Ethics Of Transplantation Research Articles

The ethics of uterus transplantation

Why should wombs be viewed any differently to kidneys and lungs? George F Winter examines some of the quandaries surrounding the emotive topic of Utx.

The ethics of facial transplantation

George F Winter looks at the potential ethical pitfalls should facial transplants become a common feature of our beauty-fixated society.

Transplantation Ethics and Policy

Addressing all of the ethical and policy challenges in the field of organ transplantation is a daunting task for a short review. Rather than focusing on each issue, this review starts with a discussion of the underlying ethical principles that drive transplantation ethics and proceeds to address a few of the important ethical challenges in transplantation, recognizing that it is not a comprehensive overview of every issue. Just as policy should follow the underlying ethical principles, the second part of the review addresses policy development and implementation in the United States and selected challenges worldwide. Of note, this review covers underlying ethical principles, the dead donor rule, the allocation of scarce resources, organ allocation, deceased organ donors, living organ donors, speculation for the future, and transplantation policies. This review contains 15 references.

False Hope: When Waiting Your Turn Isn’t Fair

False Hope: When Waiting Your Turn Isn’t Fair

Realizing HOPE: The Ethics of Organ Transplantation From HIV-Positive Donors.

The HIV Organ Policy Equity (HOPE) Act now allows transplantation of organs from HIV-positive living and deceased donors to HIV-positive individuals with end-stage organ disease in the United States. Although clinical experience with such transplants is limited to a small number of deceased-donor kidney transplants from HIV-positive to HIV-positive persons in South Africa, unprecedented HIV-positive-to-HIV-positive liver transplantations and living-donor kidney transplantations are also now on the horizon. Initially, all HIV-positive-to-HIV-positive transplantations will occur under research protocols with safeguards and criteria mandated by the National Institutes of Health. Nevertheless, this historic change brings ethical opportunities and challenges. For HIV-positive individuals needing an organ transplant, issues of access, risk, and consent must be considered. For potential HIV-positive donors, there are additional ethical challenges of privacy, fairness, and the right to donate. Careful consideration of the ethical issues involved is critical to the safe and appropriate evaluation of this novel approach to transplantation.

Promoting Living Kidney Transplantation

Kidney transplantation is the best approach for treating patients with end stage renal disease, offering patients the best chance of returning to normal health. While the techniques used in kidney transplantation surgery are mature and highly successful, there is a severe shortage of donor organs. Statistics show a serious imbalance between organ donations and patients on the waiting list for organ transplantation. Moreover, evidence from empirical studies has shown a better transplantation outcome for patients who receive living donor transplantation than for those who receive organs from cadavers. Although using relatives as donors offers an effective way to reduce the problem of organ shortage, this strategy faces many challenges and many other factors affect the promotion of living donor transplantation. This article elaborates how cultural and psychological factors, kidney transplantation awareness, and ethics and laws impact upon living kidney donations and then proposes coping strategies for promoting living kidney transplantation.

Transplant Ethics and the International Crime of Organ Trafficking

Transplantation procedures have become increasingly sophisticated and nowadays offer unforeseen opportunities of survival to hundreds of thousands of patients. However, due to the global organ shortage, unethical practices like organ trafficking and transplant tourism have progressively emerged and spread worldwide, rapidly becoming a highly profitable business for transnational organised criminal groups. These practices represent a serious threat to public health and human security, egregious violations of fundamental human rights and a bold infringement of universal principles of medical ethics, and they thus call for a robust response from the international community at large. Being a complex and multifaceted phenomenon of global proportions, the major challenge in combating organ trafficking is to criminalise “all” unethical conducts as transplant-related crimes at both the domestic and international level. This article aims to offer a critical overview of the international legal instruments applicable in the field and to discuss the pivotal role that international criminal law can play in support of prescriptive bioethics in the global fight against organ trafficking.

Veatch and Ross's "Transplantation Ethics" (Book Review)

Veatch and Ross's "Transplantation Ethics" (Book Review)

Operation Frankenstein: Ethical Reflections of Human Head Transplantation

Practically every human organ is commonly transplanted providing temporary or permanent relief from a pathologic condition. Although organ transplantation can prolong life, the question arises as to whether it is ethical for any organ of the human body to be transplanted, particularly that of the human head. Plans have recently been announced to perform the first human head transplantation within the next few years; however, the ethics of human head transplantation have not been formally addressed. Here, we present several ethical concerns of a human head transplantation procedure, focusing on bioethical considerations, psychological consequences, and reproductive implications.

Reproductive implications of human head transplantation.

Sir, I read with enthusiasm the manuscript by neurosurgeons Ren and Canavero on his progress toward the first human head transplantation procedure.[1] Certainly, history has demonstrated that many “quantum leaps” in medicine challenged the accepted norms at the time. However, I would suggest that no prior “quantum leap” in medicine (e.g., “antiseptic handwashing, balloon angioplasty”) compares to the ethical concerns that are coupled with human head transplantation.[1] Head transplantation may 1 day serve as a last resort treatment option when traditional medicine fails; however, I contend that this procedure also opens the door for numerous quandaries pertaining to reproductive ethics. It would be beneficial for the neurosurgical community to discuss human head transplantation in the context of reproductive ethics such that certain inquiries about the procedure may be realized, discussed, and deciphered prior to making the first incision. The surgical procedure of resecting a living head and relocating it onto a cadaveric donor body will provide the recipient with the donor's body including their reproductive organs. To be clear, I will consider the head as the definition of human identification or personhood. Therefore, I will define the “recipient” as the individual whose head is being transplanted and the “donor” as the individual who is donating their body. First, recipients can never truly reproduce; rather, the donor body will reproduce the action of the recipient. This begs the question – is it ethical for the recipient to use the donor's reproductive organs to have a child when the donor is technically deceased? Assuredly, it would be challenging for the recipient to inform the “child” that the child's natural mother or father died prior to their conception or that the child's biological parent donated their body to the “recipient.” This may (understandably) cause the child psychological distress. Nevertheless, prior to the first human head transplantation surgery, the neurosurgical community ought to provide the living donor with a comprehensive understanding of the reproductive implications that are coupled with donating one's body including the familial ramifications of “recipient reproduction.” Second, biologic differences (e.g., age, fertility) between the recipient and donor of the same-sex should be addressed. It is unknown whether head transplantation surgery would be successful if there were a substantial age difference between the recipient and donor such as 10, 25, or 50 years? Moreover, consider the ramifications of a fertile individual receiving an infertile body or an infertile individual receiving a fertile body. Sterilizing a fertile donor body, before head transplantation, may help to solve some of these predicaments; however, guidelines should be implemented on age and fertility to appropriately match a recipient to a donor. Third, we ought to consider the reproductive implications of human head transplantation when subject to slippery slope argumentation. Canavero suggests this protocol as a lifesaving procedure; however, such surgery may 1 day be viewed as a life enhancement procedure. Currently, same-sex human head transplantation surgery appears to be quite a challenging task in and of itself. Although years from now, if this surgery becomes common practice, wouldn’t the next innovative thinker suggest the first opposite-sex human head transplantation procedure? Gender reassignment head transplantation surgery may currently sound preposterous but it does beg the question – does the medical community have the authority to deny this procedure to transgender individuals in the future? Transplantation ethics encourage the medical community to do the best with the limited number of donated organs, yet gender reassignment head transplantation surgery, as well as general head transplantation, may be disregarding this utilitarian approach to organ donation. Indeed, these quandaries pertaining to the reproductive implications of human head transplantation are difficult to ponder; nevertheless, discussing these ethical predicaments and creating guidelines for them may benefit the neurosurgical community before we decide to transplant the first human head. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Interaction between Society and Medical Ethics in Saudi Arabia

Discussions on bioethical issues within the Saudi society are a relatively new development. However, they have taken increasing importance over the last two decades. This accompanied the massive advances in medical care, the beginning of medical and biological research, the establishment of pharmaceutical companies and the exposure of society to international norms. By and large the driving forces of the need for bioethical discourses are the practical needs arising from these recent developments in our region rather than that being due to theoretical or academic investigation. In this article, we discuss issues related to the interaction between society and medical ethics in Saudi Arabia with particular reference to organ transplantation ethics.

Robert M. Veatch and Lainie F. Ross: Transplantation ethics, 2nd ed.

On the whole, the long-awaited second edition of Transplantation Ethics does not disappoint. Structurally, the book can be readily employed as a reference compendium for those seeking discrete information supplemented by references for additional reading. It is sufficiently versatile to be comfortably read straight through, or it can be read (or assigned), textbook-style, as specific chapters or sections for a comprehensive overview of core controversies such as the definition of death or principles or organ allocation. The book also includes a useful treatment of more contemporary topics such as uterus transplantation and vascularized composite allografts. The transplant professional without a substantive background in ethical theory or medical ethics will find sections of it conceptually challenging, which should be understood as a positive recommendation: It deserves to be the definitive reference on the shelf of transplant professionals interested in ethics and public policy. Early on, Veatch and Ross outline a non-consequentialist, secular, liberalindividualist, egalitarian ethical framework, which informs discussions of specific ethical problems and challenges throughout the rest of the book. However, philosophers whose considered normative commitments deviate from this bill of particulars won’t find many arguments in this book which will much disturb their dogmatic slumbers. Theology-based concerns, virtue theory, and neo-Hippocratism (a favorite hobby-horse of Veatch’s, though it isn’t clear whether any individual neo-Hippocratics exist) are relegated to the dustbin of irrelevance or parochialism. ‘‘Feminist theory’’ is regrettably reduced to ‘‘care ethics,’’ and is dismissed in a

Philosophy of organ donation: Review of ethical facets.

Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviews several fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.

The Ethics of Organ Transplantation edited by Steven J. Jensen

The Ethics of Organ Transplantation edited by Steven J. Jensen

Bioethics: why philosophy is essential for progress

It is the JME's 40th anniversary and my 20th anniversary working in the field. I reflect on the nature of bioethics and medical ethics. I argue that both bioethics and...

Hand transplants and the mandate for tolerance.

The field of vascularized composite allograft (VCA) to achieve its full potential will require induction of tolerance. This review will introduce a new method of potential inducing tolerance in hand transplantation. Hand transplantation is never a life-extending transplant. This fact resulted in considerable debate both for and against the use of immunosuppression for nonlife-extending transplants. There is considerable debate about the ethics of hand transplantation. There is now consensus that nonlife-extending transplants are acceptable in properly selected patients. However, ideally, hand transplants should not receive life-long immunosuppression. Therefore, attempts to achieve drug-free tolerance through nonlife-endangering therapies are warranted. To this end, we propose implementation of tolerizing therapy long after periinflammation has subsided and drug minimization has proven successful. Evidence that short-term treatment with low doses of IL-2 or a long-lived IL-2 immunoglobulin (Ig) can tilt the balance of immunity from tissue destructive to tolerance come from preclinical demonstrations in mouse and nonhuman primate models of autoimmunity and/or transplantation and even more recent clinical trials. We believe that with the proper use of low-dose IL-2 given at an opportune time in the inflammatory process of transplant that reduce immunosuppression and even tolerance can be induced in hand transplantation. We propose that tolerance can be inducted after a long period of conventional treatment to avoid 'tolerance-hindering' adverse inflammation that occurs in the posttransplant period. With abatement of posttransplant inflammation and with time, we will institute low-dose IL-2-based therapy to support the proliferation, viability and functional phenotype of regulatory T cells.

Ethics of facial transplantation revisited

There have been 26 cases of facial transplantation reported, and three deaths, 11.5%. Mortality raises the issue of risk versus benefit for face transplantation, a procedure intended to improve quality of life, rather than saving life. Thus, one of the most innovative surgical procedures has opened the debate on the ethical, legal, and philosophical aspects of face transplantation. Morbidity in face transplant recipients includes infections and metabolic consequences. No graft loss caused by technical failure, hyperacute, or chronic graft rejection or graft-versus-host disease has been reported. One case of posttransplant lymphoproliferative disorder, 3.45% and one case of lymphoma in an HIV-positive recipient were reported. Psychological issues in candidates can include chronic pain, mood disorders, preexisting psychotic disorders, post-traumatic stress disorder (PTSD), and substance abuse. Early publications on ethical aspects of face transplantation focused mainly on informed consent. Many other ethical issues have been identified, including lack of coercion, donor family consent and confidentiality, respect for the integrity of the donor's body, and financial promotion of the recipient and transplant team, as well as the cost to society for such a highly technical procedure, requiring lifelong immunosuppression.

Ethics of uterine transplantation

British Journal of MidwiferyVol. 22, No. 3 CommentEthics of uterine transplantationGeorge F WinterGeorge F WinterSearch for more papers by this authorGeorge F WinterPublished Online:24 Mar 2014https://doi.org/10.12968/bjom.2014.22.3.160AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Belkin L (2012) Giving Birth With a Borrowed Womb is Not What Makes You a Mother. http://tinyurl.com/o49tg5l (accessed 6 February 2014) Google ScholarCastanos R, Rogers W, Lotz M (2013) The Ethics of Uterus Transplantation. Bioethics 27(2): 65−73 Crossref, Google ScholarOrange R (2014) Hopes for First Womb Transplant Baby. http://tinyurl.com/oa9yzjr (accessed 17 February 2014) Google ScholarWomb Transplant UK (2014) Why the Need for Womb Transplants? http://tinyurl.com/p228w52 (accessed 6 February 2014) Google Scholar FiguresReferencesRelatedDetailsCited byThe future of artificial wombsGeorge F Winter7 July 2017 | British Journal of Midwifery, Vol. 25, No. 7 1 March 2014Volume 22Issue 3ISSN (print): 0969-4900ISSN (online): 2052-4307 Metrics History Published online 24 March 2014 Published in print 1 March 2014 Information© MA Healthcare LimitedPDF download

What Are the Harms of Refusing to Allow Living Kidney Donation? An Expanded View of Risks and Benefits

Recent Organ Procurement and Transplantation Network policies relating to living kidney donation (LKD)warrant renewed attention to the ethics of transplantation from living donors. These policies focus on risks related to potential donor evaluation, informed consent and follow-up. The ethical basis of living donation is a favorable risk/benefit ratio for the donor, but regulations and research have given less attention to the benefits of donation. Relatedly, the transplant field has also failed to consider potential harms from denying patients the opportunity to donate. These harms may be substantial in the setting of directed kidney donation to a spouse/partner, sibling or child.We argue that complete assessment of donor risks and benefits demands consideration of not only the risks and benefits of donation, but also those of refusing a donor. In contrast to the ever-expanding literature on risks of donation, there are no data describing outcomes for individuals who were turned down as kidney donors. We consider factors contributing to this omission in the transplant literature, argue that current regulations may perpetuate a narrow understanding of relevant risks and benefits in LKD, and identify areas for improvement in research and clinical practice.

The Ethics of Transplants: Why Careless Thought Costs Lives, by Janet Radcliffe Richards.

The Ethics of Transplants: Why Careless Thought Costs Lives, by Janet Radcliffe Richards.