Ethical considerations in transplant patients

Abstract

Given the complex factors involved and the consequences of the decision-making process, the selection process involves a complex set of ethical considerations. Organ transplantation remains one of the most challenging issues in bioethics because it touches on so many already difficult subjects: end-of-life care, rationing, euthanasia, surrogate decision-making, justice, financial conflicts of interest, and the definition of death itself. In the United States, the operating principles used for the procurement of organs include (1) the "dead donor rule, " which dictates that individuals must be declared dead before any vital organs are removed for transplantation, or (2) the "Uniform Determination of Death Act" (UDDA), which defines an individual as dead when he/she sustained either irreversible cessation of circulatory and respiratory functions or irreversible cessation of all functions of the entire brain, including the brain stem. The more modern version, the UDDA, has allowed for two new mechanisms for the procurement of organs: (a) "donation after cardiac death, " (also known as DCD) and (b) donation after brain death. In this chapter we discuss ongoing ethical issues in the field of organ transplantation, from issues related to the procurement of organs to the dilemmas associated with the selection and listing of candidates, organ allocation, and the issue of transplant tourism.