Advances in medical sciences and related fields have allowed rapid strides to be taken in the sphere of organ donation and transplantation. This is more evident in the case of liver transplants as thousands of patients undergo successful liver transplants across the globe, all year round. Liver transplant is necessary when a diseased person fails to adequately perform necessary functions to support a patient.
Liver Cirrhosis is by far the most common cause that results in the need for a liver transplant. Chronic hepatitis B and C; bile duct diseases; genetic diseases; autoimmune liver diseases; primary liver cancer; alcoholic liver diseases and fatty liver disease are the other conditions that can be cured by a successful liver transplant.
While the ability of doctors to perform successful liver transplants has greatly reduced mortality rates, on the negative side has given rise to several ethical issues concerning organ donation and transplant. The three most common ethical issues that surface in the sphere of organ donation include – issues of procurement; issues of allocation; and issues of affordability. The issue is further complicated when you scratch the surface – because each of these ethical conundrums is inter-related. One cannot take a standalone approach and each of these must be addressed in relation to the others.
Like most things in our life, the demand for a cadaver or live-donor organs far outstrips the demand – therefore every time a liver transplant is necessitated one must face the question of from where should the liver be procured? The number of donors available – both cadaver and live-donors – are far fewer than required.
The organ donation process is relatively inefficient for a number of reasons. Organs are lost when clinicians fail to recognize the criteria for brain death. Educational programs for health care providers could be helpful in clarifying the laws regarding the declaration of brain death. Requests for donation often have been handled by inexperienced personnel, a factor associated with a reduced consent rate.
Therefore, we see that procurement of an organ is not easy, nor is it a straightforward system too. While donors have their own valid reasons to withhold consent, even those expressing consent are not always harvested due to procedural reasons.
In terms of allocation, there is no existing fool-proof mechanism that ensures a fair chance of survival to everyone. The issues of governing ‘emergency,’ ‘necessity,’ and ‘immediacy’ are often clouded by a number of subjective factors. The recipient of transplant should preferably accrue a greater benefit than others but arriving at this conclusion is easier said than done.
Two main competing principles are considered in all organ allocation decisions. They are justice and utility. The allocation of organs faces a classic dilemma: any system designed to distribute organs efficiently is likely to be seen as unjust or unfair. The proponent of maximizing utility focus on doing as much good as possible with a limited resource, while advocates of justice as the basis for distribution have their eyes on a pattern of distribution that they consider fair. In their view, justice means giving benefit to the worst off. Physicians tend to prefer utility, while governments generally advocate justice and fairness.
Finally, having procured and allocated the organ to the right recipient the state is faced with the question of affordability. Procedures to transplant an organ are expensive at best and can be cost-prohibitive. While the rich and the affluent (upper sections of society) can afford them, this option is often not available to those who are relatively poor. Should a recipient or a diseased patient be disallowed a transplant for the want of money? Our contemporary civilized governments should certainly be able to solve this ethical dilemma.
But, there is no fixed formula or methodology to arrive at a consensual agreement as those who can afford may feel aggrieved for being denied a transplant procedure despite having the resources.
While medical science helped us find successful solutions to complex medical conditions, there are ethical challenges that need a more humane approach.