because of ethical or other reasons, artificial organs can come in help.
The Golden Rule
The Golden Rule longs to the Bible. This moral idea suggests that a person should treat other people, as he/she would want others to treat him/her (Mayer et al., 2013, p. 32). All individuals dream about a long life and good health. They would use the opportunity to save their life using transplant organs in case of urgent necessity. Nevertheless, somebody should donate these organs. Therefore, people are expected to give their permission to use their organs for other individuals’ benefit if it is necessary. On the contrary, Kluge claims that it is unfair to give equal access to transplant organs to all people. For example, some individuals were born ill or got the disease during their life. Others were addicted to alcohol and tobacco, damaging their own health. These categories cannot be similar in their order for transplantation (Meln, 2014, p. 16).
Virtue ethics is the fourth philosophical approach that “emphasizes the virtues or moral character” (Hursthouse, 2012). The three major ideas of this viewpoint are virtue, practical wisdom, and eudaimonia (Hursthouse, 2012).
Virtue ethics does not strive for glory or fortune. This ethical pattern draws attention to happiness as the highest good. According to the virtue ethics, the real values are “trustworthiness, respect, responsibility, fairness, caring, and citizenship” (Mayer et al., 2013, p. 34). Individuals lose virtues when lacking moral or practical wisdom.
Moral and practical wisdom are extremely important. In case of their absence, people would be deprived of their virtues. Choosing the wrong way to wealth and physical well-being, individuals reject all the advantages. Their life would not have the real value (Hursthouse, 2012).
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In the context of virtue ethics, organ supply and creation of artificial organs are extremely practical, necessary, and wise. They bring happiness and well-being to humanity despite some ethical objections. Ignoring wealth and fame, individuals donate their organs to save other persons’ life. They obtain virtues for this heroic act. These deeds are honest and sincere, making other people highly appreciate the donors. Respect is the reward for them. Responsibility can influence the will to donate organs. People understand that every human being is responsible for his own life and behavior.
He is expected to help people who are in need. Fairness suggests to ignore fraud and the possibility to make money at the expense of other people’s grief. Caring means that donors, surgeons, and nursing staff treat patients with the due regard, helping to overcome the problem. Citizenship and law-abiding reject any illegal deed, such as numerous temptations to participate in criminal transplant activities. In fact, when the matter concerns a human life, people would give everything they have to save the dear person. It would be the grave crime to make money under these circumstances. Therefore, motivated civic stand and strict following of the legislation would contribute to the issues of solving organ-supply problem and integration of artificial organs.
Transplantation is an extremely controversial problem in the modern medicine. On the one hand, donated organs save numerous human lives, giving people a chance to obtain healthy life. Artificial organs come in help, performing functions of the original parts of human bodies. On the other hand, ethical objections exist against taking organs from sacred human bodies.
The organs for transplantation can be taken from both cadaver and living donors. There is a tendency, characterized by rapid growth of the number of living donors in the USA. Living donors can be related and nonrelated.
The End-Stage Disease Act and the National Organ Transplant Act are the key legislations concerning transplantation in the USA. The End-Stage Disease Act directs money for renal dialysis and renal transplantation for suffering individuals. The National Organ Transplant Act founded the Organ Procurement and Transportation Network.
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Ethical theoretical models can be applied to transplantation issue. Regarding organ-supply problem and the issue of creating artificial organs, main ideas of utilitarianism, universal ethics, the Golden Rule, and virtue ethics can be implemented. Utilitarianism regards a more practical approach to the organ supply and artificial organs. Nevertheless, the total obligation to give the organs in necessary cases is not ethical, making the ideas of utilitarianism poor. The universal ethics seems to be more useful in the above-mentioned situations, suggesting creation of an agreement between donors and patients that would satisfy both parties. The Golden Rule ethics positively appreciates organ supply and artificial organs because every person wants to be saved in urgent cases. Finally, the above-mentioned issues are extremely practical and wise. Therefore, organ supply and creation of artificial organs get positive mark in virtue ethics.
Studying the organ-supply and implementation of artificial organs problems in the context of different philosophical approaches, the conclusion is that utilitarianism, universal ethics, the Golden Rule, and virtue ethics positively view transplantation. Despite certain ethical disagreements, this branch is to be developed. Taking into account the strong temptation of certain individuals to make money on other people’s grief, severe control of the issue must be initiated.