Organs & Tissues as Scarce Medical Resources

Instructor: Artem Cheprasov

Artem has a doctor of veterinary medicine degree.

Who deserves to get an organ donation? Is there a paucity of organs available for transplantation? How can we improve organ donation rates? These and many other questions and concerns are discussed in this lesson.

Bioethics and Organ Donation

If you're able to drive, have you designated yourself to be an organ donor? For some people, becoming an organ donor is a very easy decision. For others, it takes time to decide whether they want to be one. And for others still, they will never become an organ donor, for various reasons, including personal beliefs about the afterlife or reincarnation.

Questions regarding whether someone should be an organ donor or how organs should be distributed to patients belong to the field of bioethics, which is the application of ethics to the biological sciences, including medicine.

Organ Donation Acquisition

Demand for organ donation and transplantation has increased all over the world as a result of vital organs failing, either over time or due to medical problems. These include organs like the liver and kidneys. Yet despite the increased demand, the number of adequate organs available for transplantation has not kept up, which means there is a great shortage of organs available for donation in just about every country in the world. This has led to the number of patients on transplant waiting lists to rise, and inevitably, an increase in the number of patients who die while waiting for a transplant.

So how have some places in the world tried to mitigate this problem? In the United States, most states have what's known as an opt-in, or explicit consent, system for organ donation sign-ups. All this means is that you have to explicitly and voluntarily state that you want to be an organ donor. This can be done by, say, mailing in a form saying you want to be an organ donor.

Some European countries have what's known as an opt-out, or presumed consent, system. This means that you have to explicitly and actively register your unwillingness to be an organ donor, otherwise you're presumed to be a willing donor.

What has this led to, in terms of organ donation consent rates? Well, in Germany, which has an opt-in system, only 12 percent of people have registered as organ donors. In Austria, which has an opt-out system, 99 percent of the populace has, by default or choice, signed up as an organ donor.

Both systems pose various ethical questions. For instance, while it may seem great that so many potential donors exist in Austria, some people may not even know they are registered as organ donors, and thus do not actively seek to opt out of being one. This may run counter to their religious or spiritual beliefs. Is it ethical to presume everyone wants to be an organ donor? Think that one over on your own.

On the flipside, is it ethical to have an opt-in system when so many people are in desperate need of organ donation and so many are dying as a result of a scarcity of organ donations? Do someone's religious beliefs supersede the need to save a person's life? Again, that is something for you to think over.

Thus, the acquisition of organs and tissues poses plenty of ethical questions.

Organ Donation Allocation

The issue of how organs that are donated should be allocated brings up its own ethical concerns. Let me pose one relatable example for your consideration. Let's say that Cindy is a 65-year-old female who has smoked several packs a day for 30 years, and now needs a lung transplant as a result. In the same hospital is a 25-year-old man named John, who has never smoked but needs a lung transplant because of a rare genetic disorder.

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