Organ transplanting-ethics and morality.

Organ transplanting-ethics and morality.

By Laurie Smith

The first successful kidney transplant occurred in Boston in 1954, identical twins Richard and Ronald Herrick were the first participants. Richard was dying of kidney disease and his brother’s was used, saving his life. I well remember 1967 when Doctor Christiaan Barnard performed the world’s first heart transplant and could only imagine the feelings of relief for those with ailing and diseased hearts. The patient, 55-year-old Louis Washkansky received a heart from a young woman killed in a traffic accident, he survived for 18 days. There were many arguments both moral and ethical, for and against and the views are still argued today. Now we have heart-lung transplants, cornea, liver, kidney, pancreas and the small intestine. Of course there are the advances in skin grafts, one of the first types of organ transplant, the use of artificial heart valves, stents, and valves from the hearts of pigs. Remarkably these valves work as well as human ones and last 10-15 years. The use of animal valves caused a barrage of controversy from various religious leaders and animal rights groups. Most kidneys and some livers are from live donors. With the liver the lobe is taken from the donor and transplanted, the donor’s liver regrows within a couple of months. Though there are reports of donors having trouble with pain, digestive problems and depression up to three years later.

For the other major organs somebody’s loved one, child or spouse has died. Their death can impact on ten other lives. Either saving them or at the very least improving their quality of life. Who hasn’t been moved by the imagery of people lying in hospital beds, in need of a donor organ? Especially when that patient is a small child, it tears at us to see the suffering. The parents sit by them agonising, waiting for someone to die so their child may live. Many patients miss out due to financial restraints, lack of health insurance, others being deemed a better match or more viable. Organ donors are few in comparison to population size, here in Australia we are number 17 in the world though we have the best outcome rate for patients. Those needing far outweigh those willing to give. Here your driver’s licence is marked if you wish to donate, you would think it was binding, it isn’t and family members can veto it. Having it in your will is a little too late for anything other than corneas and various tissues. The prime minister has put forward the idea of a scheme to pay workers $3,000.00 and their medical expenses if they donate a kidney. Workers only it seems, otherwise God forbid we would have the great unwashed making a dollar from an organ. On average 1700 Australians are waiting and about 245 receive a transplant. The problem is that only one percent of people die in hospitals and organs need to be fresh.

How much is a life worth? To those who take them indiscriminately, nothing. To a parent watching their child die it is priceless. To those in the illegal kidney trade located in China, India and Pakistan its worth up to $250,000.00. Would you accept say a kidney, one in ten of which comes from the illegal trade of human organs worldwide, and deal with a criminal organisation that preys on the impoverished? Does the grieving parent/spouse really care where it originates, as long as it works? Taking this a step further would you accept an organ from an executed criminal? I’m not saying that because the donor is a criminal that something is inherently wrong, rather that they have no choice in the matter. Most executions in China are by lethal injection and take place in mobile execution chambers parked next to major hospitals. They have used the organs from executed prisoners for decades; this is sanctioned by the government. Ten thousand transplants occur there annually and on average four thousand prisoners are executed, with seven thousand organs used. They have the highest execution rate in the world. Five years ago the government ruled that the organs could only be given to family members, and they will be phasing out the use of prisoner’s organs in 2015. This is irony at work, members of a criminal gang dealing in organs were sentenced to death in 2009. I wonder if they used their organs?

It must be the writer in me but I feel that a system where the State can trade your parts (who gets the money, a kidney sells for $15,000.00?) is nothing short of horrific. There are 68 crimes that draw the death penalty in China and many include non-violent offences i.e., monetary crimes. This brings to mind some Dystopian future where the downtrodden are chosen for execution by the State for their ability to match some wealthy individual in need of organs. I haven’t written this by plucking facts and figures out of fresh air. I’ve scoured several newspaper articles and came across the below site and believe me the more I read the sicker I became. Children are often the forgotten victims of organ trafficking. People aren’t content with using them in the sex trade, enlisting 10 year old boys to fight in war, or working them into an early grave in substandard conditions, now they are also unwilling donors. In Africa parents have sold their children’s organs, in Haiti and Mongolia orphans and street children are vulnerable to this trade. Follow this link for the full article: http://worldpulse.com/node/62193 So where do this leave us? We have a readily available product for sale: a huge market, profiteers, criminal gangs, uncaring Governments, vulnerable donors, unwilling donors, moralists and ethicists.

Mr and Mrs Brown are at the end of their tether, their daughter, Olivia is 12 and has polycystic kidney disease, and the only cure now is a donor kidney. Neither of the Browns are a match. Olivia came into the world via donor egg and sperm and she is their only child. They have watched their once healthy girl grow weaker and she is weeks away from death. One earlier kidney transplant failed, their health fund is having problems with a changeover to a new fund and time and ready money is running out. They search the internet and find a clinic in mainland China that can perform the operation for $150,000.00. After mortgaging their home, selling everything else of value and borrowing from family members they fly to Beijing with an ailing Olivia, and then on to their final destination further inland.

Temujin is an eleven year old Mongolian girl, orphaned after her parents died the previous year. She has lived a vicarious life since then, being put in and running away from state run orphanages. Now she lives at the rear of a horse stable in a provincial town, healthy but hungry the only currency she has is her body. When a man in a suit approaches her late one night with the promise of hot food and a warm bed she eagerly goes with him, willing to do anything to get out of the cold. Led into a tiny room in the town’s only hotel she sees the bed and begins undressing. A woman appears dressed in a long white gown with a syringe in her hand, a tiny prick to Temujin’s arm and darkness overtakes her. She never wakes up again; the removal of her kidneys and other organs that will survive the flight is done swiftly, professionally and her body is left in a shallow grave.

Bai Gau is a 30 year old prisoner in a Chinese jail, a member of a large religious sect outlawed there. He is due for execution and his organs have already been allocated, except for one kidney. This has been set aside for Olivia.

Let us go to India into a major city, we’ll meet Aadi he’s a Dalit one of India’s Untouchables. He lives with his wife and six children in an alley behind a warehouse; their home is probably the size of one of our bedrooms. They have little money or food and being Dalit are open to abuse and hounding from the authorities. Enter a man with $1,000.00/Rupees 55,000.00 the average wage per capita is around R 33,000.00 and you have a tangible incentive for Aadi to donate.

On the morning of the operation Bai Gau is put to death by lethal injection in the mobile execution chamber parked behind the hospital. All of his organs are harvested and at the last minute an appeal by his family has seen the kidney intended for Olivia being used for one of Bai’s cousins. Aadi’s kidney has arrived by air, destined for ninety year old Otto Schmidt, a German man who acquired his wealth during WW2 as a factory owner using forced labour from concentration camps. The organ has deteriorated in transit due to poor handling and is no longer viable.

Wang Li who is managing the Browns transplant informs them of the unfolding events and inadvertently lets slip the origin of the remaining kidney. They’re horrified, even more so when they hear that Schmidt has now promised to pay double the amount to claim Temujin’s organ. Enraged, Mr Brown storms into Schmidt’s room, the man lays there feeble, suffering. Brown explains his daughter’s situation and the origin of the kidney. Schmidt laughs at him, crowing that he’ll triple the price to gain an extra year or so of life. Snatching up an empty syringe from a tray, Brown pulls back the plunger filling it with air, sticks it into a tube going into Schmidt’s arm and injects an air bubble into it. Walking slowly away he drops the syringe in a rubbish bin and returns to his wife and daughter. Later that day Temujin’s kidney is successfully transplanted into Olivia Brown who makes a full recovery.

There are a few moral questions here:

1. Does any government have the right to dispose of executed criminals organs?

2. Once they knew the origin of the kidney should the Browns have allowed the operation to go on?

3. Knowing the circumstances of Bai Gau’s involuntary donation was it right for them to have gone ahead if the donation hadn’t been stopped?

4. Otto Schmidt was at the end of his long life. Did he deserve Temujin’s kidney?

5. Did his wealth make him more deserving?

6. Did Olivia’s condition and impending death make the murder of Schmidt right?

7. Knowing the method of donation should Temujin’s kidney have been used even after Schmidt’s death?

8. Does saving the life of your child mean that you should set aside all moral and ethical considerations that have served you up to now?

Now for a hypothetical viewpoint, probably stemming from my love of the Twilight Zone, so here goes. Schmidt although having a past steeped in greed and suffering, upon receiving his new kidney experiences a new paradigm in his life. The wealth he has accrued over time is put to use in helping build orphanages in underdeveloped countries, giving thousands of children a new start in life. Moral questions,

1. If Temujin’s kidney wasn’t used would her death have all been for nothing?
2. Does a better existence for a thousand children make up for one child’s murder?
3. Does it matter where the money comes from as long as it is being put to a good cause?
4. Can a person whose life had been steeped in evil and greed, truly rehabilitate?

The Browns return home and spend years repaying their debts, Olivia, happy to be alive at first, becomes depressed and withdrawn at not being able to attend college. She begins drinking at 16 and taking party drugs, all to the detriment of her kidney. After drinking half a bottle of Tequila she drives her boyfriend’s car through a red light, smashing into another car, taking the life of a young heart transplant surgeon. She survives, only to end up on dialysis and dying two years later. Mr and Mrs Brown are already in conflict since the operation and separate, suffering deep depression over the murder of Schmidt and the death of his daughter, Mr Brown suicides.

Moral question,

1. Does the end justify the means?

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