Organ Transplant History

The Convenor, The Co-ordinator Essex Black & Ethnic minority Fellow Speakers Invited Guests Participants,
Ladies and Gentlemen.
Introduction I am honoured to be invited to deliver this very important lecture on this very important health issue of organ donation and transplantation especially amongst Africans and other ethnic minority in the United Kingdom. Although I do not work with organ donation I support good health, longevity and high quality of life. What I am going to say today affects all Africans where ever they may live on the globe and in fact all of mankind. This is a story of love and support for each other whenever possoble.
You must forgive me as I am going to the use the word African rather than the word Black or Black African as advertised because I do not believe in colour coding of any race.
There is no doubt there is increased need for organ donation and transplantation in the world today due to sophistication of science and medical treatment. To use stem cell for everyday treatment of diseased organs will take many more decades so organ donation and transplantations will continue to hold the pride of place for a long time.
Organ transplantation is the surgical removal of a tissue or organ from one individual (dead or alive) and the placement of that organ in another individual for the purpose of improving the health of the recipient. Most transplant programme depends on either cadaveric or livingorgan donation. There is scarcity of human organs for transplantation so many patients face
imminent death or long suffering.
Organ donation and transplantation creates a culture of life and love. Many religious and
secular approaches justify organ donation and transplantation because it promotes life. The
Catholic Church for example favours it, especially in the encyclical Evangelium Vitae, which
states that ‘organ donation is an act of the virtue of charity’ My speech will dwell on the
promotion of organ donation and transplantation. We shall look at the scale of the problem
amongst Africans, religious, social, cultural, legal and ethical aspects of organ donation and
inform on how Nigerians especially the Benin (Edo speaking people) of Southern Nigeria
believe, and the final section is on the promotion of organ donation and transplantation.
SCALE OF PROBLEMS
10,000 people in UK are in need of organ transplant to save or enhance their lives.
Organ donation rates are relatively low amongst Africans and African-Caribbean’s.
The African is 3 times more likely to need a kidney transplant than the Caucasians population.
A total of 23% of the people who are waiting for an organ transplant are Africans & Afro-Caribbean
and South Asian ethnic minority groups.
Only 3% of organ donors come from African background. The huge disparity
between need and organ donation is very apparent.
Africans do badly in all health Indices.
Mothers of African ethnic origin are 2.3 times more likely to have a stillbirth at parturition.
They are 2.3 times more likely to have a neonatal death than mothers of Caucasian origin.
Research has shown that non-Caucasians women are one and half times more at risk of
experiencing severe pregnancy-related complications than Caucasian women.
This risk doubles for African women especially African-Caribbean women.
The overall estimated risk of severe complications is 89 cases per 100,000 maternities in the
UK.
For Caucasian women this risk is around 80 cases per 100,000 maternities,
It is 126 cases for non-Caucasian women as a whole,
But it is 188 cases of severe complication per 100,000 maternities for African women.Worse still it is 196/100,000 maternities for African Caribbean women.
You can see that the African do badly in all health indices which is a cause for serious concern and
should be a cause for serious concern in the African community.
The way forward is Education, education and education, interaction, change of attitude and
participation.
The History of Organ Transplant.
Scientists have long thought about the idea of replacing a diseased organ with a healthy one
from a donor. The problem at first was that the human body is not particularly receptive to
foreign tissue. The immune system is like an army, constantly on guard against any invasion
of bacteria viruses or other potentially dangerous substances. When tissue from a donor is
placed inside the body of a recipient, this immune army sees it as a foreign invader and goes
into battle mode. White blood cells attack and destroy the unknown tissue in a process known
as rejection.
Scientists subsequently realized that the problem of rejection didn’t occur when the organ donor
and recipient were identical twins. The genetic similarity appeared to prevent the immune response.
Massachusetts surgeon Joseph E. Murray used this concept to his advantage in 1954, when he
accomplished the first successful kidney transplant between identical twins at Brigham and
Women’s Hospital in Boston USA.
Dr. Murray’s surgery was a major breakthrough, but it wasn’t a solution. After all, very few
people have an identical twin they can rely on for organ transplantation. In the late 1960s,
doctors figured out a way to perform transplants between non relatives by suppressing the
recipient’s immune response with drugs like cyclosporine. The trouble was that the drugs
themselves were highly toxic. Due to the risks of infection and those of the
immunosuppressant drugs, most transplant patients didn’t live long after their operation.
By the 1980s, anti-rejection drugs had improved to the point where transplantation surgery
became pretty routine and far less risky than it had been a few decades earlier. Survival rates
rose. Once surgeons had streamlined the process of transplanting essential organs like hearts,
kidneys, liver and lungs — they turned their focus to “nonessential” parts of the body. In the
late 1990s, surgeons in Lyon, France and New Zealand performed the first successful hand
transplants. The next step was to attempt a face transplant.
Religious aspects of Organ Transplant:
All the major religions of the UK support the principles of organ donation and transplantation. However, within
each religion there are different schools of thought, which mean that views may differ. All the major religions
accept that organ donation is an individual choice.The following information comes from the NHS leaflet which offers a brief guide to religious viewpoints regarding
organ donation. If you have any doubts, you should discuss them with your spiritual or religious leader.
Buddhism & Organ Donation:
There are no injunctions in Buddhism for or against organ donation.
. The needs and wishes of the dying person must not be compromised by the wish to save a life. Each decision
will depend on individual circumstances.
Central to Buddhism is a wish to relieve suffering and there may be circumstances where organ donation may be
seen as an act of generosity. Where it is truly the wish of the dying person, it would be seen in that light.
If there is doubt as to the teachings within the particular tradition to which a person belongs, expert guidance
should be sought from a senior teacher within the tradition concerned.
When he discovered a monk sick and uncared for, the Buddha said to the other monks,
“Whoever would care for me, let him care for those who are sick”.
Christianity & Organ Donation
The Christian faith is based upon the revelation of God in the life of Jesus Christ. Throughout his life Jesus taught
people to love one another and he proved his love for the world upon the cross. It seems in keeping with this that
Christians consider organ donation as a genuine act of love and a way of following Jesus’ example. This act of
love then becomes part of a Christian discipleship or faith journey that is motivated by compassion to help
someone else and demonstrates a sense of social responsibility.
Sacrifice and helping others are consistent themes in Christianity, which teaches the principle of seeking for
others what you hope others would do for you. Enabling life to be lived as fully as possible is consistent with the
teaching of the Son of God, Jesus Christ:
“…freely you have received, freely give”
Matthew, chapter 10:8Christians should be encouraged to help others in need. Discussing organ donation with family and friends is a
responsible and thoughtful act.
Hindu & Organ Donation
There are many references that support the concept of organ donation in Hindu scriptures.
Daan is the original word in Sanskrit for donation meaning selfless giving. In the list of the ten
Niyamas (virtuous acts) Daan comes third.
Life after death is a strong belief of Hindus and is an ongoing process of rebirth. The law of karma decides which
way the soul will go in the next life.
Organ donation is an integral part of the Hindu way of life, as guided by the Vedas. That which sustains is
accepted and promoted as Dharma (righteous living). Scientific treatises form an important part of the Vedas –
Sage Charaka deals with internal medicine while Sage Sushruta includes features of organ and limb transplants.
“…it is said that the soul is invisible…knowing this you should not grieve for the body.”
Bhagavad Gita, chapter 2:25
Islam & Organ Donation.
In 1996 the Muslim Law (Shariah) Council UK issued a fatwa (religious opinion) on organ
donation. The council resolved that:
• the council supports organ transplantation as a means of alleviating pain or saving
life on the basis of the rules of the Shariah
• Muslims may carry donor cards
• the next of kin of a dead person, in the absence of a card or an expressed wish to donate their organs,
may give permission to obtain organs from the body to save other people’s lives.
The fatwa is based on the Islamic principle of necessities overrule prohibition. Normally, violating the human
body, whether living or dead, is forbidden in Islam – but the Shariah believes this can be overruled when saving
another person’s life.
However there are also a significant number of Muslim scholars who believe that organ donation is not
permissible and hold the view that this does not fall under the criteria of the Islamic principle of necessities
overrule prohibition due to other overriding Islamic principles.
Both viewpoints take their evidence from the Qur’an and the Ahaadith and therefore individual Muslims should
make a decision according to their understanding of the Shariah or seek advice from their local Imam or scholar.
The Muslim Law Council UK fatwa draws on one of the basic aims of the Muslim faith: saving life.
“Whosoever saves the life of one person it would be as if he saved the life of all mankind.”Holy Qur’an, chapter 5:32
Judaism & Organ Donation
In principle, Judaism supports and encourages organ donation in order to save lives (pikuach
nefesh).
This principle can sometimes override the strong objections to any unnecessary interference
with the body after death, and the requirement for immediate burial of the complete body.
As all cases are different, Jewish law requires consultation with a competent Rabbinic authority before consent is
granted.
For more information please contact the Office of the Chief Rabbi, or another competent Halachic authority.
“One who saves a single life – it is as if he has saved an entire world.”
Pirke D’Rav Eliezer, chapter 48
Sikh & Organ Donation
Sikh philosophy and teachings place great emphasis on the importance of giving and putting
others before oneself.
It also stresses the importance of performing noble deeds and there are many examples of
selfless giving and sacrifice in Sikh teachings by the ten Gurus and other Sikhs.
Sikhs believe life after death is a continuous cycle of rebirth but the physical body is not
needed in this cycle – a person’s soul is their real essence.
“The dead sustain their bond with the living through virtuous deed.”
The transplantation of organs from living donors is morally permissible when such a donation
will not sacrifice or seriously impair any essential bodily function and the anticipated benefit
to the recipient is proportionate to the harm done to the donor. Furthermore, the freedom of
prospective donor must be respected, and economic advantage should not accrue to the
donor
No religion formally forbids donation or receipt of organs or is against transplantation from living
or deceased donors. Only some orthodox jews may have religious objections to “opting in.” However,
transplantation from deceased donors may be discouraged by Native Americans, Roma Gypsies,
Confucians, Shintoists, and some Orthodox rabbis.
No religion formally obliges one to donate or refuse organs.
No religion formally obliges one to consider cadaveric organs “a societal resource” or considers
organ donation “a religious duty” (except some rabbis and isolated Muslim and Christian scholars)
No religion has a formal position on “bonus points,” which is priority on the waiting list. Living
organ donation is strongly encouraged only between jesus christians (15 of 28 jesus christians worldwide
have donated a kidney). No religion forbids this practice.No religion prefers cadaveric over living donation.
No religion formally forbids non–heart-beating donors (nhbd) cadaveric donation or cross-over donation.
Due to the sacred of human life, the Catholic Church is against donation from anencephalic donors or after
active euthanasia.
No religion formally forbids xenotransplantation. Addressing the participants of the First International
Congress of the Society for Organ Sharing in 1991, Pope John Paul II said “There are many questions of
an ethical, legal and social nature which need to be more deeply investigated. There are even shameful
abuses which call for determined action on the part of medical association and donor societies, and
especially of competent legislative bodies” and later on “In effect, the human body is always a personal
body, the body of a person. The body cannot be treated as a merely physical or biological entity, nor can its
organs and tissues ever be used as item for sale or exchange”.
Addressing the participants at the XVIII International Congress of the Transplantation Society in 2000,
Pope John Paul II said “Accordingly, any procedure which tends to commercialize human organs or to
consider them as items of exchange or trade must be considered morally unacceptable, because to use the
body as an object is to violate the dignity of the human person” and later on added “The criteria for
assigning donated organs should in no way be discriminatory (i.e. based on age, sex, race, religion, social
standing, etc.) or utilitarian (i.e. based on work capacity, social usefulness, etc.).” To conclude, according to
the Catechism of the Catholic Church Compendium signed by Pope Benedict XVI on June 28, 2005, 476.
Organ transplantation is morally acceptable with the consent of the donor and without excessive risks for
him/her. For the noble act of organ donation after death, the real death of the donor must be fully
ascertained.
Social and cultural aspects of organ donation
In Asian countries, it is more difficult to obtain cadaver kidneys for renal transplantation because of certain socio-
cultural beliefs and customs. The issues affecting living related kidney donation are more social than cultural.
This is due to the web of family pressures and personal conflicts for both donor and recipient surrounding the
donation. Important misconceptions and fears are:
fear of death,
the belief that removal of organ violates sanctity of decreased,
concern about being cut up after death,
desire to be buried whole,
dislike of idea of kidneys inside another person,
wrong concept of brain death, and
the idea of donation being against religious conviction.
In Singapore, with the introduction of the Human Organ Transplant Act (HOTA) in 1988, the number of cadaveric
transplants have increased, including those from the Medical Therapy Act (MTA). HOTA andeducation have played pivotal roles in bringing about an increased yield of cadaveric kidneys. With the availability
of living unrelated donor (LUD) transplants in India, our living related donor (LRD) transplant programme has
suffered, because patients would rather buy a kidney from overseas than get a relative to donate one. Patients
are also going to China for overseas cadaveric transplants where the kidneys come from executed convicts.
People in countries like Hong Kong, Japan and the Philippines share the same Asian tradition of not parting with
their organs after death. Muslim countries like Malaysia require the deceased to have earlier pledged his kidneys
for donation prior to death before they can be harvested for transplantation at death.
Benin (Edo Speaking) People of Southern Nigeria.
The Benin or Edo speaking people of Southern Nigeria, see the body as sacred and not to be dismembered or
violated. Liken that to the biblical teaching which says the body is the temple of the Lord and should not be
dishonoured by dismembering it at donation. The Benin people believe in reincarnation that the body is only a
vehicle for the soul or human spirit. Hence they comfort the relatives of the deceased that the deceased is not
dead but has only transcended this life as his/her soul has gone beyond human perception. ‘wa ghe vie ba
mwen no wu’ That transcended soul reincarnates 14 times to atone for perceived sins before going into
sublimation or eternity. It is believed that a dismembered part may be missing in subsequent reincarnation which
how the people explain birth defects. These ancient and traditional beliefs are gradually giving way to modern
thinking that organ donation saves and prolong the lives of the recipient and as such should be encouraged.
However the fear of the unknown keeps holding people back from doing the needful in organ donation.
Medical Aspects of Organ Donation and Transplantation
Living organ donation has advantages from an immunological point of view because there is
often a large degree of similarity between the tissue types of the donor and the recipient.
However, we cannot fully avoid the risks to donors and recipients.
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Many of the studies report only minor risk to the donors, but earlier there was anxiety
concerning risks to the donors. Today one can find a much more positive attitude towards
living organ donation. It is noted that in the case of a living donor, mortality after surgery is
extremely low. For instance, a survey of U. S. kidney transplants shows that there are only 5
donor deaths in 19,368 live kidney transplants.
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Patients who decide to undergo
transplantation are subject to normal surgical risks. There are also complications of urological
and vascular problems, especially with regard to kidney transplantation.
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Besides,
transplantation affects the recipient body’s structure. The main benefit to the recipient is that
he/she gets a new lease on life or even a better quality of life.Legal Aspects of Organ Donation and Transplantation
Due to the illegal medical practice in transplantation, commercialization of human organs and
so on, many countries formulated transplantation laws. The status of transplantation law can
be divided into three groups: opting-out, opting-in, and required request.
• According to the opting-out system, every human being is considered a possible
donor after death unless he/she has officially expressed a contrary option. It is also
known as presumed consent.
• By opting-in we mean a process by which people voluntarily sign and submit a will
saying that they want to become donors once they are dead. If they do not do this,
they will not be legally considered donors.
• Required request law requires hospitals to ask the family of a deceased patient for a
donation of organs and tissue if the deceased is a suitable candidate for organ
donation.
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Many countries have either enacted or are in the process of drafting legislation to control the
area of living donor transplantation. Although the general field of transplantation is still in a
state of change and growth, the fundamental legal issues that must be confronted remain
unchanged. There have been recent developments in legislation, especially giving priority to
the genuine consent of the donor. Although the majority of legislation has been written for
cadaver organ donation, slowly, regulation is developing for living organ donation as well.
The clauses of the laws are made on the basis of medical, ethical, religious, social and
cultural considerations.
In most countries, the law prohibits trade in human organs and address the donor’s right, the
adequate supply of organs to the needy, the optimization of transplantation costs and the
promotion of transplantation procedures.
Ethical Issues in Organ Donation and Transplantation
The practices of organ donation and transplantation raise many ethical questions. How can
we morally justify organ donation and transplantation? What are the ethical issues connected
with the donor, with the recipient, and xenotransplantation?
Catholic Church holds that the virtue of charity is the norm for the justification of the
cadaveric, and living organ donation and transplantation. Pius XII in his address to
ophthalmologists in 1956 argues that acts of donation cannot be viewed as a duty or as
obligatory. Such acts are supererogatory and not obligatory.
Moreover, John Paul II justifies organ donation and transplantation based on charity in
general. In the address on blood and organ donations of August 1984, John Paul II
commended the National Association of Italian volunteer blood and organ donors for their
spirit and initiative. He urged them “to promote and encourage such a noble and meritorious
act as donating your own blood or an organ to those of your brothers and sisters who have
need of it.’’
In addition, in an address to a Congress on Renal Illness and Transplants (April 30, 1990), he
speaks about the Church’s main concern for renal illness and donations. The Pope asks the
directors of Catholic institutions to encourage this generous act of organ donations: “Thosewho believe in our Lord Jesus Christ, who gave his life for the salvation of all, should
recognize in the urgent need for a ready availability of organs for renal transplants a
challenge to their generosity and fraternal love.’’ Further, in his address to the participants of
the first International Congress of the Society for Organ Sharing (June 20, 1992), the Pope
considered organ transplantation as a new way of serving the human family. In organ
transplantation man/woman has found a way to give himself/herself, in blood and body. This
gesture allows others to continue to live.
This gift is actually an authentic form of human and Christian solidarity. Similarly, John Paul
II writes in Evangelium Vitae no. 86 that organ donation is an act of love when it is done in
an ethical manner. The death and resurrection of Jesus Christ establishes the supreme act of
love. This extends a deep meaning to the donor’s offering, which is saving the life of another
person. Love (charity) constitutes the main element in organ donation and transplantation,
especially in the case of the organ donor.
Moreover, other religions also support organ donation and transplantation even if their point
of emphasis is slightly different.
• In Judaism, Rabbi R. P. Bulka observes: “One may laud the donor who makes … a
heroic sacrifice, but it certainly would not be proper to place pressure on individuals
to be so altruistic.”
• Greek Orthodox Church, Stanley S. Harakas writes about the donation of a kidney.
Organ donation rescues “the life of another person as a loving act of mercy. The
donor is to be commended if he perceives his sacrifice not as a violation of his bodily
integrity, but as a gracious and loving unselfish act.”
• Quoran and Hadith (the Prophet Mohammed’s sayings and examples), the Islamic
Code of Medical Ethics (1981) upholds: “If the living are able to donate, then the
dead are even more so; no harm will afflict the cadaver if the heart, kidneys, eyes or
arteries are taken to be put to good use in a living person. This is indeed charity.”
• In the Buddhist tradition, organ donation is an act of helping another person in his/her
extreme need. It is an act of generosity and compassion. Organ donation and
transplantation is acceptable also in the Hindu tradition.
Care for the other and altruism are the secular terms that we can find in the literature on organ
donation and transplantation. Even if many use these terms, the basic idea behind them is
charity. Here, care for the other or altruism in organ donation is not self-sacrifice alone, but
there is sufficient self-concern for one’s own self. Many scholars justify organ donation on
the basis of altruism, charity, love or care for the other. From what has been stated there is no
moral obligation for organ donation. The virtue of charity is the main motive for it.
According to the Catholic perspective, donors can donate organs except brain and
reproductive organs. The brain is significantly determinative of personal identity. The
reproductive organs are associated with reproductive identity. Neither the brain nor the
reproductive organs may be procured from human beings or animals for transplant to a
human person (Evangelium Vitae no. 63).
Church also holds that “to take tissue from a live foetus for transplantation is unethical”
(Evangelium Vitae no. 63). Great concern must be given to ensure that all cadaveric foetal
tissue to be used for transplantation is derived from natural miscarriages or from ethically
obtained cell lines.Commercialisation has a serious negative impact on many of the medical and ethical values
intimately connected with organ transplantation. The Catholic Church is against paid organ
donation. Parts of the human body are not to be treated as commodities. Trade in human body
parts is unacceptable, as in any other disrespectful use of the organs or tissues of a living or
deceased person. At the World Congress of the Transplantation Society (Rome-2000), John
Paul II said “any procedure which tends to commercialize human organs or to consider them
as items of exchange or trade must be considered morally unacceptable, because to use the
body as an “object” is to violate the dignity of the human person.” Paid organ donation
spoils the spirit of altruism. In paid organ donation, one does not fully respect the other.
Ethical Issues Connected With Donor
The main ethical concerns related to living organ donation include functional integrity, and
the consent of the donor.
Catholic Church has used the principle of totality for the justification of living organ donation
and transplantation. A simple expression of the principle of totality means, “the parts of the
physical entity, as parts, are ordained to the good of the physical whole.” From the medical
perspective, the principle of totality would mean “all the parts of the human body, as
parts, are meant to exist and function for the good of the whole body, and are thus
naturally subordinated to the good of the whole body.” The term “totality” points to the
duty to preserve intact the physical component of that integrated whole. The official
statement of the Church regarding the application of the principle of totality to medical
problems can be seen mainly in the period of Pius XII. He reaffirmed, clarified, and applied
the principle of totality to medico-moral questions in many addresses delivered from 1944-
1958. According to him, “a part of the body has no meaning outside its reference to the whole
that as a part is to be thought of only in relation to the whole.”
Understand the difference between functional integrity and anatomical integrity. One must
distinguish between the good of the adequately functioning body and the good of the full
integrity of the anatomical whole.” The principle of totality is concerned with the former and
not the latter.
Ashley & K. D. O’Rourke presents their own formulation of the principle of totality and calls
it the principle of ÔTotality and Integrity.’ It reads as follows:
“Except to save life itself, the fundamental functional capacities which constitute the human
person should not be destroyed, but preserved, developed, and used for the good of the whole
person and of the community.” On the one side this principle grants priority for some human
values over others. On the other side, it breaks the “fundamental integrity” of human person
for certain kind of worth, “except in the most extreme choice between life and death.’’
For Benedict M. Ashley and Kevin D. O’Rourke, organ transplants are justified when the
functional integrity of the donor is maintained. They give a summary of moral reflections on
living organ donation and they present certain principles for living organ donation and
transplantation:
• There should be a serious need faced by the patient, which can only be satisfied by
organ donation.• Even if donation reduces “anatomical integrity, it should not diminish the “functional
integrity” of the person.
• The risk in donation as “an act of charity is [to be] proportionate to the good resulting
for the recipient.”
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• There should be “free and informed consent” by the donor. All these norms can be
seen in the principle of totality.
The 1975 Ethical and Religious Directives for Catholic Health Care Facilities states “[T] he
transplantation of organs from living donors is morally permissible when the anticipated
benefit to the recipient is proportionate to the harm done to the donor.” The Directives also
mention that the donations of organ should not reduce the “functional integrity” of one’s
body. Moreover, the 1994 Directives, section no. 30 directly deals with the need of
safeguarding functional integrity in living organ donation and transplantation. It reads as
follows:
The transplantation of organs from living donors is morally permissible when such a donation will not sacrifice or
seriously impair any essential bodily function and the anticipated benefit to the recipient is proportionate to the
harm done to the donor. Furthermore, the freedom of prospective donor must be respected, and economic
advantage should not accrue to the donor.
Informed Consent of the Donor
The informed consent of the donor is another key requirement in living organ and
transplantation. If donor’s decision is not autonomous or self-determined this leads to treating
a person without respect. Respect for autonomy requires that the donor must be able to
exercise the power of free choice.
In the case of living organ donation, no physiological benefit is to be expected by the donor.
It is clear that the first matter of critical importance is how far the amount of risk, pain, and
length of incapacity is communicated to the donor so that an informed decision can be made.
. Art. 3 of the WHO Declaration states that “the donor should not be influenced or abused.”
Organ donation, says John Paul II, is a free and conscious decision either on the part of the
donor, or of someone who legitimately represents the donor. It is also a decision of giving
without any remuneration. Really, donation concerns the well being of another person. It is
very difficult to make an assessment of fully informed consent of the potential donors,
especially in the case of prisoners, mentally challenged persons, and minors.
Cadaveric Organ Donation
The donation of organs and tissues after death is a generous act. With regard to the cadaveric
organ donation and transplantation, the main ethical issues include the concept of brain death,
and consent.
Ethical Issues Connected with the Recipient
There should be a proportionate relation between physical risk to the donor and good for the
recipient. The risk in donation as “an act of charity is [to be] proportionate to the good
resulting for the recipient.” CCC no. 2296 states:Organ transplants confirm with the moral law and can be meritorious if the physical or psychological dangers and
risks incurred by the donor are proportionate to the good sought for the recipient.
It is morally inadmissible
directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of
other persons.
The general principle that surgery cannot be carried out without the consent of the person to
be operated upon is equally applicable to organ transplantation as well. Recipients also
should give their consent for the operation. The physician should inform the donor and the
recipient in an honest, appropriate and comprehensible manner of the possible risks of organ
donation and transplantation.
According to Catholic perspective “patients should be treated equally when being admitted to
transplant programmes. There should be no unjust discrimination on the basis of social
factors such as inability to pay, mental illness, past misuse of substances, lack of family
support, lack of education, advanced age, remoteness or ethnicity. Only clinical factors such
as urgency, need and ability to benefit should be taken into account.’’
Xenotransplantation
Transplantation of animal organs to human being is permissible provided the procedure will
not impair the integrity of the recipient nor impose inordinate risks on the recipient or others.
With regard to the animal-human hybridisation, Church says that “the introduction of parts of
the human genome into animal tissue or vice versa must not involve extensive animal-human
hybridisation, inheritable changes to a human being, or the formation of an organism
possessing some human and some animal material which may capable of further development
as an embryo.”
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Promotion of Organ Donation and Transplantation
The present state of organ donation and transplantation includes different types of
transplantation, different types of donations and one should consider also the medical, moral,
and legal problems connected with the practice of organ donation and transplantation.
Types of Transplantation
Auto grafts, isographs, homographs, and heterografts.
Auto graft (syngenic) is the transplanting of an organ or tissue within the same individual
from one part of the body to another.
Isograft (Isogenic) is the transplantation of organs or tissues between two genetically
identical individuals, such as identical twins.
Homograft (allogenic graft) is the transplantation of an organ from one individual to another
within the same species.
Heterograft (Xenogenic graft) is the transfer of organs between individuals of different
species, usually from animals to human beings.Types of Donations
Cadaveric and living organs are the two main sources for transplantation.
The cadaveric donation includes related and unrelated donations.
There are five types of living organ donations:
• Living Related Donation: donation between genetically related persons,
• Living Unrelated Donation: donation between non-genetic or non-emotional persons.
There may be also emotionally related transplantations.
• Crossover Transplantation: In renal transplantation certain donors cannot donate their
organs to a particular recipient because of the ABO incompatibility and other
problems with histocompatibility (e.g. positive T-cell cross matches) but without any
ABO problem with other recipients (crossover transplantation). For instance, donor A
cannot give a kidney to recipient A but he/she can give it to recipient B. Similarly
donor B cannot give a kidney to recipient B; but he/she can donate to recipient A.
• Domino: in this programme an organ may be transplanted to a patient whose own
organ then still can help another patient on the waiting list.
• Indirect Living Organ Donation: close relative of a recipient wants to donate his/her
kidney to the donor. But this living related transplantation is not possible due to blood
group incompatibility. The recipient is then placed higher on the waiting list, while
the organ from the donor is added to the organ pool.
We have seen in the last section the ethical issues related to organ donation and
transplantation. The virtue of charity will be an important element in increasing organ
donation. This kind of value education can be promoted both by religious groups and by
secular agencies.
This inter-human relationship is very clear in the case of organ donation and transplantation,
which expressed in the relation between donor and the recipient. It is not an “I-It”
relationship, but an I-Thou relationship. This means the donor is moved by the face of the
other (recipient) who is in a critical stage, which is helpless. The deep relationship shows the
empathy with the other. For instance, the French philosopher Merleau-Ponty writes: ”
• There is an essential relationship between body and consciousness such that the body
is never – even throughout transplant surgery – just a body, but rather a perceiving
entity, that is to say animate.
• Every body receives its specificity and becomes animate through the perception of
another.’’
Organ donation also highlights the value of solidarity in society, especially in medicine.
Organ donation points to a social dimension where donors and the recipients are part of the
society. The social aspect is also one of the elements that assist in making decisions in organ
donation and transplantation. The value of solidarity encourages the donors and recipients,
and others who participate in transplantation, to make responsible decisions. We also argue
that from a moral point of view, commercialisation of organs does not promote organ
donation and transplantation. Selling body parts for money reduces the value of the person.
There should be no material profit in charitable or altruistic organ donation. In the presentsituation where we are facing a crisis of organ shortage, helping patients who are in a critical
stage, really shows the social character of the human person.
Conclusion
There is a real scarcity of human organs even though organ transplantation facilities are
widely available. In this context, both living and cadaveric organ donation and transplantation
should be promoted.
• African and ethnic minority should be encouraged to be involved in organ donation to
ease the waiting list of their kin men and women on the organ donation programme.
• Africans should do their best to be exposed to all available resources in the
environment in which they live so that they can utilise these resources to their fullest
advantage as well as contribute to it to make successful it for mutual benefit.
• Africans and other ethnic minority should not socially exclude themselves from
community activities like organ donation because when they do so it is to their
detriment because if you do not give, you will not receive and when you freely give,
you also freely receive.
• The bible says that for lack of knowledge our people perish, Africans must do
everything possible to acquire knowledge and good education because there is power
in knowledge and education.
• In order to prevent commercialization, transplantation law should be promulgated
effectively and purposeful programme to eliminating poverty is another step towards
decreasing the commercialization of human organs.
• Governments should control agencies and hospitals engaged in transplantation with
respect to their profit motives.
• International co-operation should be promoted in organ donation and transplantation.
Developed countries can help developing countries in promoting research in
transplantation technology. A global vision associated with a local vision can
facilitate the promotion of organ donation and transplantation.
• One of the efficient means to promote organ donation is to educate people about the
scarcity of human organs for transplantation and Africans should be in the forefront
of this campaign as presently they are the most disadvantaged.
Evangelium Vitae (no. 101) speaks about the proclamation and promotion of life: “The
Gospel of life is given to us as a good to be shared with all people including Africans: so that
all men and women may have fellowship with us and with the Trinity.” Organ donation and
transplantation highlights the relational and social dimensions of human life. Through organ
donation and transplantation also one can proclaim and promote the gospel of life. More
clearly, patients in a critical stage of kidney or other organ failure have to either undergo
transplantation or face death. In these people one has to see the real face of the other.’ We
have to promote basic ethical care for the other. We cannot force anyone to donate, but
people should be motivated to make free and voluntary donations. In this condition, a spirit of
charity, relevant both from religious and secular points of view can work properly with
regard to the promotion of organ.
References:1, UK Obstetric Surveillance System (UKOSS), Dr Marian Knight from the National Perinatal
Epidemiology Unit at the University of Oxford 2, Centre for Maternal and Child Enquiries (CMACE) Perinatal Mortality 2008: United Kingdom. CMACE: London, 3, http://health.howstuffworks.com/medicine/modern/face-transplant1.htm 4, P. Bruzzone: Religious Aspects of Organ Transplantation Volume 40, Issue 4, Pages 1064-1067 (May 2008) 5, Cultural aspects of Organ transplant: Ann Acad Med Singapore. 1992 May;21(3):421-7.
6, Scaria Kanniyakonil: The Promotion of Organ Donation and Transplantation http://www.lifeissues.net/writers/kan/kan_03organdonation1.html#b25 7, NHS information leaflet on organ donation