Indian Transplant Newsletter Vol. V Issue NO.: 17/18 (Feb-Jun-Oct 2004)
Print ISSN 0972 - 1568

Ethics of Organ Donation and Transplantation at Crossroads

Indian Transplant Newsletter.
Vol. V Issue NO.: 17/18 (Feb-Jun-Oct 2004)
Print ISSN 0972 - 1568
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Ethical principles in the process of organ donation relating mainly to kidney have been a favorite point of discussion for the last few years .one of the main objectives of all this discussion has been to look seriously at the compensation issue in the process of organ donation. some of the pundits from the west who never believed that payments should be allowed’, have now changed  their opinion in the face of organ shortage. The shifting stance of the “world transplantation society is also a matter or intrigue and an indication of changing times and values.

In 1971 the committee on ethics said in a statement –‘buying and selling of organ is completely unacceptable’.

In 1980 it said-‘live unrelated kidney donor should not be practiced under any circumstances’.

In 1990 there was some shift in their thinking and they said-‘’we firmly believe that organ donation between non-related but emotionally related individuals is permissible’’.

By the year 2003,they made a complete about turn and said ‘’given the increasing success of living donor and given the scarcity of cadaver organs, living donor transplant has been regarded as regrettable necessity’’(Guidelines on renal transplantation –EUA-February 2003)one cannot have ‘regrettable necessity ‘govern principles of ethics. This change in attitude is matter of some concern when it comes from an international body. in a way the ‘Indian way of doing things ‘seems to have prevailed with time, some of our own colleagues who have believed in this principle of ‘regrettable necessity ‘will probably have the last laugh on the matter.

The dichotomy and dilemmas in determining what is right and what is wrong when we implement scientific advances to the needs of today’s society is due to the inability of the human thinking and emotional development to keep pace with these rapid advances. for example, if we were to follow the Hippocrates tradition of ethics in living kidney donation than nonmaleficience –the obligation not to inflict harm ,as a principle is breached ,as a surgery and the loss of an organ or tissue does carry risks for a person who in fact in case of living donation is not even a patient! To follow Hippocrates tradition tradition one has to ignore the principles of nonmaleficence  in favor of beneficence-the obligation to benefits others to do the greatest good for the greatest  good for the greatest number(utility)by using a living donor and hence helping in the treatment of a kidney failure patient. Both these important principles of Hippocrates are generally applicable in almost all the ethical practices of medicine ,however they fail totally and cannot be applied together in case of living donation.

Today, in the western world the rates of cadaver transplants has not gone up in proportion to the waiting lists, and they seems to be exploring various possibilities including compensation and are hoping that compensation can be worked out and regulated so that no exploitation of the donor takes place

Should india also look seriously at the paid organ donation programme and make it all official instead of hiding behind the sub clause (3), clause 9 of chapter II of transplantation of human organ act that makes commercialization of kidney possible ,we believe in the principles of ‘family above individuals ‘rather than ‘individuals autonomy’ and in all honesty our ethical principles have to be more focused towards the family and sharing and cannot be based strictly on the Christian theology of west .perhaps it is time for us to chart out our own ethical course based on our own traditions.

The transplantation of human organ act was passed in 1994 in india and in the years we have not let the cadaver transplant take–off seriously .we here live generally in chaos,does anyone honestly believe that the government.can run an effective paid organ donation programme .There is another myth in india ; that only poor donate organs to rich .This may be true in living organ donation but is not true in cadaver donation .most of the cadaver transplants have been done in private institutions and the class of patients who have actually donated are usually middle class people .of course ,there is a large pool of brain dead patients in government .hospitals but so far only two government .hospitals have been regularly doing cadaver transplants and in other hospitals majority of organs are wasted .we in india have to solve our solve our own problems in this field; we should not let altruism be driven out in favour of paid donor programme .Taking this attitude is likely to drive away the altruistic donor.we should also look seriously at options like’ swap transplants’between families.

The last century belonged to development ,technology and scientific revolution .the first half of this century will essentially determine how ethics of scientific advancement is likely to evolve for our future society.most of the cutting edge scientific advances in health sciences relate to organ regeneration ,tissue engineering and cloning.the question we need  to answer is ‘not if he can do it,but should we be doing it’.to some extent the principles of ethics of kidney transplants and the lesson we have learnt from it are likely to govern many of the future ethical principles.

The ethics of kidney donation if it has to be re-written ,will influence all major ethical principles of the future .hence some caution and restraint needs to be practised rather then treating the issue solely from the point of organ shortage and’regrettable neceesity’and should involve a wider debating platform.


To cite : Shroff S, Navin S. Ethics of Organ Donation and Transplantation at Crossroads. Indian Transplant Newsletter Vol. V Issue NO.: 17/18 (Feb-Jun-Oct 2004).
Available at:
https://www.itnnews.co.in/indian-transplant-newsletter/issue17/18/ETICS-OF-ORGAN-DONATION-AND-TRANSPLANTATION-AT-CROSSROADS-224.htm

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