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EDITORIAL
Year : 2021  |  Volume : 15  |  Issue : 2  |  Page : 91-92

The ethical and moral compass of directed deceased donation


1 Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
2 Department of Nephrology, Osmania Medical College, Hyderabad, Telangana, India

Date of Submission27-Jan-2021
Date of Decision20-Apr-2021
Date of Acceptance03-Jun-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Urmila Anandh
Department of Nephrology, Yashoda Hospital, Secunderabad, Telangana; Alexander Rd, Kummari Guda, Shivaji Nagar, Secunderabad, Telangana - 500 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_3_21

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How to cite this article:
Anandh U, Sahay M. The ethical and moral compass of directed deceased donation. Indian J Transplant 2021;15:91-2

How to cite this URL:
Anandh U, Sahay M. The ethical and moral compass of directed deceased donation. Indian J Transplant [serial online] 2021 [cited 2021 Oct 20];15:91-2. Available from: https://www.ijtonline.in/text.asp?2021/15/2/91/319885

Organ transplantation is considered to be one of the “miracles” of modern medicine.[1] This “miracle” unfortunately has been fraught with ethical and moral issues from the very beginning. The readers of this journal are fairly conversant with the ethical issues which beset the procedure of organ transplantation. The harm done to a healthy donor is not a major issue in deceased donor transplantation. However, deceased donor transplantation brings forth issues about consent, evidence of death,[2] and fair and equitable distribution of organs.[3]

The ethical dilemma is always overshadowed by the acute scarcity of organs. Over the years, many countries including ours have tried to address this issue proactively.[4] The ethical principles that have guided organ transplantation are (i) the organs are to be harvested with the consent of the donor (explicit before death) and/or that of near relatives and (ii) there will be no financial compensation related to this gesture. The overarching guiding principle is that organ donation is purely a voluntary act of altruism and constitutes a national resource to be used for the common good.

Despite having laws and guidance, organ donation has not increased substantially over the years worldwide. This has led many countries to explore the idea of directed or conditional donation. Directed donation raises the question as to whether the deceased donor is the owner of his organs. The ambiguity about the ownership of organs leads to the solicitation of directed donation. This ambiguity is further aggravated in situations of living donation and altruistic living donations from strangers. It appears parallel ethical constructs are at play in deceased and living donation.[5] Living donation works on the principle of autonomy of the donor and his desire to gift his organ to someone with whom he has a relationship. On the other hand, the organs of the deceased donor is considered a public resource. The autonomy of the person to decide whom to gift his organs after his death is still a matter of ethical debate.[6] His organs are considered a gift to the society and they are to be utilized in a fair and equitable system.

Directed donation is permissible under US state laws based on versions of the Uniform Anatomical Act 9.[7] In Australia, it is ethical for deceased directed donation to occur when

  1. Evidence that the person was prepared to be an organ donor after death
  2. Evidence (living will, advance care directive, or prior planning with the transplant team) that the person expressed a preference to donate his organs to a close relative
  3. Potential recipient is eligible for transplant and consents to receive organs from the donor.[8]


The Transplantation of Human Organs of India does not specifically address this issue.[4] This has led to an instance where the Government of India allowed directed deceased donation in the past in India. There is currently no policy on this issue also from the National Organ and Tissue Transplant Organization (NOTTO). The advisor to NOTTO feels that directed deceased donation should be accepted on a case-to-case basis but only after certain guidelines are framed by public policymakers. The guidelines are quite similar to that of the Australian Government except that the potential recipient should be listed beforehand and only one organ should be considered for directed deceased donation.[8] Rejecting a directed deceased donation will lead to no organ donation in that instance, depriving others the benefit of life-saving surgeries (Personal Communication Prof. Sanjay Agarwal Advisor, NOTTO). The state should frame laws and guidelines with absolute clarity on directed deceased donation so as to avoid situations as described in a case report in this issue of the journal.[9]

 
  References Top

1.
Starzl TE. Ethical problems in organ transplantation. A clinician's point of view. Ann Intern Med 1967;67:l732-6.  Back to cited text no. 1
    
2.
A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968;205:337-40.  Back to cited text no. 2
    
3.
Jonsen AR. The ethics of organ transplantation: A brief history. Am Med Assoc J Ethics 2012;14:264-8.  Back to cited text no. 3
    
4.
Sahay M. Transplantation of human organs and tissues Act-”Simplified”. Indian J Transplant 2018;12:84-9.  Back to cited text no. 4
  [Full text]  
5.
Cronin AJ, Price D. Directed organ donation: Is the donor the owner? Clin Ethics 2008;3:127-31.  Back to cited text no. 5
    
6.
Truog RD. Are organs personal property or a societal resource? Am J Bioeth 2005;5:14-6.  Back to cited text no. 6
    
7.
Ethical Principles to be Considered in the Allocation of Human Organs (Approved by the Board of Directors on June 22, 2010). Available from: http://optn.transplant.hrsa.gov/resources/ethics. [Last accessed on 2021 Jan 26].  Back to cited text no. 7
    
8.
National Health and Medical Research Council Australia. Ethical Guidelines for Organ Transplantation from Deceased Donors; 2016. Available from: www.nhmrc.gov.au/guidelines/publications/E76978-1-925129-59-5. [Last accessed on 2021 Jan 26].  Back to cited text no. 8
    
9.
Seth AK, Singh T. A directed deceased donation that never was - A case report. Indian J Transplant 2021;15:166-8.  Back to cited text no. 9
  [Full text]  




 

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