Summary
In the United States, a person wishing to become a donor must register in a unique registry of his state (online or by mail). According to Ali et al. (2020), “from a medical perspective, transplantation may be the best treatment for organ failure” (p. 2). It is recommended to inform relatives, who also have the right to decide on donation, about this. In most states, consent to donate can be expressed upon receipt of a driver’s license, after which the document is marked accordingly. Hospitals are required to inform the transplant coordination organizations operating in each state after a patient dies. It is they who check the consent of the deceased, negotiate with the family and search for potential recipients. At the national level, the process is coordinated by the non-governmental United Organ Distribution Network, which is under contract with the government. It maintains a centralized computer database of donors and recipients. Between 2006 and 2012, the organs of American soldiers mortally wounded in Iraq and Afghanistan and taken to a hospital in Germany saved about 140 lives in Europe. Implantation of an organ from a living donor is possible when a healthy person is ready to donate an organ to a patient who needs such an organ to save life or improve its quality.
Today, there are several problems associated with organ donation. According to Smith et al. (2019), “In 2017, close to 136,000 solid organ transplants were performed worldwide, but, according to WHO estimates, this activity is sufficient only to meet 10% of transplant needs” (p. 4). The most common organ for this type of implantation is the kidney. After it in the list is the share of the liver. The lung lobe is relatively rare as a living donor implant. The main problem in matters of implantation and organ sales is that every day in the United States, 17 people die in the queue for donor organ transplants (Health Resources & Services Administration, 2022). In this regard, it is necessary to improve the existing system of organ donation in order to avoid deficiency and deaths in the queues for them.
The incredible cost of unofficially buying an organ, coupled with an exceptionally long waiting list, encourages people to travel abroad to centers that offer fast and cheap services. The lower prices mean that those who cannot afford the American organ market can find a suitable price offer abroad. In the US, the sale of organs is illegal, so those who want to get a transplant without waiting go to other countries such as India, Brazil, Pakistan and China.
Organization of the Organ Donation System
Organ donation, procurement, and distribution require an integrated and carefully coordinated approach. According to Fernandez-Alonso et al. (2020) “The organ donation process requires specialized training to avoid organizational barriers.” In the United States, this entire process is managed by independent local RSOs. The ORO has specially trained staff to assist with screening potential donors, diagnosing brain death, obtaining consent from relatives for organ harvesting, donor treatment, the procurement process, and organ allocation. Further, this organization assists in the procurement and transportation of organs. The regional ORO system currently plays a major role in the allocation of organs for transplantation. This system was created in order to reduce the time of preservation of organs and thereby preserve their quality and achieve the best outcome of transplantation.
Americans who get a driver’s license in the US, are asked when the document is drawn up if they agree to become a posthumous donor. Each donor is registered in the administration of their state, and a corresponding mark is placed on their rights. Once every four years, during the re-registration of driver’s licenses, their owner confirms or revokes their consent. In most states, the procedure provides consent not for donation in general but for the provision of specific organs and tissues. Tissues are, for example, the cornea of the eye, bones, and skin. After all, in addition to the demand for organs, there is a great need for donor tissues, which are widely used in reconstructive surgery in America. When a person becomes a donor, the donor organization calls the state administration to find out whether the person applied to become a donor during their lifetime. This information is coded and available only to donor organizations. If a person gave consent during their lifetime, then there is a corresponding will and the opinion of relatives; if suddenly they are against donating organs, it will not matter. In rare situations, the case went to court, but the relatives did not succeed in winning it.
Donor organs are screened for compatibility with patients on waiting lists, a process coordinated by UNOS. According to the organization, “The matching criteria developed by the transplant community, and approved by the OPTN Board of Directors, are programmed into UNOS’ computer matching system” (United Network for Organ Sharing, 2022). Each list is compiled based on specific criteria that allow each patient to be assigned a specific position on the list. All lists reflect the patient’s waiting time and blood type according to the ABO system. For lung transplantation, these criteria are leading. Kidney transplant waiting lists additionally include the patient’s human leukocyte antigen (HLA) phenotype and priority on these lists is given to recipients with the most appropriate HLA phenotype. For other organs, this criterion does not apply. The waiting lists for heart and liver transplantation additionally include organ-specific criteria, in particular, the severity of the disease, i.e., priority is given to the most seriously ill patients. All lists are patient-specific, so organs are assigned to specific patients on the transplant center’s list.
Ethical Issues in Organ Transplantation
The ethics of clinical transplantology are based on basic international bioethical principles. Scientists claim that “The implementation of brain death standards requires a broad base of people, social ethics and morality, and ideological support” (Zhang & Zang, 2021, p. 185). The most important of them are enshrined in the Convention on Human Rights and Biomedicine. A certain range of ethical issues accompanied transplantation throughout the history of the development of this method of treating diseases, and it was the case of heart transplantation that caused a kind of revolution in the public consciousness. It is the heart that a person attaches special importance to, not only as an organ but also as a place where “the soul lives and feelings are born.” Thus, the transplantation of the heart of one person to another raised questions about how this operation affects the personality of a person and his spiritual and mental life.
Due to that the vast majority of donors are patients diagnosed with brain death, the main ethical problem here is the establishment of such a diagnosis. First of all, this is due to the development of resuscitation, transplantation, and other technologies in medicine. Depending on what state of the human body is recognized at the moment of his death as a person, it becomes possible to stop maintenance therapy, to take measures to remove organs and tissues for their further transplantation. Clinical criteria for brain death should be improved to meet epistemological definitions of death by adding measures of cerebrosomatic disintegration (Sulmasy, 2019). In most countries of the world, the diagnosis of brain death is the basis for a medical conclusion about the moment of death of a person. Brain death is a new image and a new meaning of human death. However, the concept of brain death is not identical to the concept of biological death. Biological death is an irreversible cessation of physiological processes in cells and tissues.
Organ transplantation is considered differently depending on whether the donor is alive or dead. If the situation with the removal of organs and tissues from a dead donor is connected, first of all, with the issue of ascertaining the death of a person, then the issue with living donors is the justification for surgical intervention. Is it moral to prolong the life of the recipient for some time at the cost of deteriorating health, conscious trauma, and shortening the life of a healthy donor? The humane goal of prolonging and saving the life of the recipient loses the status of humanity when the means of achieving it becomes harmful to the life and health of the donor.
Legal Regulation of Organ Donation and Sale in the USA
In the US, there is the United Network for Organ Allocation (UNOS), a non-profit scientific and educational organization that maintains a waiting list. Kanyári et al. (2021) state that “In the past five years, the number of donations from deceased patients varied between 160 and 180 annually” (p. 1402). A number of volunteer organizations cooperate with it. Transplant organizations do not state, but they are not private in the usual sense. Each state has its own UNOS, to which all hospitals located in the region are attached. For example, about 70 hospitals are attached to the New Jersey organization. By law, hospitals that contract with Medicare, the health insurance service, are required to report the availability of a potential donor to their UNOS or face fines.
Selling organs is illegal in almost every country in the world, including the United States. However, despite this, there is a black market for the sale of organs. There is one known problem with a donation “only 1–2% of deaths meet criteria to be considered organ donors” (Ahmad et al., 2019, p. 2). There has been a growth in the number of deaths of organ recipients around the world as a result of poorly performed operations, improper selection of organ donors, and a large number of deadly infections transmitted through donor organs, including HIV and hepatitis C. Lying kidney sellers suffer from post-operative infections, weakness, and depression. Some commit suicide, waste the money received, and their remaining kidney fails.
Suggestions to Improve the Situation
To improve the current situation, the organ transplant sequencing system could be completely changed. It should work on such a principle that organs would be given to the person who needs them most first of all. In this way, high mortality while waiting for transplantation can be avoided. In addition, it is worthwhile to provide for the unobtrusive promotion of organ donation in the event of death so that more people would agree to donate their organs. Thus, it will be possible to significantly increase the number of healthy organs suitable for transplantation.
If we take into account all the nuances of organ transplantation, we can conclude that there are many problems in this area that must be solved. This paper lists several possible solutions that should improve the situation. Organ transplantation is a medical idea that saves many lives, but with a little improvement in the system, it could save even more.
References
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