by Alison Wayman
Organ donation methods currently used within the United States and the world produce less supply than what is demanded. We must start to discuss the process of cloning organs because there are 180,000 people in the United States as of now (the number of people keeps on rising) who are waiting for an organ transplant however the number of humans who will receive an organ is less than one in three (Dobson 7). Currently, there are three methods of cloning organs that could increase the number of organ transplants; embryo, stem cell, and xenotransplantation. Cloned organs are starting to appear more and more within the scientific community, which leads me to believe that in a few years they will become a major resource for medical transplantations within the medical community. New developing laws could also increase the number of organ transplants.
Cloning organs can be controversial because of people’s moral values. One of the major values people hold is their belief in religion. Most religions in the United States accept organ transplantations while others do not accept transplants. The reason that some religions do not allow organ transplants is that they believe that it is a violation of the deceased. If they take out organs or parts of their bodies, the deceased cannot rest easy, and this will haunt them. Many United States religions accept transplantations to be acts of neighborly love and charity, so they tend to accept the idea of transplants (Woloschak 700). The ethics surrounding organ donation within the United States was shaped by the beliefs of the major religions that are shown throughout the United States (Woloschak 701).
The current views surrounding organ donation in China are very different from the views surrounding organ donation in the United States. China’s citizens mostly follow the religion of Confucianism. In this religion, they believe that one’s body does not only belong to oneself. This means that an individual does not have control over what is done with their body, but decisions are made. When it comes to donating organs, it is a family discussion/decision. “If one died and did not voice his opposition to his organs being donated before he died, then, his family will have the right to donate his organs after they have “collectively agreed”” (Wang and Wang 207). Where in the United States you are allowed to decide on organ donation by yourself without having to consult your family.
The current method surrounding organ transplants is there is a list that patients who require transplants will be placed on called the “Transplant List” and it is controlled in the United States by the United Network for Organ Sharing (UNOS). This list is not based on wealth or status for who gets organs but instead is based on their length of time on the list, the severity of illness, and the cross-matching of body types (blood, plasma, etc.) to see if they will receive an organ. After that, they have surgery to get the organ transplanted into them. Once the transplant is finished, the body of the person must accept the new and foreign item. They do have assistance in the acceptance step by what is called immunosuppressive drugs which helps the patients to not reject the organ. If the body rejects it the organ will fail and then the person has a chance of dying or be placed back on the transplant list.
The guidelines set around organ cloning are very important to help define what attempts/processes are ethical and which ones are not. “Three main moral principles have been defined as a framework of principles for bioethics: respect of autonomy, beneficence, and justice” (Sürmeli and Şahin 78). If we do not follow specific guidelines or laws when doing extreme research or trying to create a new thing, such as the cloning of organs, then we run the risk of creating something unethical.
The first defined principle is respect for autonomy. This principle is very important in the scientific and medical field, along with regular areas of life. If we do not respect the human body and life then we are destined to make mistakes or cross lines that should not be crossed when developing the method of organ donation within the United States and the World. “The general attitude of the medical community to organ transplantation is that permission for organ donation must be free and unconstrained and the respect for the body should be maintained even in death” (Woloschak 701).
This principle can also be considered when discussing the possibilities of uncontrolled donation after circulatory determination of death or “uDCDD” (Munjal et al. 19). This is a method in which when a patient is determined “brain dead” or their blood has stopped the circulation process throughout the body, which leads to them not getting the proper supply of blood to function. The doctors then start to take out the organs from those patients and move them to patients that are on the UNOS list such as patients that are unhealthy and close to dying.
Evidence of uncontrolled donation after circulatory determination of death has occurred in many countries. Madrid which has tripled its number of uDCDD donors which also increased their overall organ donation levels from 1994 to 2006 (Munjal et al. 20). This process has also continued to increase countries’ number of organ donations even if the number of brain-dead patients has decreased over time; this is because using brain-dead patients dramatically increases the number of donations and they could even have fewer deaths, but more donations. It is predicted that if the United States were to pick up this method of donation, they have the potential to increase donations by 22,000 more each year.
The arguments against uncontrolled donation after circulatory determination of death relate to the idea of reusing the organs. Some people believe that recirculating the organs after the human’s death is “undoing” the natural determination of death. That the use of the deceased’s organs will undo their death. However, the counter-argument against this is that all organ transplants now come from a person or animal already dying. This method helps to save so many more people than all the other methods. Therefore, it should be introduced to the American medical arena. The second defined principle of beneficence is the act of producing or performing good deeds in the world. This principle occurs in organ donation on both the surgeons' and the donor’s sides. Donors in the past used to be only close biological family members. However, in recent years it has been expanded to family members, friends, or even strangers. This has greatly increased the number of donations possible within the world and the United States (Iltis 3).
Along with relaxed donation limitations, the benefits of donating have increased and become more relaxed as well. “Originally, donors could receive nothing in exchange for their donation. Now, they may receive the promise of a transplant for another person through paired exchanges or chains, and in some places, a voucher for future use by their designee” (Iltis 3). This new incentive for humans to donate their organs helps them to produce goodness into the world (benefice) while at the same time receiving something out of it. This has and will increased the number of organ donations that we are seeing.
The third principle, justice, is needed within the medical field because if we do not treat everyone fairly and the same then we run into the risk of some people dying or getting sicker than they were before. This means continually developing medical research to help increase the number of organ transplants to ensure that justice is being provided to everyone. This will help to provide justice so that everyone will have better chances of getting an organ transplant to help save their lives.
New methods are being developed to increase the availability of organs for people in need. One major one is cloning organs, three tested types of organ cloning are currently available, stem-cell transplants, xenotransplantation, and human embryo cloning. Stem-cell transplants and xenotransplantation are ethical methods of organ transplantation. However, the human embryo is not an ethical method of organ transplantation. Stem-cell transplantation is taking the healthy cells of a donor and transplanting them to the unhealthy organs of the patient needed. Once the healthy cells are transferred to the unhealthy organ they will start to replace the dead cells to create a new healthy organ. This is an alternative to having to replace the entire organ where instead you can replace a few cells. The other ethical method of organ cloning to is xenotransplantation. This is the process of cloning animals to use their organs for humans who need organ transplants. Cloning piglets occurs by cloning them from their adult pigs, then their organs are used for human transplants. “The cloning paves the way for the next step towards pig-derived xenotransplants—the production of modified or so-called knock-out pigs, whereby a specific gene linked to hyperacute rejection in humans has been inactivated.” (Dobson 1). Dobson is saying that the process of using animal organs for transplants with lead to less rejection. The first successful xenotransplant performed on Baby Fe was a baboon heart, which survived twenty days before graft rejection occurred (Woloschak).
The use of human embryos is unethical in the cloning of human organs because it is taking the process of terminating a pregnancy to then use those cells in the production of new organs. Many people are against this because they do not want to see unborn children killed. This method has not had much proven success, so it is not a popular type of transplantation. There are some concerns that people express surrounding the various methods of cloning organs. In the article written by Woloschak, they say here has been reason to clone animals however, there is not much reason behind cloning humans because it would be unethical. That is why no scientific procedures are being performed with cloning humans to produce organs. “Ethical review boards are in place to prohibit experimentation on humans that is not reasonable and safe; such review boards should not view cloning as safe and reasonable practice for humans” (Woloschak 702). As we mentioned before, justice is required in all medical tasks and situations, people also provide the argument that it can create a different class of subhuman. “Arguments about developing clones as a source of tissues for transplantation are especially worrisome because they involve the development of a subclass of human beings (or perhaps just “Subhuman”) who would not have choices about whether they wanted to give up their organs for transplantation or not” (Woloschak 702). This relates to what the Confusions believed in China was that the decision of organ donation was not up to the individual but whoever is “in charge” or the majority. If we were to adopt the cloning of humans and a class of subhumans was created then we would no longer be providing justice for everyone because some would not have the same advantages. It would also not follow the first principle of bioethics (respect for autonomy) because then there would no longer be respect given for all human lives, therefore not being able to perform ethical science any longer. We also would be breaking the second principle of beneficence because we would no longer produce goodness into the world instead we would be ending human lives for less benefit if we were to adopt a different method of cloning, such as stem-cell and xenotransplants.
Overall, there are good methods in place now for organ transplants. However, with the always-increasing demand for organs and the always-decreasing supply of organs, we need to start to develop new methods for organ transplantation. The new methods that have proven successful that we could adopt and enforce are uDCDD, xenotransplantation, and stem-cell transplants. uDCDD being the patient is determined brain dead and the blood has stopped circulating which can lead to a donation. Xenotransplantation is taking animal organs and transplanting them into humans. Stem-cell transplants are taking healthy cells from a human and growing more from them. We then can follow the guiding principles of bioethics, respect for autonomy, beneficence, and justice while providing many more organs for humans who need transplants.
Works Cited
Dobson, Roger. “Cloning of Pigs Bring Xenotransplants Closer.” National Library of Medicine, 25 Mar 2000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127197/
Iltis, Ana S. “Living Organ Donation Near and at the End of Life: Drawing and ReDrawing the Boundaries Around Permissible Practices in Organ Donation”. The Journal of Law, Medicine & Ethics, vol. 47, no. 1, 2019, pp. 123-125. Sage Journals https://journals.sagepub.com/doi/epub/10.1177/1073110519840491
Munjal, et al. “Uncontrolled Donation After Circulatory Determination of Death”. Hastings Center Report, 2013. https://web-s-bscohostcom.nhcproxy.mnpals.net/ehost/pdfviewer/
pdfviewer?vid=8&sid=20ba90aa-b51b-4ad3-b312-81fc099dcfaa%40redis
Sürmeli and Şahin. “Preservice Science Teachers’ Opinions and Ethical Perceptions in Relation to Cloning Studies”. Cukurova University Faculty of Education Journal, vol. 41, no. 3, p. 76-86. https://dergipark.org.tr/en/download/article-file/46494#page=81
“The Moral Case Against Cloning for Biomedical Research.” Issues in Law & Medicine, vol. 18, no. 3, Spring 2003, p.261. EBSCOhost, https://web-p-ebscohostcom.nhcproxy.mnpals.net/ehost/pdfviewer/pdfviewe…
Wang and Wang. “Organ Donation by Capital Prisoners in China: Reflections in Confucian Ethics”. Xi’an Jiaotong University, Xian, Shaanxi, People’s Republic of China. Journal of Medicine and Philosophy, vol. 35, p. 197-212. 2 Mar. 2010. https://web-s-ebscohost-com.nhcproxy.mnpals.net/ehost/pdfviewer/pdfview…
Woloschak, Gayle E. “Transplantation: Biomedical and Ethical Concerns Raised by the Cloning and Stem-Cell Debate”. Zygon, vol. 38, no. 3, 2003. EBSCOhost, https://web-sebscohost-com.nhcproxy.mnpals.net/ehost/pdfviewer/pdfviewe…