Organ transplantation essay topics are on verge of medicine and ethics and may take the form of a range of discursive questions:
1. What is the best way to decrease the shortage of organs for transplantation?
2. Should the legislature concerning organ transplantation be changed?
3. Should there be an opt-in or opt-out donor system?
4. Should people be refused organ transplantation for leading an unhealthy lifestyle?
5. Should the organ transplantation committee consider patient’s personal details (marital status, children, accomplishments, personal qualities) when choosing what person will receive an organ?
6. Should doctors be required to report the cases of organ trafficking (when a person has a needed organ though he did not get it being on the national list)?
7. Should inmates be listed in the national waiting list?
Although each of these organ transplantation topics is good for an essay or organ donation persuasive speech, it is also critical for making personal life choices. Whatever organ transplantation topic you choose, you will have to inform yourself about
1. how high the need in organs is,
2. what the legislature is and how the organs are allocated,
3. what ways to decrease the shortage of organs for transplantation have been suggested,
4. what organ trafficking issues exist (even though it may be a separate topic, the statistics and horrifying instances of organ trafficking prove that something has to be done with the shortage of organs in the wealthy countries)
The following sources provide such information. In addition, you may cite them in your essay!
The 2004 Report of the Centre of Bioethics is a great source to start with as it provides a great overview of the legislature, allocation principles, and possible solutions accompanied with the alternative or opposing views.
Here are the most important facts and ideas you can find in this text:
- Transplantation may be from a deceased donor (in this case, organs are called cadaveric) or a living donor (directed donation to the relative or the loved ones or nondirected donation to a stranger). In each case, legislature prohibits any monetary remuneration for the living donor or relatives of the deceased, whose organs have been given for transplantation.
- The sole organization responsible for the allocation of organs in the USA is The United Network for Organ Sharing (UNOS). To get an organ, a person should be on its list.
- The computer processes the information about the newly available organ and produces the ranked list of donors who can receive it. The criteria used are: (1) organ type and size, blood type, (2) distance between the organ and the patient, (3) level of medical urgency, (4) time on the waiting list. Additional factors such as the availability of the patient and his willingness to receive an organ and the patient’s satisfactory medical condition for transplantation are considered by local organ procurement organizations (OPO). No other factors such as level of income, race, gender, merits, or even ability to sustain anti-transplantation treatment are considered.
- The shortage of organs is due to a number of factors: the increase in the number of people in need of organs (due to the aging of the population, medical technological advances), and the declining numbers of car crash fatalities due to seat belt campaigns and air bag use.
- On average, 17 patients die every day while awaiting an organ. In 2002, 6,187 people on the U.S. organ transplant waiting list died because the organ they needed was not donated in time. More relevant statistics may be found on the UNOS website.
- If the donation wishes of the deceased are unknown, the permission has to be obtained from the family member with the authority using the defined hierarchy.
Opposing views on the distribution criteria:
- Some argue that the current system of including people who ruined their organs by their lifestyle choices such as smoking and alcohol use is unjust, as such people make the list longer and reduce the chances of people who had no control over their organ failures to get the needed help. Such criterion is referred to as the medical “worthiness” bias. The opponent of the bias state the determining of “worth” and including factors other than medical need is a slippery slope, which can lead to biased distribution.
- Another debated criterion is the consideration of the success of the transplantation, which is measured as a number of years the patient will live when transplanted an organ. The naysayers suggest such approach (1) leaves space for bias, (2) is simply a guess for success is impossible to predict for sure, (3) puts older people at the disadvantage. (other sources also mention the suggestion to consider not the length but the quality of life after transplantation such as the ability to communicate, care for oneself, etc.)
Five strategies to increase the availability of organs:
1. Education (educational campaigns promoting the idea of donation
2. Mandated choice (all the people are made to make a choice: donate or not to donate organs after death). The issue with this strategy is that people fear lest the death may be declared earlier or not so much affords will be put into saving the patients if his donation wish is known. Therefore, when the policy was tested in Texas in 1990’s, 80% chose not to donate.
3. Presumed consent (opt-out system – all are donors unless they specifically request not to donate). Opponent say that the needed level of public education and understanding of their rights will be difficult to achieve and some people who oppose to donation may find it difficult to indicate their wish.
4. Prisoners (taking organs of prisoners who are put to death).
5. Incentives (both financial and not-financial incentives such as covering funeral expenses or donating in the name of the deceased are discussed). Buying and selling of organs is banned as the means of exploitation of the poor who are likely to overlook the possible drawbacks of donation for monetary incentives.
Center of Bioethics (2004). Ethics of organ transplantation. Retrieved from web address.
Center of Bioethics. Ethics of Organ Transplantation, 2004, web address.
The source considers incentives as a possible solution to the organ shortage. The greatest amount of debate for financial incentives surrounds kidney donation as
- cadaveric organs cover only 20% of the national waiting list,
- living donors end up losing own their money for their altruism (due to travel costs, time off work, possible complications, sometimes, need of lifelong medical treatment),
- unlike heart, kidney may be donated without a severe damage to the donor’s health
Introducing the payment for organs is opposed as the way of exploitation of the poor. The opponents suggest once the market is created, it will be impossible to regulate. Nevertheless, if there is a regulated organ market
- the physicians will assess whether donors are healthy enough to donate and assure donors are informed of the risks, which is drastically different from the trafficking schemes where the health of the donor or the recipient is not considered.
- Extremely poor will be excluded from the system as having high risks of kidney disease
- The rich should not necessarily have right to buy the organs they wish. The organs may be bought by the state and distributed by the UNOS using its distribution criteria. Thus expenses are justified as the transplants pay off after about 18 month versus dialysis.
In addition, the interviewed expert stresses that wealthy countries with a high demand for organs should assume responsibility for the flourishing of trafficking business. Therefore, reducing organ shortage in the U.S. will also reduce organ trafficking market in the developing countries, where the poor may not rely on adequate social and legal protection.
Rettner, R. (2009). Great debate: Should organ donors be paid? Live Science. Retrieved from web address.
Rettner, Rachael, “Great Debate: Should Organ Donors Be Paid?” Live Science, 2009, web address.
The source presents the excerpts from the speeches of the experts, made on the public debate on the issue. Here are the most persuasive:
Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute who received a kidney from a friend in 2006,
“We are not talking about a classic commercial free-for-all, or a free market, or an eBay system. We’re talking about a third-party payer. For example, today you could decide to give a kidney. You’d be called a Good Samaritan donor. … The only difference in a model that I’m thinking about is where you go and give your organ, and your retirement account is wired $40,000, end of story.”
Amy Friedman, director of transplantation at SUNY Upstate Medical University
“I agree with our opponents that the black market must be closed. I disagree with asking patients to accept death gracefully, instead of resorting to the black market. My position is that development of a legal, regulated mechanism for donor compensation is the only means of effectively eliminating the demand for this covert activity, closing down the black market and improving safety for donors and recipients. … Compensation for the organ donor’s time and risks, by providing life insurance, lifelong health insurance and even a direct monetary fee, is more appropriate than for the donation of an egg, the rental of a uterus for a surrogate pregnancy, or the participation in clinical experimentation, all of which are legal.”
Francis Delmonico, professor of surgery at Harvard Medical School and adviser to the World Health Organization on transplantation,
“What we do here has a profound influence on the rest of the world. Now, I say that because I’ve been to Manila. And … it’s not a matter of balanced thought when a 14-year-old has to sell a kidney to an American that comes there … About 20 patients a month go from Israel to Manila because of cheap prices. If there’s a market legalized in the United States, in the global context of medical tourism, do you think that the 72-year-old patient on the list would wait for a kidney here, versus going to buy a 20-year-old kidney in Manila?”
David Rothman, professor of social medicine at Columbia University and director of the Center on Medicine as a Profession,
“What this is really about is the sale of organs from living donors. … There are very, very good reasons – many drawn from behavioral economics, some drawn from past experience — that suggest that, in fact, to create a market might diminish the supply, not increase it. In the first instance, if I can buy it why should I give it?… In England, where the sale of blood was not allowed, rates of donation were considerably higher than the U.S., where the sale of blood was allowed.”
Knox, R. (2008). Should we legalize the market for human organs? NPR. Retrieved from web address.
Knox, Richard. “Should We Legalize the Market for Human Organs?”, NPR, 21 May, 2008, web address.
The source argues for the legalization of organ trade and opt-out system. The source explains the need in kidneys as “biological life insurance” but stresses the desperation of people who spend years on dialysis and long to obtain the organ by any means and on the ability of the poor to give informed consent. It also mentions the disincentives, when people willing to donate to friends refuse to do that because then they will be denied life insurance.
Castello, M. (2013). Ethical dilemmas surround those willing to sell, buy kidneys on black market. CBS News. Retrieved from web address.
Castello, Michelle. “Ethical Dilemmas Surround Those Willing to Sell, Buy Kidneys on Black Market”, CBS News, 1 Nov. 2013, web address.
Black Market Organ Trafficking
“Organ Trafficking: A Deadly Trade” by Julie Bindel tells several stories of organ trafficking schemes and presents important statistics. In particular, according to a recent World Health Organization (WHO) research, there are 10,000 black-market operations involving purchased human organs annually and 5-10% of all kidney transplants are obtained through organ trafficking. The article shows donors can be kidnapped and forced to give up an organ. Doctors can deceptively convince them they need an operation and remove an organ without the knowledge of the patient. Some victims can be murdered to order. Among the targeted, there are many children, especially from poor backgrounds or disabled. In many cases, donors give consent to sell their organs, but eventually get neither money nor proper after operational treatment.
Bindel, J. (2013) Organ trafficking: A deadly trade. The Telegraph. Retrieved from web address.
Bindel, Julie. “Organ Trafficking: A Deadly Trade”, The Telegraph, 1 Jul. 2013, web address.
“Trafficking in Human Bodies” is an extensive official report conducted on the request of the European Parliament. It gives a very detailed information on the forms and routs of organ trafficking. In addition, it clearly appeals to the responsibility of the wealthy states who drive the organ business in the third world developing courtiers. Furthermore, it discusses the current legislature concerning the prevention of organ trade (rather lack of its effectiveness). In particular, it considers the role of doctors and stresses the necessity to change legislature to place more responsibility on those who actually conduct illegal transplant operations or consult patients on obtaining organs illegally.
The source will be very useful for those who have to write longer papers. Those, who have to write short position essays can move directly to the conclusion, which gives a very good summary of the report.
Bos, M. (2015). Trafficking in human bodies. Retrieved from web address.
Bos, Michael. “Trafficking in Human Bodies”, 18 Jun. 2015, web address.
“Human Harvest: China’s Organ Trafficking” by Leon Lee tells about the study performed by Nobel Peace Prize nominees, David Matas and David Kilgour, who have spent years investigating organ harvesting in China. In the documentary, which summarized their work, the researchers show that the organs, excessively transplanted in China, usually come from the political prisoners. Namely, the members of the Falun Gong movement, banned by the Chinese Government, are killed to order for transplant tourists.
Lee, L. (2015). Human harvest: China’s organ trafficking. SBS. Retrieved from web address.
Lee, Leon. “Human Harvest: China’s Organ Trafficking”, SBS, 7 Apr. 2015, web address.
Transplantation Organs for Prisoners Debate
“Offender Organ Transplants: Law, Ethics, Economics, and Health Policy”. The article considers the relevant law and ethical issues and argues for the provision of all the necessary medical care to prisoners, transplantation operations in particular, as necessary attribute of a democratic state and essential component of correction. At the same time, is acknowledges the fact that prison population has an increased need for transplants due to health history and ethnic and racial make-up.
McKinney, E.B., Winslade, W.J., & Stone, T.H. (2009). Offender organ transplants: Law, ethics, economics, and health policy. Houston Journal of Health Law & Policy, 7(17): 39-69.
McKinney, E. Bernadette et al, “Offender Organ Transplants: Law, Ethics, Economics, and Health Policy”, Houston Journal of Health Law & Policy, vol.7, no.17, 2009, pp.39-69.
“Donating Organs to Inmates Targeted”. The article discusses the bill suggested by Denham, which meant to allow people to opt out of letting the organs they donate go to prisoners. The bill followed the heated discussion of the allocation of a health (most expensive transplant organ) to the prisoner who still died a year after the operation for being “not a model patient”.
Warren, J. (2003). Donating organs to inmates targeted. Los Angeles Times. Retrieved from web address.
Warren, Jenifer, “Donating Organs to Inmates Targeted”, Los Angeles Times, 24 Jan. 2003, web address.
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