UNIT 2: ORGAN TRANSPLANTATION

Unit 2: Organ Transplantation includes six cases/situations?some centering around the transplantation of organs, some involving cells, and one addressing transplantation of appendages.

Transplantation is not a new procedure. Corneas were transplanted in 1905, although the procedure did not become routine until the 1940s. Skin was transplanted first in the 1920s. In the 1950s, a kidney was transplanted from one twin to another. In the 1960s, the first livers and hearts were transplanted. Since then, lungs, hands, testicles, ovaries, and other body components have been moved from one person to another.

The field of transplantation got a major boost in 1973 when researchers at a drug company in Switzerland extracted the first immunosuppressive drug?cyclosporin?from the fungus Tolypocladium inflatum, which they had collected from soil on a hillside in Norway. In 1984, Japanese researchers extracted an even better drug, FK506, from another soil organism, Streptomyces tsukubaensis. With both cyclosporin and FK506, five-year gaps separated the discoveries of the drugs from their first uses in patients. These drugs revolutionized the field of transplantation; they greatly reduced the likelihood that transplanted organs would be rejected by the recipients and also made it possible to transplant organs from donors to recipients whose tissue types were not perfectly matched.

The ethical issues associated with transplantation are many. Is the human body a commodity? How should decisions be made about who should receive scarce organs? Who should pay for transplants? Should one person receive several organs or should several people each receive one? Should one person have a second transplant when the first one fails or should a different person be given a first chance at a new organ? Should organs be given to people who have abused their bodies (smoking and drinking, etc.) or only to people whose organs are damaged by disease? Should hands or other appendages, which are not essential to life, be transplanted? Who can "donate" the organs of people who cannot give informed consent to the process? Should money now spent on transplantation be put to other uses? Is it possible to prevent the coercion of some donors? When should courts be involved in these questions? Should state and federal lawmakers be involved in transplantation? The questions go on and on; the answers are never simple.

The questions raised by the cases discussed here and in other transplant stories have medical, ethical, international, social, legal, cultural and technological overtones. The supply of organs is well below the demand. In a society where resources are not limitless, questions of how these resources should be allocated are fundamental.

Language use in the field of transplantation is somewhat unusual: organs are harvested and then transplanted, organs are donated, donors give a gift (often the gift of life), the recipient receives a gift, and so on. The gardening and gift-giving imagery add a strong nonmedical mystique to the whole transaction.

Although few teens want to think about their own mortality, every teen who applies for a driver?s license in the United States now is actually asked to do just that when completing the license application. Although the purpose of this unit is not specifically to help teens answer that one question?will you be an organ donor?? classroom discussions generated by this unit should help students think seriously about this issue and other issues related to it and help them arrive at their own informed decisions.

Recurring Themes

In addition to the recurring themes listed for every bioethics unit, three other themes recur in discussions of organ transplantation:

Directed donation
Coercion
Criteria for candidacy as donors and as recipients