Organ transplantation
Abstract
Organ transplantation can be defined as a medical procedure where an organ is removed from the donor’s to a recipient body (Bagheri, 2016). This is an issue that has been on the public debates for some time now. The majority still believed that the act is evil and immoral. Others, on the other hand, believes that it is primarily done to save people lives and as such could be legalized. This paper looks the possible issues surrounding organ transplants like the organ tourism and trafficking. It also looks at the causes of this act at the potential effect they have on an individual, s community, and the state. The paper is arranged into subheading suggesting what is disused.
Introduction
Organ transplantation can be defined as a medical procedure where an organ is removed from the donor’s to a recipient body (Bagheri, 2016). The transfer is always done to replace the damaged or the missing organ. In organ transplanting, both the donor and the recipient might be in the same location or sometimes an organ may be transported from the donor’s site to different location where the recipient is. Sometimes organs or the tissue may be transplanted into the same person body. When this happens, the procedure is normally referred to as the autocrats (Bagheri, 2016). In rare occasions though, an organ transplant can occur between two different species through a process known as the allografts. Some of the organs and tissues that have been successfully transplanted include kidney, hearts, intestines, lungs, and liver. Organs such as brain cannot, however, are transplanted. The tissues that have gone through successful transplant include tendons, bones cornea, heart valves and the skin. Globally, kidneys are the organ that is commonly transplanted. It is closely followed by the liver and then hearts.
Persons of all ages are considered to be potential organ donors. Everyone who has been prescribed for organ donations is in most cases put to wait for a long time before the actual transplant. During this time, doctors are supposed to match the donor s and the recipient to reduce the risk of transplant rejection (Budiani & Delmonico, 2008). The discovery of organ transplant surgery was in good faith. It was made possible to save lives. With time, however, there have been different reasons for organ transplantation. Some of these reasons have led to organ trafficking and organ tourism. To look further into the subject of organ transplant, this paper will look at the reasons for an organ transplant, trafficking, and tourism. It also looked and the possible effects of this procedure and the way forward.
History and background of organ transplantation
The history of organ transplants is traced back to 1883. However, it was until 1954 that the first successful living-related kidney was transplant was done. Over the time that organ transplant has been into existence, as depicted by the Spanish, transplant Organization, Spain is the country that shows the world’s highest rate. Apart from the citizens who barely are waiting for an organ surgery United States, there is a long list of in the rest of the world. According to Budiani & Delmonico (2008), there are more than 2 million persons who currently organ need a transplant in China? Out of this figure, 90% are recorded to be of a kidney transplant. In Latin America, the donor rate is recorded at 40- 100 per million in every year. This number is similar to that of the developing countries. As experienced in Muslims dominated countries, the case is however slightly different. Traditionally, the majority of faith believes that body desertion in life or death should be forbidden and are therefore likely to reject the organ transplant.
Since the demand for organ trafficking has over the time exceeded its supply, organ trafficking and tourism have been used as an avenue to fill this gap. Before the year 2000, the problem of organ trafficking was only primary limited to the Indians. The major recipient of these areas was reported to come from the Gulf States, Japan, and some other Asians countries (Budiani & Delmonico, 2008). In the following years, due to high demand in organ transplant, the aspect of organ trafficking has significantly spread globally. There have been organized crime groups and also groups that have been able to exploit the situation and thus to encourage the practice.
Organ trafficking also has a long history; scholars trace it back to 1990s (Cohen, 2013). During this time, organ trafficking was specifically done in a human being for organ removal. In the past two decades, according to Cohen (2013), the number of organ transplant facilities has increased thus making this black market to thrive as well. According to a report filed in 2012, there have been 114,690 solid organs that have been transplanted (Cohen, 2013). This number only covers 10% of the global need for transplantation. Records have still shown the widening gap that exists in demand and supply for the organs and tissue transplant. For example, in the United States around 1990 and 2003, it was recorded that the kidney donations increased by 33%. Subsequently, it was also recorded that the number of kidney transplant patient list grew by 236%. This widening gap made the organ black-markets to even to expand further (Cohen, 2013). It is currently estimated that organ trafficking accounts for about 5-10 percent of the kidney transplant that is perfumed yearly throughout the world. Also, the trade of organ in the global market has been seen as an ethical issue. Currently, even the physicians who are having no part of the organ trade bare responsibility for their actions (Cohen, 2013).
Another issue that has come up due to organ transplant is the transplant tourism. This aspect, however, with time has become a connotation for the organ trafficking. Despite all these demands, there have been various arguments that have been put forth for the legalization of the trade. In 1970, some pharmaceuticals were introduced to prevent organ rejection. Also, there have been various policies that have been forged in both the developing and developed countries to bar the organ trade. In China, by May 2007, doctors who were found to be practicing the organ commercial were subjected to fines. As such, the country has only allowed and accredited a few hospitals in the region to conduct organ transplant. In Singapore, the trade is banned. The reason for this move was to hinder the exploitations of the poor and also socially disadvantages donors (Howard & Cornell, 2016).
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Reasons for donations and organ transplant
There are various reasons as to why organ donations occur. Some of the possible reasons include; living related donors pared exchange, Good Samaritan, financial compensation and forced donation.
For the living related donors, these are the donor who usually donates to their family members of sometimes to their friends. In this type of donation, there is only emotional investment involved. Living related donors unusually offset the risk of surgeries by the psychological benefits of not losing someone whom they consider too dear to them (Howard & Cornell, 2016).
The second reason for donation is the paired exchange. This is usually a technique that is used to match the willing living donor to their corresponding recipient. The type of technology used for this particular reason is called serotype. For instance, in cases whereby a spouse is willing to donate for his partner but lack biological match, then the willing spouse kidney can be exchanged with other willing partners who apparently could be having a biological mismatch. The program is mainly practiced in New Zealand.
The third reason is for the good Samaritans. This is whereby the donation is given to someone not known to the donor. There are individuals who willingly chose to do this type of donation. Some have been found to be donating to the next person on the list. Currently, there are websites that are being developed to helping such donations.
Another reason for organ donation is for financial compensation. In Australia, monetary compensation for organ donation has been legalized. In this kind of donation donors normally get money for the exchange of their organ. This practice however is primary dominant most of the developing nations. According to Neuberger (2016), it is the major reason as to why the activity is currently receiving organ medical tourism. In Pakistan, it is recorded that about 40-50% of the village residents only have one kidney as a result of organ transplant they have been reported to be selling their kidneys to the wealthy person coming from other nations. In this country, the donor is only offered $2500 for the kidney. Unfortunately, they are just able to receive half of that amount since the middlemen take so much. In Chimei, a region in southern part of India poor fishermen are reported to be selling their kidneys after majority lost their live odds to the ocean tsunami in2014. In the year, 2010, it was said that police had closed a fertility clinic which was being accused of trafficking human eggs. This is a violation of the European Union laws.
According to World Health Organization, about 11,000 organs were obtained on the black market in 2010. According to the body, the organs are sold every hour, every day of the year. As explained by the body, the majority of people find it quite easy to trade in body parts one they have been dehumanized. Dehumanization is usually done through a process of organ harvesting (Neuberger, 2016).
Finally, some individuals will be donation organs on forced circumstance. This kind of donation is known as a forced donation. Over the time, there has been concern that various authorities have been receiving organs from individuals who redeemed undesirable like the prisoners. According to world medical association, prisons and other desirable individuals who are in custody are not able to give consent freely, and as such, they should not participate in organ transplantation. As stipulated by a Chinese prime minister in one of the interviews, about 95% of the entire organ that is used for transplantations is from prisoner show haven executed.
According to a study that was done in India, the debt was reported as the primary reason for selling the kidney. These individual are fond of selling their kidney with an attempt to elevate themselves from poverty. Also, the kidney sale according to this study presented to the donors an opportunity for personal and family stability. Some of that interview in the study acknowledges that they were able to use the money for purchasing homes, starting up business, obtaining land and identification of various personal opportunities.
The growing demand for the organ transplant can n also is a cussed of the increased trafficking and organ tourism. The advances in medicine have since opened new opportunities to the traffickers. Today, doctors can take part of the l organ to the living donor. The increase in demand has also increased the organ brokers who are consequently offering large kidney packages.
Transplant tourism: causes, ethical issues, and effects
Transplant tourism can be defined as the aspect of traveling abroad for an organ transplant. As much as some of the transplants could be emotionally related, the majority of the organ tourism that are carried out are however for commercial transactions (Neuberger 2016). The practice of transplant tourism carries in itself many risks. The risk is mainly notable for the recipients. Some countries, transplant tourism, has since continued widely. As reported, the practice has risen in the developing world for the last twenty years.
Currently, there are many countries in the world where the transplant tourism has taken place. However, the states that top with the highest number of cases in China, India Philippines, Iraq and Pakistan (Swazey, 2017). According to a study done on the patient on transplant waiting list in the United States, patients who had undergone transplantation in the last 20 years were 373(Swazey,2017. Out of these transplant greater percentage was a kidney transplant. It was also recorded that the transplant took place in different countries, but the more significant rate was recorded in China and Philippines.
There are, however, various types of organ tourism. As explained in the figure below. Organ tourism usually takes multiple forms. According to the traditional model, there is a patient who will travel from less developed nations to the relative developed nations. The primary purpose, in this case, is primarily to receive medical services, which is not available in their home country. In most case, however, transplant tourism occur when both the parties could be who are living in the same country that has less straight end requirements or could be said to be having better transplant facilities.
With the increased demand for organs, the transplant tourism has since been tarnished by organ trafficking and the aspect of commercialization and as such often thought to be illegal. In light of this, it is laws useful to note that not all tourism involving the transplant recipient or donor is associated with the unethical behavior.
Causes of transplant tourism
The first drawing factor is the need for transplantations. Currently, there is a significant emerging burden associated with the kidney disease in the developing countries. This factor has been brought by the aging population n and the high incidence of diabetes two prevalence in the area. Unfortunately, this could be happening in a country that has no right facilities for transplant. Inexistence or lack of great centers in these regions usually poses a high barrier to the delivery of an efficient and effective organ transplant. Because of this, affluent residents of these countries would be in most cases tempted to seek help elsewhere thus transplant tourism.
In the developed countries, where the transplant facilities are well equipped, there are also aplenty waiting times. The waiting period can increase clinical deterioration and reduced the quality of life. When this occurs wealthy patient from this areas, have in most cases registered in many hospitals to increase their chances of transplant. Also, some patient in the developed economies would allsorts to countries that have established transplant programs but have the low prospect of operation thus causing transplant tourism.Another reason for the organ transplant tourism is the organ donation. The fact that currently, there is lack of legislation and infrastructure has hindered the growth of the deceased donor programmed in the developing countries. In light of this, the living donors in this countries have since continued to be the sole source of transplantable kidneys. Poverty has also contributed to the tourism since the majority of the citizens in the developing nations tend to live below the poverty line, most will be willing to travel abroad to donate their kidneys.
Effects of tourism transplant
Most of the donors who are involved in the organ transplant have shown a decline in the psychological and medical health immediately after donations. This comes about despite the fact that these individuals will receive an incentive which comes in monetary value. The recipient is also vulnerable to the non-infections risk and the infectious risk. One of the noninfectious risk that likely to affect the recipient is the logistical challenge during the transition of care. There have been multiple studies that have consistently shown that there have been poor communication in the translating center abroad and the continuity center in the recipient host country. Some of these miss communication have greatly been brought about by inadequate documentation of the donor information. According to a study conducted in Canada, there was more than the two-fold increment in the risk of graft failure and also a death that resulted from transplant tourism. Also, a patient who has gone through transplant tourism is recorded to have about 23% increment of the risk of hospitalization. This number is an even father in the first three months after transplantation according to the study.
The second effect of transplant tourism is the medical and surgical complications. A patient who has undergone transplant tourism is likely to experience anastomosis and urinary fistulas.
The second group of risk is that which is infectious to the recipient. First, upon transplant, there is a high risk of infection. The tourism group has over the time shown an increased infection risk. According to Swazey (2017), the rate of infection in this category is estimated at 45-54% against the 5% in the nun tourism group. Infection that is experienced in the transplant tourism can be as a result of the producer complications, geographically restricted pathogens or bold borne pathogens. In the developing countries.
Bacterial infection is another risk that is likely to affect the recipient during the transplant tourism. Many research today have described the wound infection as one of the diseases that affect the recipient. The infections have also been characterized with a lot of resistant or organisms. Some of this organism include; multi-drug resistant and the vancomycin resistant. The multi-drug resistant for instance has been found to be a great concern in the developing nations. As part of the bacterial infections, transplant tourism is also at risk of getting viral infections. Some of the viral infections decision that are associated with the transplant include HPV, HIV, and the CMV. According to the reports, CMV has been reported at the threat of 33%. So other complications associated with the transplant tourism is the fungal and the parasitic infections.
Transplant tourism according to report is, unfortunately, increasing despite numerous international policies that are being put in place to prohibit the practice. In general, the transplant tourism carries the risk such as those of surgical complications typically, increased mortality, bacterial, fungal as described above. As such the physician should also have a high degree of suspicion for the infection complications such as those which are gotten when one returning from transportation abroad.
Ethical and moral concerns
The presence and the need for organ transplant procedures in developing nations tend to be raising various ethical concerns. The interests have been observed in term of both the source and the method that is being used to have the transplant done. According to the world health organization, the practice of transplantation tend to be promoting health, but the notion of transplant tourism tend to be violating the human rights. The body has citizen the practice as one which is deemed to exploit the poor in an attempt of having intended health consequences. The developed nations also seem to be having the same problems and concerns; there is the issue of enthusiasms for increasing the supply and organs. Organs have been regarded in most asked as the temple of life and as such should be much respected.
Extent the risk extends to the donor and the local transplant facility. All of the nations except Iran have now outlawed commercial transplantation. However, since there has been a significant mismatch in the supply and demand for the provision of organs in the developed and the developing nations. To understand the ethical aspect in these countries, it is important to have a deep understanding of what an organ is. In most of these countries an organ has been defined as a group of specific tissues that works together to conduct specific function in the body. Importantly, organ transplant usually have surgical operation. During this time, a failing organ in the body is normally removed and as such replaced with a new one. Ethical issues in organ transplant are related with;
• Accurately determining the onset of death as a starting point for donating an organ.
• Getting informed consent from the donor and their families.
• Managing the available treatment due to a shortage of donors.
• To answer whether donors should be given incentives to encourage them or not.
• To determine whether there is an acceptable balance between risk for the patient and benefit for society.
The following are the ethical issues surrounding organ transplant:
Organ shortage
There is organ shortage due to low numbers of donors hence limited people get a transplant. Studied shave also shown that there is an agape widening gap between the number of existing donors and the recipient. The number of people who need organ transplant increase daily.
Cadaveric donors
A person may agree to donate their organs once they die but they make this decision while they are still alive in an advance directive. A person is considered dead if their brain ceases to function or their heart stops beating. One cadaveric donor can donate several organs to different people.
How to increase cadaveric organ donations
• People should indicate their wishes regarding organ transplant so that when they die the hospital management or the immediate facility is able to comply with their written wishes. The wishes in this case might be the exact opposite of what their families would want. The wishes can be indicated on income tax forms or drivers licenses.
• There is presumed consent where organs are usually removed when a person dies. Those advocating for presumed consent advocate for organ donation since once a person is dead they no longer need them. However, there are those that argue that donating organs may unfairly burdensome people.
• Giving donating family’s assistance with funeral costs may also increase cadaveric organ donations. Providing payment incentives may increase the number of cadaveric donors.
Aborted fetuses
It has also been argued that organs generated from fetus aborted that have been aborted in late pregnancy can be used for transplant. This ways it can be sued to save another life. As much as this idea could be life saver, it is discouraged because it may lead to people conceiving a child with the intention of aborting for the commercial purposes of its organs. Currently, there are various international standards and legal frameworks that are structured t against the organ commercialization. Some of these foreign measures are added ion world health organizations, world medical associations, the declaration of the Istanbul and the counsel of European resolutions.
The world health organization is one of the bodies that have been working tirelessly to bring an end to the commercialization of human organ. Between 1987and 2010, the agency has been working towards ethical standards in the field of a human organ. By 1991, the body published its first version of the guiding principles on organ transplant which was adopted. Some of the critical issues addressed in this release were the free and voluntary informed concenter and the aspect of non-commercialization of the human organ. These particular guidelines were later updated in 2008. In 208, the body elaborated on the prohibition of the sale of a human organ.
Another body which has been in the stead first fighting for non-commercialization of the human organ in the world medical association. By 1985, the body had already issued its statement of live organ trade. It this report the body vividly condemns the sale of the human b organ. The body has also promoted a policy which is aimed at giving guidance to the medical association and physicians and other related healthcare providers.
Organ Trafficking
According to the United Nations, aspect of organ trafficking have in it’s the recruitments, transfer, transport, harboring and receipt of individuals either using threat or use of force. Some of the effects that can be used in crossing initials include the abduction of fraud, abuse of power, deception, giving payment benefits. The practice of organ trafficking’s today been opposed by many throughout the globe. The reason for opposing it is based on the fact that it is a global injustice that in evolved the use of vulnerable segments of region or population (Cohen, 2013).
Most of the nations that have gone into a record of practicing organ trafficking like the Philippines and the Pakistan do not in most cases release the actual available statistics pertaining number of new patients that could have moved to their nations for transplant. However, according to the data by the Sindh Institute of Urology and transplantation, it is also documented that at least 2000 kidney transplant have been done in the nation of Pakistan. This claim has been supported by the fact that a series of over 8patients have gone to Pakistan through Trinidad to buy organs.
In the country of Philippines, a newspaper in 2007 reported that there had been over 3000 sales that have been performed in the state. In most case, the more significant percentage of organ trafficking has been that of children. In 2004, the United Nations reported a high increased in the number of children organ trafficking across the world as much as most of the children who were disappearing during these time could not be al due to trafficking cases greater percentages were assumed to be belonging to the trafficking statistics.
At the beginning of 2000, there were also two other European countries which were found to be involved in trafficking. After this years there have been various cases of organ trafficking acrostic world (Cohen, 2013). Around this years, there were about 2000 different information the trafficking in organs. Recently, the media have played an essential role in reporting various cases of organ trafficking in human beings. The report is said to have increased in Europe as a result of the economic and financial crisis.
Trend in organ transplantation
Since the evolution of the transplantation, there has an even high number of the shortfall that is brought in by the availability of the suitable donor organs. Also, the number of patients on the waiting list has significantly grown due to this mismatch in supply and demand s of the organ. By the year 201, it was recorded that there were about 8000 patients on the transplant waiting list in the US alone. Out of this number, the more significant part of it about 7000 were those waiting for the kidney transplant? The existence of transplantation has brought in a lot of practices which as are currently being carried out to save the lives. Some of the possible trends in the organ transplant include;
Immune suppression.
The introduction of the chemical immunosuppression is known to suppress the immune system. The suppressions inmost case is sufficient to enable engraftments of the transplant. Some of the modern immunosuapicion that are being carried out include the cyclosporine and tacrolimus. Cyclosporine was initially introduced as an n antifungal drug, two years an after this discovery the drug had undergone its first medical trails in Cambridge. The drug has shown its potential effect in improving kidney transplantation. According to reassert it has been found to currently 90-95 favorable rate. It operates by in inhibiting the T cells proliferation by way of blocking its activation. Tacrolimus also works just like their counterparts the only difference is that it acts by different binding calcineurin.
Another arising aspect in the organ and transplantation is the enotrasplantions. This is the use of organs from different species such as other animals to help in the transplant. Xenotransplantation has been brought by the shortage of donor organs in the market.
Another significant trend has been being seen in the organ donor. In the year 2005 its record that there were 7593 deceased donors and about 6896 living donors by the end of 2006. The deceased donors have been of late form d the highest number of donors. Also, they are known for the provision of multiple organs. The number of the decked donors cording to research has been recorded at 3.06 transplanted organs per deceased donor. On the contrary majority of the living donor only account or provide for one part or could be producing an incomplete organ. Consequently, out of 30,148 number of organs that were transplanted in 2005, the higher number about 23,249 organs were from deceased donors and only 6,899 out of the total number were from the living donors.
The percentage of kidneys thrust is being recorded but are not however transplanted has remained relatively constant from 19995
Pancreases transplant has also been another trend in the transplantation of the organs. Pancreases transplantations usually perfumed to help in reestablishing insulin secretion. The operation is commonly perfumed in conjunction with the 14 kidney transplantation. In the year 2005, there were about 540 pancreases transplant and approximately 903 joint transplantation. The majority of this transplantation were recorded to have come from the deceased donors. Apart from pancreases, another organ which is currently being transplanted is the intestine? The first successful intestine transplant was perfumed in 1987. The first small intestine transplant was however perfumed in 1991. In the year 2005, the number of intestine transplant was recorded at 178. In all these operation majorities of the recipient were children. In the seam year, about 40ercent of the identifying transplant recipient were below five years. (Martin, & Delmonico, 2014).
Other picking up activity in the organ transplant is the organ trade. Since the number of demand for the organ is literary more than its supply, some individuals have been taking advantage of this situation. These individuals commonly referred to timid men have been involved in organ trafficking and organ trade. The trade include vulnerable and desperate individuals who are willing to sell part of their organ for monetary benefits. The donor in this case usually put their lives in danger for an s little as $2000. In India for instance, around, 2000 people are reported to be selling their kidneys illegal each year. Curtly, the trade has significantly risen such that about 10,000 black operations tend to be taking place annually worldwide in more than one hour. According to the world health organization, the black market is still dominated in India. (Martin, & Delmonico, 2014).
Psychological effect of organ transplantation
The continued development of edge stage organ failure with the realization to the fact that life can no longer continue to attend to be having media intervention. Some of the psychological disorders associated with the organ transplant include depression, none an adherence and anxiety among others. Some of the scholars also argue that the operation can also lead to sexual dysfunction to the transplant patient. Some of the effects are brought in by tintype of drugs that are often used during these operations. For instance, the use of immunosuppressive drugs like the glucocorticoids and the cyclosporine are some of the drugs that have been implicated in the cause of psychochiartric imbalances like the delirium, generalized anxiety disorder, hallucinosis, and euphoria. Some of these diseases usually require regular treatment with the help of psychopharmacologic agents. The administration of this agents may, however, be considered hazardous because of the adverse effects in the body.
The altruistic act of kidney transplant tends to confer some psychological ben
