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Ethics of Ambiguity: A Buddhist Reflection on the Japanese Organ Transplant Law

Ronald Y. Nakasone

David E. Guinn (ed.)

in Handbook of Bioethics and Religion

This chapter examines the structure and role of ambiguity in the Japanese Organ Transplant Law by looking at the Chinese Huayen Buddhist doctrine of dharmadhatu-pratityasamutpada (fajie yuanqi shuo) ... More

This chapter examines the structure and role of ambiguity in the Japanese Organ Transplant Law by looking at the Chinese Huayen Buddhist doctrine of dharmadhatu-pratityasamutpada (fajie yuanqi shuo) or universal dependent “coarising”, a major interpretation of the Buddha's pratityasamutpada, dependent-coarising or interdependence. Specifically, it will examine the nature of ambiguity through the zhuban yuanming jude men or “the attribute of the complete accommodation of principal and secondary dharmas” that Fazang (643-712) formulated. The interdependent and evolving Buddhist vision of reality causes ambiguity in decision making and action.Less

The Evolution of Organ Transplantation and Procurement Policy

in The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

This chapter this traces the historical paths that led to modern transplantation technology and the organ procurement policy that supports it. It discusses the genesis, advances, and constraints of ... More

This chapter this traces the historical paths that led to modern transplantation technology and the organ procurement policy that supports it. It discusses the genesis, advances, and constraints of organ transplant technology. It describes the important aspects of an organ transplant process. It outlines the types of transplants and sources of organs, and examines the patients' perspective. The chapter also considers the existing procurement system and its philosophical-ideological base: altruistic donation.Less

Consuming Differences: Post-Human Ethics, Global (in)Justice, and the Transplant Trade in Organs

Nancy Scheper-Hughes

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

This chapter presents a global analysis of the phenomenon referred to as “transplant tourism.” It describes how patients with the financial capability procure organ transplants illegally from abroad. ... More

This chapter presents a global analysis of the phenomenon referred to as “transplant tourism.” It describes how patients with the financial capability procure organ transplants illegally from abroad. The globalization of organ and tissue markets highlights how the economic inequities that propelled Jesica and her family to travel to the United States in search of health care also encouraged other poor people of the world into selling their organs.Less

Justice in Organ Allocation

Rosamond Rhodes

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

Focusing on the central ethical issue of Jesica Santillan's case, this chapter discusses the question of whether transplant organs were allocated justly. Specifically, it analyzes how notions of ... More

Focusing on the central ethical issue of Jesica Santillan's case, this chapter discusses the question of whether transplant organs were allocated justly. Specifically, it analyzes how notions of justice should, and should not influence organ matching and that organ allocation should be governed by the principles of “clinical justice”. The chapter also provides insight on the United Network for Organ Sharing (UNOS) policy and the ways in which issues of urgency, efficacy, equity, and the interests of small transplant centers are weighed in organ allocation.Less

Human Organ Transplant Ordinance: Facilitating Adult Live Donor Transplants?

Athena Liu

in Law and Medicine: Current Legal Issues Volume 3

Organ transplant raises difficult legal and ethical issues. Organs may come from a live or dead donor, and a donor may be an adult or a minor. This chapter deals with only live adult (over eighteen) ... More

Organ transplant raises difficult legal and ethical issues. Organs may come from a live or dead donor, and a donor may be an adult or a minor. This chapter deals with only live adult (over eighteen) donors and recipients. Live transplant is mainly governed by the Human Organ Transplant Ordinance (HOTO) which has two main objectives: first, to prevent organ trading, which can take two forms: commercial agencies acting as intermediaries between donors and recipients, and recipients buying organs by paying potential donors as a means of inducing a donation which would not otherwise have taken place. The other objective of the HOTO is to protect the right to self-determination of both donors and recipients. The chapter first examines the scope of the HOTO by reference to the meaning of ‘organ’ and ‘payment prohibited’. Parts II and III examine the legal structure for related and unrelated donations and the extent to which the objectives of the HOTO are achieved. Part IV examines the position of adult comatose recipients. In a recent Hong Kong case, such a patient died as a result of not being able to have a liver transplant. The chapter discusses the position of such a patient under a recent amendment to the HOTO and examines one of its implications.Less

Justice in Transplant Organ Allocation

Rosamond Rhodes and Thomas D. Schiano

in Medicine and Social Justice: Essays on the Distribution of Health Care

This chapter examines the current national system for allocating transplant organs in the United States. Advancing science that has improved the success of organ transplantation also creates an ... More

This chapter examines the current national system for allocating transplant organs in the United States. Advancing science that has improved the success of organ transplantation also creates an increased demand for life-saving organ transplantation. Systems for organ allocation vividly exemplify a wide-ranging problem of justice. In transplantation of vital solid organs such as liver, the scarcity of what is to be distributed is glaringly obvious while the political forces that affect allocation policy are hard to see. The injustices that result are even harder to discern. Despite the pronounced disparity in waiting times for transplantation, and the disparate treatment for different groups of people who need a transplant organ, the United Network for Organ Sharing system espouses its commitment to justice, equity, and efficacy.Less

Neurocognitive Effects of Solid Organ Transplantation

Nataliya Zelikovsky and Debra S. Lefkowitz

in Cognitive and Behavioral Abnormalities of Pediatric Diseases

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for ... More

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills. Less

Social Costs and Benefits of Transplants

in The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

This chapter makes the medical and financial case for large increases in transplant activity. It reviews studies that examine in detail the social costs and benefits of various transplants, and ... More

This chapter makes the medical and financial case for large increases in transplant activity. It reviews studies that examine in detail the social costs and benefits of various transplants, and finds, consistent with overwhelming medical opinion, that transplantation is the best and most cost-effective treatment for a number of serious disorders. In the case of kidney transplants and end-stage renal disease, one can justify paying very large compensation to donors (or their families) based solely on savings to public health funds. Many billions of dollars or euros are lost every year through continued reliance on the current system of organ procurement. In contrast, it is more difficult to rationalize large increases in certain other transplant procedures purely based on direct medical cost effects. It is unlikely, given current technological constraints and life expectancies, that large expansions in heart-lung transplants will “pay for themselves” in this sense.Less

Economic and Political Causes of the Shortage of Organs

in The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses

This chapter examines several primary causes of the organ shortage, beginning with the most basic economic explanation: the prohibition on compensating organ donors. For very many people, human ... More

This chapter examines several primary causes of the organ shortage, beginning with the most basic economic explanation: the prohibition on compensating organ donors. For very many people, human organs are not appropriate articles for “commerce,” and this fact has led many critics to suggest that the results of introducing compensation will not be satisfactory. Whether due to a loss of donations, public revulsion, or expansions in the waiting lists, human organs are viewed by some as very poor candidates for economic transactions. The chapter also considers several other contributing forces that appear to exacerbate the organ shortages in most countries. These include the institutional structures of organ procurement organizations, weak incentives at some intermediate stages in the transplant process, and substitution behavior among donors under uncompensated systems.Less

Mind/Medicine

Sharrona Pearl

in Face/On: Face Transplants and the Ethics of the Other

This chapter explores the history of cosmetic surgery and its intersections with transplants, showing how FAT is both and neither and something else entirely. Through a deep dive into the literature ... More

This chapter explores the history of cosmetic surgery and its intersections with transplants, showing how FAT is both and neither and something else entirely. Through a deep dive into the literature of cosmetic surgery, the chapter maps the discursive terrain on which face transplants have been charted, discussing the rhetoric of facial manipulation in the context of FAT. If the lack of a face is a debilitating medical condition for which a transplant is the cure, what is the difference between that and a more cosmetic intervention—is it a difference of degree or kind? The narrative differentiating the former from the latter, this chapter shows,is one of risk: the risk of the operation and especially of the lifetime on immunosuppressants while living with a new face. But risk is just an excuse that obscures the true source of our objections. After a discussion of the first transplants and their relationship to the birth of bioethics as a field, the chapter explores the first facial reattachment and reactions to it. It moves to fears of identity transfer and cellular memory, tracking the literary and cultural manifestations of these phenomena, thinking about how these concerns impact conceptions of transplant surgeries more broadly.Less

Science, Halakhah, and Public Health Policy: The Definition of Death, Heart Transplants, Organ Donation, and the Allocation of Scarce Medical Resources

Daniel B. Sinclair

in Jewish Biomedical Law: Legal and Extra-Legal Dimensions

This chapter discusses the following topics: the definition of death, heart transplants, organ donations, the gap between the halakhah and modern organ transplant policy, and the rationing of scarce ... More

This chapter discusses the following topics: the definition of death, heart transplants, organ donations, the gap between the halakhah and modern organ transplant policy, and the rationing of scarce medical resources.Less

Human Trafficking and Organ Trade: Does the Law Really Care for the Health of People?

Daniel Sperling

in Law and Global Health: Current Legal Issues Volume 16

This chapter discusses the health risks associated with living donations; the legal responses to and management of organ trade under the trafficking framework; and the problematic association between ... More

This chapter discusses the health risks associated with living donations; the legal responses to and management of organ trade under the trafficking framework; and the problematic association between organ trade and human trafficking. Analysis of case law in various countries reveals that the law, and especially the re-formulation of organ trade under the criminal offence of human trafficking, is insufficient and ineffective and does not pay serious attention to the physical harm that may be associated with itLess

Spare Parts and Desperate Need

Anne Phillips

in Our Bodies, Whose Property?

This chapter moves on to markets in body tissues and parts, focusing on the trade in live kidneys. Given the risks to vendors, and the significant number of patients dying each year while waiting for ... More

This chapter moves on to markets in body tissues and parts, focusing on the trade in live kidneys. Given the risks to vendors, and the significant number of patients dying each year while waiting for a transplant, why not make the transactions more open? Why not allow people to sell nonvital parts of their body while they are still alive? If we allow them to donate, we presumably do not consider the health risks prohibitive. Why not also allow them to sell? It is argued that the kidney trade relies on and undermines our status as equals. The chapter also returns to claims about property as protection, restating and developing reservations about those who favor more body property as a means to resist excessive marketization.Less

Existing Rationing Systems: Organ Transplantation, Scarce Drugs, and Oregon

Philip M. Rosoff

in Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

This chapter initiates the main argument by describing in detail three systems of open, formal rationing in American healthcare: solid organ transplantation, scarce drug allocation, and the Oregon ... More

This chapter initiates the main argument by describing in detail three systems of open, formal rationing in American healthcare: solid organ transplantation, scarce drug allocation, and the Oregon Health Plan (created in the late 1980s to improve and expand medical care for poor residents of the state). While there are clear differences between the three approaches, as well as dissimilar goals and aims, they bear striking similarities in several crucial domains. Remarkably, all three systems have been accepted not only by the people immediately affected (patients), but also by the public in general, indicating that rationing per se may not be as intolerable as suspected.Less

Organ Transplant

K. Kannan

in Medicine and the Law

Prolongation of life and improvement of quality of health assumed immense possibilities with organ transplants from live and deceased donors. When a person can be treated as dead in order for organs ... More

Prolongation of life and improvement of quality of health assumed immense possibilities with organ transplants from live and deceased donors. When a person can be treated as dead in order for organs to be harvested for transplant and when life support can be withdrawn from a critically ill patient requires close monitoring and the Organ Transplantation Act contains empowering provisions to mitigate the dilemma. Issues of consent are vital to proper implementation of the Act and since they are emotive, often arising during the time of critical care of the patient, advance directives and the surrogate decisions of near relatives assume significance. Statutory controls have not quelled either the organ trade or manipulation of authorization committees’ recommendations. Prices for organs to check the scourge of black market trade in organs may seem an attractive proposition but in a country of countless indigent persons, they are bound to result in exploitation of the poor.Less

Sympathy and Exclusion: Access to Health Care for Undocumented Immigrants in the United States

Beatrix Hoffman

in A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship

This chapter analyzes whether the Santillan story fits into the larger politics of immigrant access to health care. It describes how the Santillan case highlighted and obscured central themes in ... More

This chapter analyzes whether the Santillan story fits into the larger politics of immigrant access to health care. It describes how the Santillan case highlighted and obscured central themes in immigration and health care in America with its ongoing tension between the contradictory impulses of sympathy and exclusion. The chapter also discusses access and rights to health care before 1986, the Immigrant Reform and Control Act of 1986 (IRCA) and the 1996 Welfare Reform, immigration and health care in North Carolina, eligibility for organ transplants, and the politics of charity and sympathy.Less

The “Evil” of Healthcare Rationing

Philip M. Rosoff

in Rationing Is Not a Four-Letter Word: Setting Limits on Healthcare

This chapter introduces the concept of the need for organized healthcare rationing after first discussing the dysfunctions of the healthcare system in the United States: its disorder, gross ... More

This chapter introduces the concept of the need for organized healthcare rationing after first discussing the dysfunctions of the healthcare system in the United States: its disorder, gross inefficiency, inequities, failure to offer insurance to vast numbers of Americans, and enormous (and escalating) costs. It introduces the topic of established open and overt rationing systems in the US, such as that for solid organ transplantation, and suggests that they are accepted – even embraced – by most of the public. If rationing is believed to be anathema, why is this so? It begins an argument that there may be features of the transplant (and other rationing schemes) that contribute to their acceptability, despite the fact that people who fail to receive an organ almost inevitably die.Less