Legalization of Organ Trade (discussion)(revised)

imagesuntitled

For patients with serious accidental injuries or end-stage diseases of an organ, the only way for them to survive is to perform organ transplantation. However, the demand for organ transplant is far more than supplies. Look at the graph of organ transplant in past decade, the waiting list for organ transplant keeps growing and it grows way faster than the grow of number of donated organs, which is represented by the “donor” line and “transplants” line in the graph shown above. Facing this situation, more and more people are calling for an organ market—a platform where patients and donors meet each other and the donation of organ is paid with money. In my last blog I introduce you the issue of legalization of organ market, and in this blog I will further explore some pro and cons arguments from different aspects.
Ethnic: discourage altruism?

Firstly, there are always a lot of ongoing debates on ethnic of organ market. The main concern is loss altruism. Some people are afraid that financial payback will discourage organ donation motivated by altruism. In his paper Abouna (1991) has shown that there is “considerable evidence to indicate that marketing in human organs will eventually deprecate and destroy the present willingness of members of the public to donate their organs out of altruism.” (167). Satz (2010) agrees with him and states that financial payment will reduce people’s moral obligation to do the same action. He worries that if there are more organ sellers entering the organ market, the spirit of altruism would disappear, which may result that fewer and fewer people sign up to be even a deceased donor. If everyone is getting paid, then why bother do it for free? That will look stupid and unnecessary. David Rothman support this idea from a different angle, and he points out if a market is established; the supply will be diminished because of access to available “goods” in the market.

            However, giving the circumstance that altruistic living donations are not many, even organ sale discourage altruism, it attracts more organ sellers, which provide more solid organs for organ transplant. Furthermore, Erin and Harris (2003) believe that the current ethical problem of organ donation is that “everyone is paid but the donor”. “The surgeons and medical team are paid, the transplant coordinator does not go unremunerated, and the recipient receives an important benefit in kind. Only the unfortunate and heroic donor is supposed to put up with the insult of no reward, to add to the injury of the operation.” Donors have not been greatly appreciated and well treated. In a one-year follow-up of live kidney donors, the data indicates that some donors do not have adequate follow-up or insurance coverage for donors, which is also the reason why the number of living donors does not grow much these years.
Messy “post-operation period”

Some people are worried about the follow-up care of donors after transplantation. Who is going to cover medical bills of follow-up for the donor? Apparently the insurance company won’t because the trades are neither accident nor involves involuntary actions, and the recipient will certain take care of medical bill for a post-operation period, however, the problem is how long the this period is. Anyone losing an organ will have significantly increased risk of various types of disease. Every part of our body exists for a reason; it is a result of revolution of millions of years. Although modern medicines can take care of some of the problems caused by removal of an organ, the indirect harm and potential diseases cannot be estimated and predicted. Moreover, when that happens, it is hard to determine whether it is caused by organ donation or patient’s own health condition. If we are considering this risk, the whole organ market system would have more troubles than it appears to.
Profit: how much can we get?

In term of profit, healthcare industries will take a portion not only because they provide the platform but also as a compensation of loss of profits from organ transplantation and materials for medical research. When hospitals and clinics receive donated materials from deceased, they reserve the right of determining how to utilize it; of course the priority will be find matching patients, but they surely can use that material to manufacture medicines or performing any medical research if they are aware that the donation will not be transplanted.

            If the government ever legalized organ market, strong regulation and monitoring by government is urged because only government can provide credibility and a guarantee for organ trade.The reason that guarantee of government is desired is because unlike an ordinary market, the real buyers and sellers get connected through the system, and the whole market only serves as a platform for communication. Therefore there has to be some sort of credibility to stabilize the platform. Besides, the length of post-operation period can be carefully determined by healthcare industries based on their past follow-up research data. For organ sellers, they need to sign a consent which declares he/she is aware of the risk of the procedure and responsible for all illness and diseases once pass that post-operation period for the rest of their life.In addition, before the consent, every donor will receive a complete lecture on harm and risk as well as possible changes of their medical insurance plan after organ removal. The procedure of organ removal is irreversible, and therefore to avoid any unnecessary lawsuit, hospitals need to make sure that no donors will regret their actions.

So far I introduced you the topic of legalization of organ market and explored possible solutions for arguments against this proposal. Look at data and facts from organdonor.gov, I don’t think the future of US organ donations system is optimistic. A new system regulating organ donations and transplant is expected for management of organ transplantation.

Reference
Abouna, G., 1991, “The Negative Impact of Paid Organ Donation.” Organ Replacement Therapy: ethics, justice, commerce, Berlin: Springer-Verlag, 1991. Web. 8 July 2013.
Erin, C.A. and Harris, J. “An Ethical Market in Human Organs.” Journal of Medical Ethics 29:137-138 (2003): Web. 8 July 2013.
Knox, Richard. “Should We Legalize the Market for Human Organs?” 21 May 2008. Web. 8 July 2013.
R.D. Bloom, et al. “Medical Follow-Up Of Living Kidney Donors By 1 Year After Nephrectomy.” Transplantation Proceedings 41.9 (2009): 3545-3550. Academic Search Complete. Web. 8 July 2013.

“The Sale of Human Organ.” Stanford Encyclopedia of Philosophy. 17 October 2011. Web. 8 July 2013.
U.S. Government Information on Organ and Tissue Donation and Transplantation. Web. . 8 July 2013.

Advertisements

Legalization of Organ Trade (Introduction)

illegal-organ-trade-meat-small-39944untitled

               Imagine you lived in East Coat, someone in your family just had a car accident and their kidneys had been severely damaged, therefore they must have kidneys transplanted into their body to survive. Facing the fact that there are more than 90,000 people in front of you on the national kidney transplant waiting list, you have no other options rather than looking for other sources for that life-saving kidney.

               Then you heard from your friend from their friends that there is a guy named Levy Izhak Rosenbaum and he had been selling kidney underground for a long time. Caring nothing but your family’s life, you reach out to him and paid up to $150,000 for that kidney. Finally your family’s life is saved. From your point of view, even you paid a lot of money to him, Levy I. Izhak still created a miracle that saved your family and he surely is better than those dam useless hospitals. However, around a year ago, Levy Izhak Rosenbaum was arrested for kidney trafficking in New York. He was sentenced with 30 months, thought he might end up deported back to Israel.

               The issue of organ trafficking has always been so controversial and it is never settled. Therefore someone proposes a more compromising approach—legalizing organ trade, which is the issue I am going to explore and take a stand in my next two blogs. In this particular discussion the term “organ trade” or “organ market” refers to a platform where recipients and donors of a particular organ are connected and circumstances when donors can proceed after removal of an organ, typically referring to kidney donation. However, even this proposal remains controversial due to different voices representing different aspects of this matter.

               In contrast to what people think, an organ market is not an ordinary and free market. Instead the concept of organ market involves a third-party buyer and buyer system. The market merely provides a network and platform for buyers and sellers, while it has to be strongly regulated. Most support that basic regulation and structure of the market:  valid consent from organ sellers, reasonable prices determined by market, and proper post-operative care.

               People who are in favor of legalization of organ market believe that if organ sale is performed properly, it is not quite dangerous. With adequate post-operative care for donor and less-horrifying-and profit-making price, more lives could be saved through the market. According to Amy Friedman, the director of transplantation at SUNY Upstate Medical University, she believes that “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.” More liberally speaking, people have the right to sell their organs; with the payment they can start a business or have improvement of their life quality. Besides, banning organ sale may result more black market and organ trafficking, which makes government harder to moderate and regulate.

            On the other hand, some people think that organ sale only discourage donation of organs. David Rothman, professor of social medicine at Columbia University and director of the Center on Medicine as a Profession, has worried that creating a market can depress the supply because no one is willing to donate once they know they are available sources, resulting fewer and fewer people supplying the market.

            In 2008, there was a huge debate on legalization of organ market in Asia Society and Museum in New York City. The debate ended up with more support of legalization among audience. After the debate, 60 percent of the audience favored in buying and selling organs instead of 44 percent, and people who are uncertain have declined from 29 percent to 9 percent. Despite of oppositions from healthcare industries and some professionals, public’s attitude is gradually becoming more supportive on this controversy.

            If it is possible, are there any successful examples of this? Iran is the only country which legalizes kidney trade in the world, and up till today they do not have a waiting list for kidney transplant. Spain has a similar consent system which allows decease to donate their organs unless they declare that they are unwilling to donate their organs before. The Health Minister of Singapore, Khaw Boon Wan has expressed interests in legalizing payment of kidney donors.

            In this blog I have presented you the issue of legalization of organ market and different views on it; in my next blog I will further investigate the issue and express my personal opinion on this issue.

Reference
http://optn.transplant.hrsa.gov/latestData/rptData.asp
http://crookedtimber.org/2012/07/12/a-u-s-organ-trafficking-conviction/
http://plato.stanford.edu/entries/organs-sale/#HarRis
http://www.npr.org/2008/05/21/90632108/should-we-legalize-the-market-for-human-organs
http://www.cato.org/publications/commentary/right-sell-organs
http://www.time.com/time/world/article/0,8599,1833858,00.html

Follow-up of Organ Donors (Revised)

imagesCA4N77GYOrgan-Donors2

According to unos.org, there are more than 6,000 living donations every year. Among cases of living organ donations, most of the donations are for their family or close friends, which is known as directed donation. Another situation is called non-directed or altruistic donation, when the donor does not name the specific person to get the transplant. Most of the living organ donor falls into the first category, which is from direct donation.
Organ donors are constantly ignored. News on organ transplant is usually about some famous organ transplant surgeons, desperate candidates on the waiting list or recovery of organ recipients; Insurance companies do cover for follow-up medical examinations of organ donors, however they stop paying for the follow-ups after a period of time.

This is the risk we have to take

Being a living donor is not easy. First of all, a complete screening is required before living organ transplantation. The donor needs to go through a series of test to make sure that their body is strong enough to survive with rest of the organs and that particular organ is healthy and can be transplanted. This is not only for matching purposes, this is also to test if the remaining part of that organ (if possible) can bear heavy work and any progressive disease may present. Second, because this is an invasive procedure, even a small mistake made during the operation can become a terrible infection, not to mention the long-time risks which make donors more susceptible to certain diseases. There will surely be impact on their lives after removal of that organ, even though the level of impact depends on what kind of organ is removed. More seriously there are reports of death of donor after the donation. Chad Arnold, who donated 60 percent of his liver to his brother, died four days after the surgery.Despite the fact that liver can typically grow to its normal size in two months. According to organdonor.gov, because living organ transplantation is relatively new procedure, there aren’t many studies done on this procedure. Even the Federal government does not encourage anyone to be a living donor, because some latent problem cannot develop until decades after.

There will definitely be some impact on donor’s life after donation. What we can do is to minimize it to a level which the donor can cope with. Studies have indicated that donors have good life performance over long term in general.

Why some donors didn’t do well?

The reason why some donors cannot tolerate the procedure well is that some of them did not receive adequate follow-up and medical care. In US, most recipients’ insurance companies only cover follow-up only during defined “early post-operation period”, which is until the donor has mostly recovered from the surgery. Unfortunately, usually they will not pay for any follow-up examinations after that, and therefore many donors are forced to quit follow-up medical care.

More and more transplant professionals have argued that insurance companies should extend the coverage of post-procedure period. This will encourage living donors to do regular medical follow-ups for the rest of their lives to ensure that they have good health conditions. On the other hand, Health Resource and Services Administration (HRSA) has signed an agreement with the University of Michigan, which provides financial supports to living organ donors. This can also reduce the financial impact on donors.

Can we be optimistic?

Winston Churchill once said, “We make a living by what we get. We make a life by what we give.” Giving always build special connections between the giver and the receiver. Living organ donations have reduced all kinds of inconvenience of the normal procedure of organ transplantation, such as waiting time, location restriction, and it greatly increases the chance of matching for family members. Organ donation can be a life-saving gift to a transplant candidate, which is a truly representation of altruism.
There are some physiological beneficial effects on the donor. For instance, according to a study done by NIH, after a nephrectomy (removal of a kidney), the risk of developing hypertension (high blood pressure) and proteinuria (protein present in urine, which is abnormal) can be greatly reduced.

In this blog I talked about the problem of follow-up in living organ donors by examining from differetn aspects. It needs huge courage and determination to become a living organ donor, and they deserve to be treated better.

Work Cited:
http://www.scientificamerican.com/article.cfm?id=what-is-the-function-of-t
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824505/
http://www.unos.org/docs/Living_Donation.pdf
http://www.cnn.com/2010/HEALTH/08/19/live.organ.donation/index.html
http://organdonor.gov/about/livedonation.html

Organ Market: Does it Exist? Or Should it?

Image

According to government site of organ donation, there are 105,000 people currently on the national waiting list for organ transplantation; on average, there are 4,100 new transplant candidates added the waiting list every month. Although the number organ transplantation rises every year, the need of the procedure rises way faster.  These statistics starts to make more and more people start to think about an alternative way to obtain an organ. Without violating the law, they search for sources of organ somewhere else than hospital, which bring an urgent consideration for organ market. 

Image

Statistics of Organ Transplantation and Candidates

If the number of does not increase as fast as the population growth, this indicates that fewer and fewer people are willing to donate their organs. Why is that?

The losing confidence on medical care facilities can be the main reason. According to World Health Organization (WHO), “The welfare of the live kidney donor is largely neglected in schemes where disadvantaged individuals are exploited and encouraged to sell their kidneys.” Sigrid Fry-Revere agrees on this and she argues that organ and tissue banks are making benefits from all kinds of use of donated organ, such as organ transplantation and manufacturing of medicines, while the donors don’t receive any money from this.

Organ trade is banned worldwide except for Iran. However, only organ trade of kidney is legalized because unlike other critical internal organs, human can function most normally without one kidney. The regulation of kidney trade is under supervision of Association support of kidney patients (CASKP) and the Charity Foundation for Special Diseases (CFSD) supported by Iranian government. They match donors and recipients through tests. Currently there is no waiting list for kidney transplantation. 

On the other hand, Spain has developed a presumed consent system, which means that if the deceased is presumed to consent unless he/she specified. In addition their transplant coordination system is a great success. As a result, there are 34 deceased donors per million people, which is one of the highest percentages of deceased donors in population.

In a nutshell, there has been some huge achievement regarding booting the number of organ donors and expand the source of available organs for transplantation. US, what would you do?

 

 

 

 

Work Cited:

http://organdonor.gov/images/gapgraph.jpg

http://www.who.int/transplantation/organ/en/

http://en.wikipedia.org/wiki/Organ_trade#Iran

http://www.cnn.com/2009/HEALTH/06/17/organ.donation/

http://www.cato.org/publications/commentary/right-sell-organs

Donor Organ Transplantation

image

            In my last blog I talked about artificial organs, and in this blog I’m going to talk about donor organ transplantation. Donor organ transplantation is transfer of an organ from the donor site to another site.

I. Who are the donors?

Depending specific kinds of organ transplantation, the donor can be recipient him/herself, related family, non-related strangers or deceased people. Living people can donate one kidney or part of their lung, liver, intestine or pancreas without their primary daily functions affected. Some states (e.g. California) have voluntary donor mark their driver license. There are no age requirement of donors, but people with following conditions cannot donate any organs (womenshealth.gov):

  • HIV or AIDs
  • actively spreading brain cancer
  • certain current severe infections

II. What organ can be transplanted?

Organs that can be transplanted are:

  • · External organs: skin
  • · Internal organs: heart, kidney, liver, lungs, intestines and so on.

* note that tissue transplantation is different from organ transplantation. An organ can have several different kinds of tissue. the most common tissue transplantation are cornea and musculoskeletal grafts.

III. Who are the recipient?

            Anyone can be a recipient, as long as they pass the matching process. The common determinator are:

  • · Blood type: our body is very concerned about any foreign bodies, therefore it marks everything that come from our body and anything it cannot identify will immediately trigger immune system to eliminate that foreign body. In our blood there is a substance called active antibody, and they are ready to attack any foreign bodies at any time once they are signaled. If two different types of blood are mixed, active antibodies can cause serious problems, and therefore hospitals have to make sure donor’s and recipient’s blood type match to move on to other tests.
  • · Body size: not only we look different physically, our organs also have different sizes. A ten-year-old girl definitely cannot tolerate a thirty-year-old male’s kidney.
  • · Donor organ’s waiting time: depending on organs, an organ can live from 4 hours up to 36 hours outside human body, thus Patients might need to be transferred to the closest hospital before the organ is transferred.
  • · Severity of patient’s medical condition: organ transplantation is not recommended because the transplantation involves a big surgery procedure, and lifelong follow-up with huge amount of immunosuppressive drugs. usually elderly and infants are not recommended for transplantation unless under critical conditions. However, still there are argument regarding priority of organ recipients. For example, in “Who Should Receive Organ Transplants?”, Paul Span argues that some elderly also have great compatibility and remain relatively long lifespan.

    IV. What is the status of organ transplantation of United States?

                Every year, the number of available donors overgrows the number of people who need a transplantation. There are more than 105,000 people on the waiting list for solid transplants, and about 77 people receive organ transplants every day (womenshealth.gov). According to Span, there are 16,022 kidney transplants, 5,805 liver transplants and 1,949 heart transplant, and 1,830 patients received lung transplants.

     

                In my next blog, I will explore the fairness of organ transplantation and who and how they decide whether which patient receives priority on the list of organ recipients.

     

    Work Cited:

    http://www.womenshealth.gov/publications/our-publications/fact-sheet/organ-donation.cfm#a

    http://newoldage.blogs.nytimes.com/2013/01/08/who-should-receive-organ-transplants/?_r=1

    http://organdonor.gov/about/organmatching.html

    http://www.transplantliving.org/living-donation/being-a-living-donor/tests/

Artificial Organs: What are They? (Revised)

image

Speaking of artificial organs, most people will think of an artificial limb. In fact, it is more than that. An artificial organ is any man-made device implanted into human to replace dysfunctional or missing natural organ and restore normal function or to significantly improve patient’s ability of self-care (Wikipedia.org). Our body organ is extremely complicated, and therefore it is quite a challenge for scientists to replicate them in a functional way. During past 60 years, there have been some great breakthroughs on field of artificial organs. In this blog I will introduce some important factors that scientists take into consideration in their studies.

  • Engineering
  • In 2011, scientist at Wyss Institute at Harvard has created one of the most complicated and successful artificial organs so far— a chip that can perform multiple functions of a lung (Baker, 2011). They started with capillary cells, and then introduced other types of cells and proteins on it. The main mechanisms of lung are perfectly replicated: exchange of gas and filtration of toxins. The purpose of this experiment is not for organhttps://ruotingw.wordpress.com/wp-admin/post.php?post=4&action=edit&message=1#zemanta-disabled-more transplantation, but the successful replication marked as an achievement on artificial organs.

  • Materials and Compatibility
  • Not only the engineering of that artificial organ need to be carefully designed, but the material needs to be taken into great consideration to work with the body. Organ transplantation is not an easy task. With the defense of our immune system, our body has a strong rejection or any foreign bodies implanted in it. This is why when we get even a small earing piercing, the pierced part usually becomes swollen, red and painful. Even a small object like earrings can cause discomfort like this, imagine what the reaction would be like if a foreign body with the same size of an organ is put inside. More importantly, no organ can function by itself; they have to cooperate with other part of the bodies as well. Hence connection and communication between the artificial organ and other natural organs is required. In addition, the material must have similar properties and features of the tissue and cell. For example, Moura et al. (2011) have suggested Polyaniline nanotubes (PANINTs) can be a good choice for cardiac tissues because of its electroactive properties.

  • Ethnic
  • The experimentation requires live tissue and organs to be studied, and most of the tissue supplies come from animals, which raises an ethical issue. Animal right advocates argue that this is unethical animal abuse. Although Baker (2011) believes that advances and studies in culturing cells and tissues can soon solve this problem, the source of organ supply for studies is controversial and ethical issues are indeed a barrier for development of artificial organs.

  • Examples?
    Because artificial organs does not work as well as real organs, they are transplanted into patient only for the time of waiting to get real organ transplanted. There has been a couple of successful transplantation of artificial organs, but unfortunately, they do not last very long. The first successful artificial organ transplantation was in 1982, when a patient has an artificial heart, and the organ lasted no more than 2 years.

    So in this blog I introduce you to artificial organs and some of its key factors. My next blog post will mainly focus on artificial internal organs.

     

     

     

    Reference

    Artificial Organ. Wikipedia, the free encyclopedia. Web.

    Baker, Monya. “Tissue Models: A Living System On A Chip.” Nature 471.7340 (2011): 661-665. MEDLINE. Web. 17 June 2013

    RM, Moura & AA, de Queiroz. ” Dendronized Polyaniline Nanotubes for Cardiac Tissue Engineering.”Artif Organs. May 2011: 471-7. Web.

    http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf