Should People Donate their Organs?
There are many people languishing in pain and desperation as a result of inadequate medical organs for transplantation. Since the discovery of organ transplantation as an appropriate procedure for tackling failed body organs, the number of donors has never matched the number organ recipients at any particular time. Furthermore, the number of people who die due to unavailability of organs is increasing dramatically and the number of people who are in the hospital waiting to the organs is increasing to unmanageable state. According to Lopp (2003), ten people die helplessly in Europe every day as a result of inadequate donors of transplantable organs. Over the years, there have been testimonies of helplessness given by people who have been waiting to get organ transplantation for quite long till they end up dying without the prescribed medical remedy. With more than 100,000 Americans waiting for organ transplant at the same time, the average wait could extend to five years if the normal transplant procedures were to be followed. In United States, more than 6,000 patients die yearly while waiting in the line for organ transplant (Abadie & Gay, 2006).
Consequently, the worrying situation has seen the rise of black markets where donors and recipients are exploited by organ brokers. According to WHO (World Health Organization), the supply of transplantable organ falls far below the demand line, with the available supply being able to meet only a tenth of the current need (Lopp, 2013). Although there is no credible data, many scholars claim that thousands of patients with organ failure most likely receive illicit transplant from international black markets. Almost always, those who sell their organs tend to be poor and ill-informed about significant aspects of organ donation and medical risks.
Earlier research on organ donation have acclaimed that, although majority are aware of organ donation, many are reluctant to consider donating their organs. In order to reduce death cases related to conditions that demand organ transplant, a research is required to establish the reasons behind people’s attitude towards donation. Therefore, this research explores numerous factors related to individual’s willingness to donate. The main focus of this research was to establish the factors behind willingness to donate human organs for transplantation. In support of organ donation to sustain life, this research seeks to establish all possible reason why people should donate their organs. Consequently, the research also examines organ shortage problems and their solution, black market issues that affect organ donation, effects of education on organ donation, the influence of family members on organ donation, merits and demerits of organ donation and how to increased awareness would help change people’s thought on organ donation particularly the teenagers. This research will play a vital role in encouraging the medical communities to reconsider the motivation for human organ donation.
In order to adequately cover vital aspects related to organ donation and achieve the objective of this study, there are set question that will provide guidance on vital areas that should be covered. The question that will be answered in the research includes:
- Why should people donate their organs?
- Why are people reluctant to donate their organs?
- What is the importance of donating organs?
- How does organ donation combat the black market?
- Who should donate?
- What are the benefits for the donor?
The above questions were discussed comprehensively and answered after reading many scholarly sources, scientific articles and websites that provide significant information about organ donation. The scholarly sources from peer reviewed journals provided wide range of information that covered issues of organ donation in Asia, Europe, United States and Africa. Additionally, two surveys were conducted and information was gathered from a doctor who helps in transplantation procedures and AUS students and faculty to understand what they think about organ donation.
Organs and Organ Transplant
Organ transplant has been used for decades to treat serious health conditions that lack alternative medical remedy. Organ transplantation is a surgical procedure that provides a life-saving opportunity for people who have no other options. According to Morgan & Miller (2002), “organ transplant is a surgical operation where a failing or damaged organ in the human body is removed and replaced with a new one.” (163). The first human transplant, which became successful, was performed on twins in 1954, Brigham and Women’s Hospital.
Organs are groups of specialized cells and tissues that work together to perform a certain function in the body (Kauffman et al, 2007). Organ transplant is done to specific organs in the body which includes: kidney, lungs, liver, heart, intestine and pancreases. Artificial and animal organs serve as transplantable organs that can be used to replace worn-out of inefficient body organs. Other kinds of transplant that require complex processes include skin transplant, corneal transplant and bone marrow transplant.
There are numerous reasons for the increased demand for transplantable organs: (i) The success of transplants has improved due to advances in medical procedures which includes tissue typing techniques, and the advancement of new immunosuppressive drugs (Siminoff, Arnold & Hewlett, 2001); (ii) A high percentage of end-stage diseases that are incurable thus making transplantation the only outstanding option (Sanner, 2001); (iii) The desire on the part of many patients to extend the duration of their life through a transplant (Siminoff et al, 2001).
Why Individuals Decide to or Not to Donate
Most campaigns and initiatives to encourage organ donation have focused on the hindrances and motivation behind the decision to donate (Conesa et al, 2003). There are several hindrances to organ donation culture, based on personal believes, religious believes, fear of medical complications, and lack of sufficient knowledge among others (Morais et al, 2012).
Since the discovery of organ transplant, as a surgical procedure that could save people with condition that cannot be cured through other medical procedures, there has been mixed feelings and opinions about the aspect of donating human organs. Some have strongly and openly opposed the donation of organs, while others have supported it, considering it as least of all self-centered actions expressed by human beings. There has been high and sustained support for the organ donation from different groups and nations. However personal believes and religious believes have been significant in the perception expressed by different people (Morgan & Miller, 2002). Many religious groups believe in divine (miraculous) healing, that can be considered when certain body organs fail. Therefore, this is the basis of their reservation of their opinion or direct opposition to organ donation.
The Shinto religion strongly opposes organ donation because they consider dead body dangerous and impure (Cherry, 2013). Interfering with dead body is a serious crime that can amount to divine intervention. In this religion, it is quite difficult to obtain consent from the bereaved families for medical education, organ donation or pathological anatomy because such actions are related to interference of the body (Cherry, 2013). The families of the bereaved protect the dead body in order to protect the Itai; a peaceful relationship between the deceased and the living. On the other hand, Buddhists argue that human organ donation is an issue that should be left to an individual’s conscience.
The Lutheran Church officially passed a decree in 1984 clearly stating that organ donation significantly contributes to the well being of humanity and is an expression of sacrificial love towards a neighbor in need (Cherry, 2013). They call on church members to positively consider the selfless action of donating body organs and make suitable family legal arrangements, along with utilization of signed donor cards. The Seven-day Adventist church strongly encourages organ donation and transplant though it does not have an official statement confirming acceptance of such medical procedures. In fact, there are numerous Seventh-day Adventist medical centers that conduct organ transplant clearly confirming their support for organ donation.
Some studies from China and Korea provided substantial proof of Confucian beliefs as an impediment to organ donation. Human organ donation is essentially considered unfilial and disrespectful of parents (Liu et al, 2015). A current study among medical scholars in China established that these concerns are still very prevalent.
The Christian church encourages human organ donation, stating that such actions portrays the sacrificial love of God, as the one expressed by Jesus towards humanity, by accepting to die on the cross to save humanity (Cherry, 2013). An official resolution that was passed in 1985 and adopted by the General Assembly encourages its congregation; the Disciples of Christ, to register as organ donors and support those who undergoes organ transplant with their prayers. Organ donation is morally and ethically acceptable by the Catholic Church. It is considered a purer act of love and charity (Cherry, 2013). The support of organ donation by the Catholic Church has seen the culture gain worldwide acceptance, and especially in regions where Catholic faithful are dominant.
The Hindu religion supports organ donation since there are no religious laws prohibiting the congregation from engaging in organ donation. Hindu mythological teachings offer stories that express the use of human body for the benefits of other members of the society (Cherry, 2013). However, the choice to donate organ is entirely left to individuals decisions. Islam teachings strongly condemn violation of human body, whether dead or living (Hamdy, 2012). However, the law of altruism (the aspect of saving life) is considered core in Islam. Therefore, organ donation by both living and deceased is allowed and supported. However, although organ donation is acceptable in Islamic culture, many members within the faith are still unwilling, particularly concerning deceased donation. Thus, majority of organ transplants in many Muslim nations are commonly live donations. In Iran, deceased donation was only 13% of the entire renal transplants done in 2011 (Hamdy, 2012).
On the other hand, investigation of family refusal for organ donation in different countries revealed several explanatory factors including: fear of disfigurement and pain (often accompanied by failure to accept the argument that the dead person was not suffering simply because s/he was dead), refutation of death (particularly for family members on mechanical ventilation), and family dynamics and communication concerning fundamental decision making and death (Ben-David, 2005). The same argument was supported by majority of AUS students. With consideration to family dynamics and communication, the relatives in the extended family are a critical factor in the rejection to donation. Most students argued that their families significantly influence their decision on organ donation. In particular, although the chance to donate may be offered by medical personnel to the next-of-kin, majority often prefer waiting for other elder or more prominent family members to make the decision (Siminoff, et al, 2001).
Advantages of Organ Donation
The therapeutic utilization of human substances, including the transplantation of organs, is a fundamental part of contemporary health systems and critical to the management of serious health conditions throughout the world (Morgan & Miller, 2002). Because of the success of this medical discovery, demand for organs continues to surpass the supply from donors, at an alarming rate. It is unfortunately that it is not possible to make organ transplantation available to all who need it because there are few donors willing to meet the ever-growing need for organ transplantation (Jernigan et al, 2013).
The only ethically sound impetus for donation is altruism, the absence of any individual benefit beyond the fulfillment of giving (Abadie & Gay, 2006). Thus, majority of motivational campaigns to increase the number of donors have been seeking the altruistic aspect of helping and saving the lives of others. However, most students expressed the essence of appreciation to the donors. As a motivational approach, appreciating donors with financial bonuses would significantly encourage many people to offer their donation “altruistically”. Therefore, there is need to support organ transplant through donation because it significantly sustains human life.
Disadvantages of Organ Donation
Potential organ donors encounter a variety of challenges which are either; physical, psychological or financial (Ben-David, 2005). Normally, during the donation process, careful evaluation of these risks and comprehensive discussion with the donors to make sure that they are entirely aware of these challenges is a key approach. In the situation of potential donors who are obtained from foreign countries and are unfamiliar to the beneficiary or the transplant team, the procedure of ensuring proper assessment and preparation of the donor is unavoidably more intricate and the possibility of a donation process to a successful outcome is minimized (Morgan & Miller, 2002). The provision for considerable follow-up of the donors in their country of origin should also be factored carefully. These aspects all have implications for the health and well-being of the donor.
Though medical studies have expressed minimum health complications on the part of donor, there are possible health challenges that might arise as a result of using one organ instead of the normal two (Siminoff et al, 2001). For example, donating one kidney might subject the remaining kidney to increased pressure that might lead to the organ failure in future. Such issue is a disadvantage to the donor who might have considered organ donation out of altruism.
Cherry (2013) asserts that equal access distribution of transplant organ is not justified if it includes persons whose lifestyle choices, such as use of tobacco, alcohol and other harmful drugs, ruined their organs. In his argument, Cherry (2013) thinks that people who engage in destructive and irresponsible behavior should not seek to get good organs from others. Such people increase organ demand and as a result deprive people who have no control of their need of crucial treatment.
Effects of Education on Organ Donation
During the last two decades, vigorous educational campaigns, both voluntary and legislative, intended to increase organ donation have been unable to increase donation rates considerably. The demand for organs has increased almost five times quicker than the number of cadaveric donors. The yearly compounded rate of growth in number of patients on waiting lists has averaged 14.1% per annum, while the rate of increase of donors has averaged 2.9% per annum (Hamdy, 2012).
However, numerous studies have indicated that education plays a significant role in promoting organ donation. Countries with high literacy level, such as countries in Europe have more positive attitude towards organ donation. According the study by Lopp (2013), 55% of Europeans expressed their will to donate one of their organs to persons in need of organ transplant immediately after their death. In Africa and many Asian countries, which are considered to be continents with highest illiteracy level, the highest percentage of people disregard organ donation (Morgan et al, 2005). The reasons for African’s unwillingness to donate have been the subject of substantial speculation. In addition to little awareness and lack of knowledge, religion, inclination to directed donation, medical mistrust, and a great desire to uphold bodily integrity are the key reasons cited by several researchers for African’s reluctance to donate organs (Abadie & Gay, 2006). Therefore, education is a significant factor that determines people idea towards organ donation because it influences the general attitude towards organ donation.
In United States, the “culture of donation” was attained by first decoupling the organ procurement efforts from the transplant program and implementing an active administrative and educational plan to point out problems on the steps leading to organ donation and transplantation in hospitals (Abadie & Gay, 2006). Subsequent to this determination, civic education campaigns and training for health administration and staff were carried out. As a result of increased awareness among the people on the importance of organ donation, there is slight increase in the number of donors to support organ transplant (Cherry, 2013). Therefore, it is important to raise awareness about the benefits of donating organs to save lives and combat the organ black market. Additionally, there is need to educate people and increase their understanding about organ donation.
Black Market Effect on Organ Donation
Black markets have increasingly developed in several third world countries (mostly in Asia and Africa) where the majority are desperate to get money through any means. Trafficking in organ trade is an organized criminal activity, which involves several offenders. Those involved in these criminal actions includes; organ brokers, vulnerable and poor persons, clinical staffs, transporters and medical professional. In the black market, there are syndicates that broker transplants and acts as link between donors and recipients (Goodwin, 2006). According to World Health Organization, illegal trade of human organ has risen to such a level that an estimated 10,000 black market transactions involving purchased human organs take place per year. In addition, as the gap between organ supply and demand widens, proliferation of prospective markets for trafficking human organs continues to increase (Conesa et al, 2003). The main ethical dilemmas associated with organ transplant emanates from the shortage of the organs. Actually, not everyone who requires an organ transplant gets it. The high demand for organs is quite incomparable to the low supply of the organs for transplant.
In United State alone, more than 100,000 people are waiting transplant according to United Network for Organs (UNOS) that maintains a comprehensive website (www.unos.org) with updated status of the people in need of organ transplants (Kauffman et al, 2007). With approximately 100,000 people waiting for organ transplant the same year, and 60,000 expecting kidney transplant, the average wait could extend to five years if the normal transplant procedures were to be followed (Abadie & Gay, 2006). The number of patients dying in United States while awaiting organ transplant is approximately 6000 in a year. As a result of organ deficiency in one country, patients in need of organ transplant consider other means of getting organs through black markets.
Black market paralyses the efforts expressed toward organ donation through creating illegal alternatives where people can get human organs (Cherry, 2013).The standard of uncompensated donation of organs from living persons is also being eroded by the opportunity to obtain organs from the black market. Since a close genetic match is no longer a vital consideration in transplantation, Americans (and others) are acquiring kidneys from foreign countries such as China, Philippines, Guatemala, and Peru (Goodwin, 2006).In most case, the brokers strategically prevent the donors from meeting their organ recipients in order to exploit them financially. These brokers work in secrecy in underground markets where they pocket huge sums of money for organizing overseas transplants. In what seem to be exploitation of the organ recipients and sellers, the average amount paid to kidney buyers (broker) is about $150, 000, while the average amount paid to the sellers is about $5,000, and worst still, in some regions such as India, Egypt, Romania, and Vietnam, the kidney sellers receive as low as $1000 -$2000 (Cherry, 2013). Several analysis on major trafficking cases since the end of 1990s indicates that Israel has played a major role in organ black marketing (Goodwin, 2006). However, some countries such as Iran have a largely regulated system that ensures appropriate trade of the organs (Jahromi, Fry-Revere, & Bastani, 2015).
It is not possible to curb the proliferation of black market when organ donation centers are not adequately serving those in need of organ transplant. Encouraging organ donation can significantly reduce black market transactions (Goodwin, 2006). The fact that anyone with average health can donate an organ is an indication that, with the participation of nearly everyone, the number of donors can surpass the number of recipients.
A significant approach to stop black markets of organ trafficking was fashioned through creation of National Organ Transplant Act. The main purpose of the National Organ Transplant Act was to outlaw the assignment of a monetary worth to an organ for transplantation, thus preventing commercialization and ensuring some level of fairness in access to organs (Liu et al, 2015). However the guidelines provided by the Act are not abiding and their endorsements have been widely overlooked. Since its creation in 1984, the first person was convicted of organ trafficking in 2011.
Though there has been enormous criticism on human organ trafficking, some scholars believe that the best way to handle organ shortage is through commercializing the entire process (Goodwin, 2006). By offering payments on the organs, majority of the people would offer to donate their organs in a more transparent approach. These scholars consider organ trade an extension of the basic principle of autonomy. As majority of the scholars argue, open payment approach, based on federal legislation would significantly reduce the exploitation of organ seller and recipients by illegal brokers (Goodwin, 2006). However, organ donation is the main approach that can be used to tackle organ trafficking.
The significance of organ donation in sustaining human life is clearly elaborated. Unlike animals, human life is vital gift that should be preserved at whatever cost. Considering the fact that organ transplantation has become successful medical procedure through the modern technology, there is need to support the procedure in order to save more lives. The fact that it has been proved beyond reasonable doubt that human beings can survive without one of their dual organs, the aspect of sharing through organ donation should be encouraged to support and sustain life.
Therefore, this research significantly contributes towards establishing the reasons why people should be encouraged to donate their organs in support for organ transplant. There is need to raise awareness about the benefits of donating organs to save lives and combat the organ black market. Additionally, we should educate people in order to increase their understanding about organ donation.
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