Our Flesh and Blood

News article

By: Emma Cook

Date: March 25, 2006

Source: Cook, Emma. The Guardian Newspapers Limited. "Our Flesh and Blood." (March 25, 2006).

About the Author: Emma Cook is a journalist and writer who contributes regularly to the Guardian newspapers in the United Kingdom. She has also written for the London Independent. In addition, she is a broadcast journalist for BBC Wales and is well known for her in-depth interview style, both in print and broadcast.

INTRODUCTION

Living donor transplantation surgery first occurred in the United States in 1954, between identical twins. Ronal Herrick's healthy kidney was given to his brother Richard, who suffered from chronic kidney failure. The operation, which took place at the hospital now known as Brigham and Women's (then called Peter Bent Brigham), was a success.

There is a perpetual shortage of available donor organs from cadavers, and it is not uncommon to wait many years for the availability of suitable donor organs. Often, those in need of new organs for survival die without ever having reached the top of their particular waiting list. Living donors may be a viable option for some persons for whom there is a friend or relative who is an appropriate tissue match. Several different organs may be acquired from living donors; the most successfully transplanted to date are lung, liver, intestine, pancreas, heart, and kidney.

Kidney transplants occur with greater frequency than do any other type of living organ donor (LOD) surgeries. The risks are relatively low, as a person can live a (basically) normal life with a single kidney—which will expand and take on the workload of the missing organ. In an LOD liver transplant, a small segment of the liver is removed and transplanted into the recipient. In both individuals, the liver may fully regenerate and regain its original level of functionality. A lobe of one lung can be resected and transplanted to another individual; the lung does not regenerate. A portion of the pancreas can be resected and transplanted with no danger to either individual. Small segments of the intestine can be removed form one person and transplanted into another, although this is an infrequent operation. Among the rarest LOD transplants involves the heart: Very infrequently, a person with pulmonary disease will receive a "bloc" transplant involving heart and lungs from a cadaver donor; their healthy heart can be transplanted into another person.

The National Organ Transplant Act (NOTA), which was legislated in 1984, outlaws the exchange of money for donor organs; it is legal for the recipient to pay for the donor's transportation, lodging, lost wages, and the cost of the transplant procedure.

PRIMARY SOURCE

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SIGNIFICANCE

The most common form of LOD transplantation occurs between people who are genetic relatives, followed by unrelated but requested donors. Requested donation is when the potential recipient, or that person's representative, asks a specific healthy person to donate an organ to him or her. In those cases, it is imperative that the potential donor become thoroughly educated about the process, and be thoroughly apprised of the potential physical and emotional impacts of either decision (to donate an organ or to choose to refuse to do so). Among the major issues for family members can be the sense of guilt, or of feeling pressured to donate an organ to someone else when they may not feel comfortable doing so. For women of childbearing age, there may be realistic concerns about the implications for future pregnancies. For person of either gender, there may be concerns about potential health risks, complications or length of the surgical procedure and the recovery period.

There are myriad emotional concerns to be considered for a requested or related living organ donor: First, there is the question of whether there is a single potential donor, or more than one to choose from. In the former case, there are possible pressures inherent if the recipient cannot survive without the transplanted organ. Both donor and recipient must communicate about the chance that the surgery, or refusal, will impact their future relationship. An added emotional piece is the chance that the donor will be found unsuitable for the surgery, or that unexpected medical or historical information will be discovered as a result of the pre-transplant screening processes. If the donor is accepted and the surgery occurs uneventfully, there is still the ongoing concern of rejection of the transplanted organ, and the emotional strain of donating an organ that causes illness, or even death, for the requesting or related recipient. It is essential that both donor and recipient be as fully informed as possible of all potential exigencies before the transplant proceeds. The donor must also be made aware of future implications for obtaining life, health, disability or long-term care insurance, and the possibility that medical or psychological complications arising from the organ donation (for the donor) might not be covered by personal medical insurance (as the transplant was paid for by the recipient) or might be considered a pre-existing condition that could possibly preclude the individual from obtaining future coverage.

In an effort to minimize the potential psychological, social, and economic ramifications for both donor and recipient, many transplant centers are now requiring thorough psychological assessments as part of the intake and evaluation process. Many people find it quite difficult to make a decision regarding whether or not to donate an organ to a relative or a known recipient while they are alive, but are able to easily opt for designation as an organ donor after death. There are normal and natural grief and loss issues (often, but not always) associated with the possibility of giving away a body part, no matter how strongly the donor feels about offering to improve the health of the recipient. Some people have religious or spiritual concerns about donation of a body part as well. Despite the potential complications on myriad levels, many individuals willingly donate organs to family members or friends, and some choose to donate organs altruistically, when no known recipient is involved, but the need is known to exist.

FURTHER RESOURCES

Books

Edwards, Jeanette, et al. Technologies of Procreation: Kinship in the Age of Assisted Conception. New York: Routledge, 1999.

Fox, Renee C., and Judith P. Swazey. Spare Parts. New York: Oxford University Press, 1992.

Gold, Richard E. Body Parts. Washington, D.C.: Georgetown University Press, 1997.

Levinson, Ralph, and Michael J. Reiss. Key Issues in Bioethics: A Guide for Teachers. New York: RoutledgeFalmer, 2003.

Youngner, Stuart J., Renee C. Fox, and Laurence J. O'Connell, eds. Organ Transplantation: Meanings and Realities. Madison: University of Wisconsin Press, 1996.

Periodicals

Levey, A.S., S. Hou, and B.L. Bush. "Kidney Transplantation from Unrelated Living Donors: Time to Reclaim a Discarded Opportunity." New England Journal of Medicine 314 (1986): 914-916.

Nelson, James L. "Transplantation through a Glass Darkly." Hastings Center Report 27(1) (January-February 1997): 29-37.

Radcliffe-Richards, Janet, et al. "The Case for Allowing Kidney Sales." Lancet 352 (June 27, 1998): 1950-1952.

Strong, R.W., and S. V. Lynch. "Ethical Issues in Living Related Donor Liver Transplantation (review)." Transplantation Proceedings 28(4) (August 1996): 2366-2369.

Veatch, Robert M., and J. B. Pitt. "The myth of presumed consent: Ethical problems in new organ procurement strategies." Transplantation Proceedings. 27(2) (April 1995): 1888-1892.