Theme 3 - Organ Donation - Why is this a Global Issue?
The
Organ Donation Crisis
Organ
donation is the replacement of a diseased or non-functional organ with a
healthier one. Organ transplantation and donation has become a new successful
strategy to give people in need a new life. Organs that can be donated include
liver, heart, kidneys, cornea of the eye, lungs, pancreas and even the
intestines. Donation of body tissue, bone marrow and skin is also possible.
The
beauty of organ donation lies in the fact that there are no boundaries of race,
age, gender, ethnicity or the like to be a potential donor. There are certain
medical limitations to which organs and tissues can be used for which
receipient but there are no social or economic barriers to being an organ
donor. In fact, the HIV Organ Policy Equity (HOPE) Act (2015)has permitted even
people diagnosed as HIV positive to be organ donors for HIV positive
recipients.
People
often feel discouraged to donate organs because they feel that as deceased
donors they will never know who their organs may go to, but the fact that they
have the potential to change the lives of so many people is one of the greatest
reasons people should take this step. Donate a kidney as a living donor and see
a life being saved in front of your lives or be a deceased donor and present
the gift of life to up to eight people. The choice is with the individual but
taking the step is what matters.
There
is an increasing amount of awareness about this ideology with the growth of
institutions supporting this practice. This has helped in escalating the rate
of organ donation. However, one of the major issues with this strategy is the
potential lack of enough donors and organs to meet the needs of a rising number
of recipients. Organ donation has increased by an average of 3.7% per year,
while the recipient waiting list has grown by 19%. According to statistics from
the US Government Health Resources and Service Administration Department,
(2020) “more than 11,200 people are on the national transplant list as of March
2020 and every 10 minutes a new person is added to this list. 20 people die each
day waiting for a transplant.”
This
crisis exists in almost all countries all over the world, including the US and
ought to be addressed. This global health issue is the reason that thousands of
people are not getting the chance to live a better life despite the existence
of technology. There are distinct causes and challenges that have resulted in
organ shortage as well as several potential solutions to ensure that this
crisis is resolved.
Causes, Potential
Challenges and Possible Solutions
For centuries,
innumerable people have witnessed death due to organ decay and damage. Life has
been uncertain and despite documented episodes of organ transplantation
throughout history, the acceptance of organ donation as a prominent method of
medical treatment is gaining greater momentum in today’s times.
With the progress
of medical science and technology, today, patients who are struggling between
life and death due to failure of organ functioning can be given a second chance
- a new life. However, the development of techniques is not always the solution
to all problems in life. With this technique, have come its own set of concerns
ranging from medical, social and religious ethics to ethnic boundaries and
racial differences - organ transplantation has faced a lot of challenges in the
past and continues to face them in the process of its implementation.
Most organ
donations are recovered from patients who are neurologically diagnosed as
‘brain-dead’. However, not all patients that are terminally ill fit this
category, thus narrowing down the list of potential donors. In addition, organ
donation is deeply and legally attached to a person’s will of life. Not all
people make the decision to donate their organs, before they die. In the
absence of a deceased’s will, family consent is required to initiate the
process or organ donation after their death, making it invariable to talk to
the families about this procedure. However, approaching families of deceased
ones immediately following their deaths is often observed to solicit negative
responses. The sad truth of the situation is that consent of family has become
one of the most vicious hurdles in organ donation. In the United States, the
family consent rate is about 54% which means that just under half of the organ
donors are able to save someone’s life.
A study by Sanner
(2007) recognised certain common experiences faced by both donor families and
physicians that may be potential flaws in the health care system itself. The
donor families had a greater understanding of the circumstances and were
appreciative of the process. When the will of the deceased was unknown, many
families were reluctant to initiate the procedure. The study advised that if
dealt in a tactful manner, it may help families initiate a rational process of
thought and perhaps enhance their positive response to the procedure.
Another
study conducted by Kananeh, Brady and Mehta (2020) addressed concerns of family
consent in brain-dead patients. One important observation made by the study was
that the only parameter determining whether or not to approach the family to
suggest organ donation, was the functional state of the organs. Thus,
physicians were not discouraged by ethnic, racial, economic or other such
differences when making the decision to approach the deceased’s family.
However, racial and economic differences were observed in the responses of the
family. Caucasians and people with higher socioeconomic status were more
supportive of the cause than others.
The
next impediment to this practice is the question of moral and ethical values
and religious conscience behind these actions. Different cultures exhibit
different principles and these are all ultimately influential on a person’s
decision to donate. A study by Concejero and Chen (2009) explored the ethics of
organ donation, especially in economically backward countries of Asia. Religion
is a vital aspect of Asian culture and is therefore an essential influence even
on these decisions. While certain religions like Hinduism and Buddhism leave
the verdict to the individual’s conscience, others like Shintoism and Islam
have a definitive say in what is right and wrong when it comes to organ
donation. Apart from religion, laws in certain Asian countries are still under
debatable circumstances surrounding what can be defined as death with respect
to donation of organs. Such circumstances raise a number of moral and ethical
questions that demand to be addressed, not just in Asia but in the world as a
whole.
It
is therefore essential that such perspectives be understood and responded to.
Some of these articles present important cultural and religious perspectives
prevalent in the world, many of which are seen even in the United States. After
a defined research in this field, the study by Concejero et al. concluded that
ultimately medical needs and surgical advancement are what make the final decision.
Although religious opinions ought to be respected, yet sometimes the
significance of human life and scientific knowledge override such opinions and
judge the circumstances in a more rational way. Thus, this article spreads
light on how ethical concerns must be addressed pragmatically but must also
respond to the needs of the recipient audience.
Money is always a powerfully influential
factor in so many of life’s decisions and this is the case even with organ
donation.Many people, particularly donors are unaware of the costs associated
with organ transplantation which makes them hesitant to embark on this process.
Results from the study conducted by Cuesta-Briand, Wray and Boudville (2015)
advised that a preliminary walkthrough of the economic commitments might
encourage more people to donate and give them a better sense of understanding
of what exactly they are committing to. Donors should be made aware of the
direct and indirect costs that have to be borne including travel,
accommodation, certain medical expenses, loss of income, dependent care etc.
Reimbursement of expenses may be available in some countries and donors should
be educated about this process. Thus it
is imperative to recognise and respond to this possible barrier of ignorance of
financial obligations and take significant efforts to raise awareness about the
monetary requirements in this process.
The
research by Cuesta-Briand et al. (2015) also highlighted the fact that minority
groups or economically disadvantaged communities do not engage in organ
donation, perhaps due to financial limitations. In addition, certain communal
drawbacks such as lack of leave from job for organ donation, are considerations
that the system and concerned authorities should take care of, in order to
encourage this practice. Individualized financial advice to donors is necessary
to ensure they are aware of their monetary obligations and are better educated
about the process as a whole.
A
more modernistic solution to the organ donor crisis is the implementation of
xenotransplantation collaborated with CRISPR technology.The technique of
xenotransplantation is not very new. It is a process in which human organs are
genetically engineered to be carried in pigs and then transplanted to the
requested recipients. However, one of the major issues preventing the
implementation of this knowledge, is the presence of benign PERV virus in pigs
which is extremely dangerous to humans. Luhan Yang shares that she and her team
have developed a revolutionary technology to genetically engineered organs in
pigs to develop without this virus, making them safer for transplantation. This is a new breakthrough in the world of
organ donation and can be used to solve the organ shortage crisis.
Concejero, A. M., & Chen, C.-L. (2009). Ethical perspectives on
living donor organ transplantation in Asia. Liver Transplantation : Official
Publication of the American Association for the Study of Liver Diseases and the
International Liver Transplantation Society, 15(12), 1658–1661. https://doi.org/10.1002/lt.21930
Cuesta-Briand, B.,
Wray, N., & Boudville, N. (2015). The Cost of Organ Donation: Potential
Living Kidney Donors’ Perspectives. Health & Social Work, 40(4), 307–315. https://doi.org/10.1093/hsw/hlv068
M.F. Kananeh, P.D.
Brady, C.B. Mehta, et al., Factors that affect consent rate for organ donation
after brain death: A 12-year registry, Journal of the Neurological Sciences
(2020), https://doi.org/10.1016/j.jns.2020.117036
Sanner MA. (2007). Two perspectives on organ donation: experiences of
potential donor families and intensive care physicians of the same event.
Journal of Critical Care, 22(4), 296–304.
US Government
Health Resources and Service Administration (HRSA) (June 2020). Organ Donation Statistics Retrieved
from: https://www.organdonor.gov/statistics-stories/statistics.html
Yang, Luhan. (2018,
Oct). How to create a world where no one dies waiting for a transplant
Retrieved from: https://www.youtube.com/watch?v=xgBnYr0_FRk
.
What other challenges do you think are being faced by the organ donation? Let me know in the comments below!
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