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ORGAN AND TISSUE TRANSPLANTS: SOME ETHICAL
ISSUES
Paul Flaman
(St. Joseph's College, University of Alberta,
Edmonton, Canada)
Introduction
1. Ethical Issues Regarding the Donor
a) From the Deceased
b) From Living Persons (Adults, Mentally Disabled,
Minors)
c) From Anencephalic Infants
d) From Human Fetuses
2. Ethical Issues Regarding the Recipient
3. Ethical Issues Regarding Allocation of LimitedResources
a) Criteria for Selection
b) Using Animals
c) Artificial Substitutes for Tissues and Organs
d) High Costs, Universality and Justice
4. Ethical Issues Regarding Procurement of Organs
and Tissues
a) Buying and Selling Human Organs and Tissues
b) Media Publicity
c) Types of Consent (Voluntary or Expressed,Family, Presumed, Required Request, Routine
Inquiry)
d) Fears, Confusion and the Need for Education
Conclusion
Some Cases and Questions For Discussion
Introduction
Although the idea of organ transplantation is an
old one, successful transplantation did not occur
until the Twentieth Century. When different blood
types and their respective compatibility or
incompatibility, as well as a method of preserving
blood, were discovered, blood transfusions
became an accepted medical procedure. They
were widely used during the First World War. Dr.
Emmerich Ullmann experimented on dogs with
kidney transplants in the early 1900's. He found
that the transplanted organ functioned longer, the
closer the donor and recipient were genetically
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related. Human skin grafts were attempted in the
late 1920's. It was found that they could be
performed without the problem of rejection
between identical twins. In the early 1940's Dr.
Peter Medawar and his team experimented with
rabbits. They began to understand the immune
system which exists in higher animals and human
beings. Antigens, on the surface of cells, enable
higher organisms to recognize a foreign body. They
stimulate the production of antibodies which are
important in fighting infection. This, however, also
causes the phenomenon of rejection in organ
transplantations.
The more similar the tissues' antigens, of donor
and recipient, the less likely they are to recognize
each other as alien bodies. Tissue typing and
matching is based on this. Rejection remains oneof the main causes of failure in organ
transplantation because it is difficult to find
completely matching tissues. New drugs (e.g.
cyclosporine) greatly ease the rejection problem.
Recipients, except in the case of a transplant
between identical twins, need to take such drugs
for the rest of their lives. In the case of a successful
kidney transplant, however, the costs related to
the transplant and the required drugs are cheaper
than the alternative of renal dialysis. The quality of
life of the recipient is also better.
Today the transplantation of many organs
between well-matched human beings is quite
successful, with the majority of recipients living
five or more years. Kidney, cornea, bone marrow
and skin transplants today, for example, are
considered routine for certain conditions. Heart
and lung or heart-lung transplants, liver and
pancreas (or pancreatic islets) transplants are also
becoming more common. According to Dr. Robert
White, even a human head transplant (perhaps
better referred to as a body transplant) may be
possible. The recipient in this case though would
resemble a quadriplegic because it would be
impossible to connect the 100 to 200 million
severed nerve endings.(Varga, 211-19)
Experiments continue to be done to try to improve
the technology and possibilities regarding
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transplantation. For example, research is being
done regarding human cell cultures, transplants
from human fetuses, including brain tissue, and
from animals to human beings. The latter includes
attempts to genetically design animals with organs
that are less likely to be rejected by human beings.
Some animal products (e.g. insulin and pig heart
valves) are already used regularly. Research also
continues to be done to improve artificial organs
and other artificial aids to human functioning.
Since many people can benefit greatly in terms of
length and quality of life from organ and tissue
transplants, the demand usually exceeds the
supply. The costs related to some organ
transplants are very high as well. Therefore, many
questions are raised today regarding how best to
procure more organs, how to fairly distributelimited resources, and whether all transplants
should be covered by public funds.
The ethical and legal issues related to organ and
tissue procurement and transplantation are often
discussed in light of such principles as autonomy,
benevolence, non-maleficence, free and informed
consent, respecting the dignity, integrity and
equality of human beings, fairness, and the
common good. The Judeo-Christian perspective
affirms the great dignity of each human personcreated in the image of God (cf. Gen 1:26-31). The
various aspects, parts and functions of a human
person participate in this dignity. We are also
social beings who have a responsibility as co-
creators and stewards of God's creation. "In the
donation and transplantation of human organs,
respect is to be given to the rights of the donor,
the recipient and the common good of
society."(CHAC, 44)
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1. Ethical Issues Regarding the Donor
a) From the Deceased
In general it is seen as praiseworthy to will one's
1.
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body or parts of one's body for the benefit of
others after one's death. In 1956 Pope Pius XII
summed up the Catholic view on this:
A person may will to dispose of his [or her] body
and to destine it to ends that are useful, morally
irreproachable and even noble, among them the
desire to aid the sick and suffering. One may make
a decision of this nature with respect to his own
body with full realization of the reverence which is
due it....this decision should not be condemned
but positively justified.(quoted from Ashley and
O'Rourke 1989, 305)
More recently (1985) the Pontifical Academy of
Sciences stated:
Taking into consideration the important advancesmade in surgical techniques and in the means to
increase tolerance to transplants, this group holds
that transplants deserve the support of the
medical profession, of the law, and of people in
general. The donation of organs should, in all
circumstances, respect the last will of the donor,
or the consent of the family present.(MacNeil)
Such a donation can greatly benefit others and
cannot harm the donor who is dead. Not to offer
such a donation can be a sign of indifference tothe welfare of others. To donate, however, is not
considered obligatory. Transplantation is against
some people's consciences for religious or other
reasons.(cf. LRCC, 140-2) Consideration for the
sensibilities of the survivors may also make some
people hesitate to sign over their bodies.
In any case proper respect should always be
shown human cadavers. Although they are by no
means on par with a living human body/person,
they once bore the presence of a living person.
The probably dying potential donor should be
provided the usual care that should be given to
any critically ill or dying person. Because of a
potential conflict of interest, it is widely agreed
that the transplant team should be different from
the team providing care for the potential donor,
who is not to be "deprived of life or of the
essential integrity of their bodily functions.... No
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organs may be removed until the donor's death
has been authenticated by a competent authority
other than the recipient's physician or the
transplant team."(CHAC, 44 and 46) Various parts
of the human body can often be kept in good
condition for transplant purposes after the death,
irreversible cessation of all brain functions, of the
donor.(Jonsen, 235-7)
The Catholic Health Association of Canada (CHAC)
considers transplantations of brain cells
(presuming irreversible cessation of all brain
functions of the donor) in order to restore
functions lost through disease as permissible "as
long as the unique personal identity and abilities of
the recipient are not compromised in any
way."(45)
The German Bishops' Conference and the Council
of the German Evangelical Church consider the
transplant of "reproductive glands" as unethical,
"since it intervenes in the genetic individuality of
the human being."(374) This does not seem to
exclude transplanting all sexual body parts, but the
gonads. Any child that resulted following an ovaryor testicle transplant would have the dead donor
and not the living recipient as its biological mother
or father. This would violate the rights of the child
(see SCDF 1987, 23-26).
The case of the body of a pregnant woman in
Germany, who had been declared brain dead,
being kept alive with the hopes of the child coming
to term was recently given some media attention.
Some criticized this as not giving proper respect to
the woman. Can not this effort, however, be seen
as similar in some ways to organ donation and,
therefore, as commendable? The woman had at
least implicitly offered her body for the child's sake
before her fatal accident. Her family also
requested this.(Associated Press) Cases such as
this also raise the question of "ordinary" and
"extraordinary" means of saving life (see below
under 1.b).
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The use and possible use of cadavers and
"neomorts" (brain-dead individuals maintained on
life support) for a variety of purposes (transplants,
research, training medical students), perhaps even
a considerable time after the person's death, has
provoked ethical and legal debate. Various
concerns include respect for the dead and their
wishes, respecting the family's wishes, benefitting
others and the common good. In light of this,
anyone considering donating their organs and/or
body after their death, highly commendable in
itself, may wish to specify certain limits.(cf. LRCC,
113-17; Gaylin; and CHAC, 43 and 46)
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b) From Living Persons (Adults, Mentally Disabled,
Minors)
Transplants between living persons raise thequestion whether it can ever be ethical to mutilate
one living person to benefit another. Concerning
this many distinguish between parts of the body
that can regenerate (e.g. blood and bone marrow)
and parts that do not regenerate. Regarding the
latter some are paired (e.g. kidneys, corneas and
lungs), whereas others are not (e.g. heart). Before
transplants of organs such as kidneys were
performed, many Catholic theologians considered
this unethical between living persons. They
thought it violated the Principle of Totality whichallowed the sacrifice of one part or function of the
body to preserve the person's own health or life
(i.e. a part could be sacrificed for the sake of the
whole body), but did not allow one person to be
related to another as a means to an end. When
such transplants began in the early 1950's ethicists
gave the problem closer study.
Gerald Kelly (1956) argued that such donations
which have as their purpose helping others could
be justified by the Principle of Fraternal Love or
Charity provided there was only limited harm to
the donor. Some ethicists argued this did not
violate the Principle of Totality provided that
functional integrity of the body was not destroyed,
even though there is some loss to anatomical
(physical) integrity. Donating one of one's kidneys
could be justified for proportionate reasons, since
one can function with one healthy kidney. ("Living
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kidney donors constituted some 15% of the donor
pool in Canada in 1989."[LRCC, 20]) Donating one
of one's functioning eyes, however, can not be
justified, since one's ability to see (functional
integrity) would be seriously impaired.
Basic to medical ethics is the Principle of Free and
Informed Consent. To be properly informed the
potential living donor should be given the best
available knowledge regarding risks to him/herself,
the likelihood of success/failure of the transplant
and of any alternatives. In some cases there is
much pressure to donate (e.g. from family
members if one is a good match). The courts have
rightly refused to compel such donations.
Motivated by charity, which includes a properly
ordered love for others and oneself, one could
decide not to offer an organ.(Ashley and O'Rourke1989, 305-8; CHAC, 31 and 34)
The distinction of ordinary and extraordinary
means is also applicable to transplants. The
Catholic Church teaches that one is obliged to use
ordinary means to preserve life, but not
extraordinary means, that is, means that are very
burdensome (very painful, expensive,
inconvenient, risky, or even very psychologically
burdensome) or do not offer reasonable hope of
benefit, or are disproportionate (cf. SCDF 1980,section IV; Ashley and O'Rourke 1986, Ch. 11.5;
and CHAC, 52-4). Some forms of organ and tissue
transplant from a living donor, especially those
involving invasive surgery, involve considerable
burden to the donor. If means are available that
do not involve such burdens, such as a matching
organ from a deceased donor, these are certainly
to be preferred.
The above principles would allow in some cases
such procedures as "transplanting part of the liver
from a living adult donor into a child recipient,
whereafter the adult donor's liver regenerates
within a month and the child's new partial liver
develops as the child grows"(LRCC, 15), or
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donating one's heart if one were to simultaneously
receive a heart and lung transplant (Garrett et al.,
200).
A competent adult can give free and informed
consent to be or not to be a living donor, but an
incompetent person cannot. Can a guardian
ethically consent for a legally incompetent person,
such as a severely mentally disabled adult or a
minor, to be a living donor? Concerning this issue
some distinguish, for example, between a young
child and a mature minor's ability to comprehend
the implications of donating. Regarding medical
decisions an incompetent person's guardian is to
act for their benefit or best interests, and, as far as
possible, their wishes, if known and reasonable.
Some think children and the mentally disabled
should never be living donors. They are simplybeing used with a violation of their bodily integrity,
risks to their health and life, and no benefit to
themselves. An argument against their being a
living donor of an organ such as a kidney, is that an
alternative such as renal dialysis is often available
until a suitable deceased donor can be found.
Others argue that in some cases the psychological
benefit to the donor (e.g. a child's sibling lives)
could outweigh the risks (e.g. of donating bone
marrow).(LRCC, 48-50) The Catholic Health
Association of Canada (CHAC) says that, "Organ ortissue donation by minors may be permitted in
certain rare situations."(44)
Can it be ethical to have another child for
transplant purposes (e.g. for a bone marrow
transplant)? Conceiving and having a child for this
motive alone would involve treating him/her as a
mere means to another's benefit. This would
violate the great dignity of a person, created in
God's image, who should be loved for his/her own
sake.(cf. CHAC, 45; Garrett et al., 200)
Concerning the whole issue of living donors, the
German Bishops' Conference and the Council of
the German Evangelical Church say:
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...No one is obliged to donate tissue or an organ;
therefore no one can be forced to do so. The
decision to donate one's organs while still alive can
only be made by the individual concerned
personally. Not even parents are allowed to decide
on an organ donation by their child; they are
allowed to give their consent only for a donation
of tissue (e.g., donation of bone-marrow). The
doctor in this case has a special responsibility
because no one can control whether a donation is
truly voluntary.
When a living person donates an organ as a result
of a personal decision, then the organ's transplant
is to be carried out with due attention, and post-
operative medical care of the donors as well as the
recipients must be provided. Further,consideration must be given so that no problems
develop in the relationship between the donor and
the recipients (dependence, excessive gratitude,
guilt feeling).(375)
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c) From Anencephalic Infants
Anencephalic infants are born with a major portion
of the brain absent. If born alive they die within a
few days, although in rare cases some survive for
weeks or months. They can suck and cry and some
argue that their degrees of consciousness or
unconsciousness may vary. According to thewidely accepted criteria of death as irreversible
cessation of all brain functions, they are living
human beings/persons. To increase the likelihood
of procuring viable organs from them, some would
like to redefine death in terms of partial brain
death so that they could be considered dead
(although still breathing spontaneously...), or for
them to be exempt from the total brain death
criteria, or to consider them non-persons. Many
others, however, argue that partial brain death
criteria are invalid in light of our present
knowledge and/or such an arbitrary move would
endanger other classes of living human beings and
lead many more people to refuse to sign organ
donor cards. Although extraordinary means of
prolonging the life of anencephalic infants do not
need to be used, they should be given the normal
care of dying persons.(cf. CHAC, 45-6; LRCC, 95-
106; Garrett et al., 202; Ashley and O'Rourke 1986,
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Ch. 11.2, and 1989, 311-12)
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d) From Human Fetuses
Is it ethical to transplant brain or other tissues
from human fetuses to benefit others (e.g. those
suffering from Parkinson's Disease)? If the fetus
has died of natural causes, the ethical issues would
be similar to other transplants from the deceased.
When the fetus has died or will die as a result of
procured abortion, however, other ethical issues
arise. The Catholic Church considers direct
abortion (the intentional killing of an innocent
human being) to be gravely immoral. Some argue
that to use tissues from a fetus killed by abortion
could be done without approving direct abortion(cf. using tissues or organs from a murder victim).
Such use, however, could "justify" abortion (i.e. to
benefit others) for many women who otherwise
are unsure about having an abortion. A good end
though does not justify an evil means (see Rm 3:8).
The timing of the abortion may be influenced as
well. The widespread usage of electively aborted
fetuses would establish an "institutional and
economic bond between abortion centers and
biomedical science..."(Post, 14; cf. CHAC, 15, re
unethical cooperation)
Some argue that transplanting fetal brain tissue
would require the fetus to be still alive, that is, the
tissue would not be good for transplant purposes
after the fetus has experienced total brain
death.(cf. Duncan, 16-22) Some say that other
means of treating such diseases as Parkinson's can
and should be developed.(cf. Dailey)
Another issue involves consent. Anyone involved
in procured abortion would not qualify as the
fetus' guardian since they hardly have his/her best
interests at heart. The Catholic Health Association
of Canada (CHAC) concludes that,
"Transplantations using organs and tissues from
deliberately aborted fetuses are ethically
objectionable." (45; cf. SCDF 1987, 16-18)
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(45; 1987, 16-18.)
2. Ethical Issues Regarding the Recipient
...nobody [i.e. no potential recipient] has a claim
on organs or tissue of any person, living or dead.
The sick should thus accept the tissue and organs
freely offered by others as a gift.(German
Bishops..., 373)
This position is widely accepted.
Another moral issue involving the recipient is free
and informed consent. A competent person who
could possibly benefit from receiving a transplant
should be adequately informed regarding the
expected benefits, risks, burdens and costs of the
transplant and aftercare, and of other possiblealternatives. So should the guardian(s) of an
incompetent person. A legally incompetent person
who can understand some things that are relevant
to their condition, a proposed transplant, and
decisions that they are capable of making, should
be informed of these in an appropriate way.
Guardians should respect the wishes, if known and
reasonable, of incompetent persons in their care.
No unfair influence should be put on someone to
be a transplant recipient. Potential recipients and
their families can be tempted to pressure,blackmail or bribe a potential living donor to
donate or a health care professional to give them a
privileged position on the waiting list. Such
practices are unethical because they fail to
properly respect the freedom of the donor or they
violate other potential recipients' rights regarding
access (cf. Garrett et al., 206-7) Recipients should
also avoid any unethical cooperation in any abuses
(e.g. the organs or tissues have been procured
immorally/illegally) that are sometimes associated
with transplantation.(cf. CHAC, 15 and 31; Ashley
and O'Rourke 1986, 88 and 90-1; and 4.a below)
A potential transplant recipient and/or their
guardian(s) could also consider their decision in
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light of ordinary and extraordinary means of
preserving life (see above, under 1.b). The
competent adult Jehovah Witness who refuses a
life-saving blood transfusion, for example, because
this is against a tenet of their religion, can be
understood to be refusing means that would be
"very burdensome" for them. Courts, however,
sometimes override the decision of natural
guardians including parents when this is judged
clearly against the best interests of incompetent
persons including a child (e.g. to allow a life-saving
blood transfusion to the child of Jehovah Witness
parents). This issue is more difficult when the child
begins to develop his/her own value system, but is
still considered legally incompetent.(see n. 3
below under "Some Cases...")
Proper safety measures should be followed toprotect transplant recipients from receiving AIDS
and hepatitis viruses, etc.(cf. LRCC, 161; and
Garrett et al., 200)
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3. Ethical Issues Regarding Allocation of Limited
Resources
a) Criteria for Selection
Requests or the demand for human organs and
tissues usually exceed what is available or thesupply. Significant practical and ethical questions
regarding efficiency and fairness arise as to how
best to distribute these limited resources. On what
basis should this person rather than that person be
chosen to receive a given organ? Who should
choose? These decisions are serious as they can
involve who will live and who will die. In section 4
below we will consider some ways of addressing
this problem by attempting to increase the supply
of human organs and tissues. In sections 3.b and c
we will consider some alternative methods of
attempting to meet some of the needs in this area.
In this section, however, we will consider some
criteria for selecting which potential transplant
recipient will receive a given human organ or
tissue.
A widely used and approved criterion of selection
is to give priority to those who have great need
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and who are expected to benefit greatly. For
example, it does not make sense to give a limited
number of available organs to those who will not
benefit or who are expected to only live marginally
longer but suffer much with the transplants, when
others would benefit greatly. While this criterion is
widely accepted as fair, there is much discussion
about how to define and assess "benefit". Many
argue that both expected length of survival and
the possibilities regarding rehabilitation should be
considered.
In spite of the success of transplants, care must be
taken not only that they extend life biologically,
but that they also offer the patient a real chancefor a healthy life. The new organs should add new
years to life, and help to provide a new and better
life.
....as a last resort a choice sometimes has to be
made between a transplant immediately available
but with a very small chance of survival, and a long
term transplant offering a greater possibility of
healing.(German Bishops..., 374-5)
With regard to who will likely benefit more fromreceiving a transplant, medical criteria such as
blood and tissue typing (i.e. who is less likely to
reject the transplant), and the absence of other
life-threatening diseases, are used. Other factors
such as the potential recipient's will to live,
motivation and ability to follow post-operative
directions (e.g. taking immunosuppressants), his or
her family support, and the skill of the transplant
team can also be relevant to the success of a
transplant.(Garrett et al., 213-216)
Potential recipients (i.e. those likely to benefit
from a transplant) are registered on a "first come,
first serve" basis. This, or random methods of
selection (e.g. a lottery) where there is equal
chance, is fair provided that the need and benefit
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are approximately the same among potential
recipients.(cf. Varga, 226; and Ashley and
O'Rourke 1986, 112, and 1989, 308)
Some argue in favor of using criteria such as social
worth, and merit or demerit, to select or prioritize
potential recipients. Concerning "social worth", for
example, is it fair to give priority to a mother of
young children over a single person, or to a
successful doctor over someone who is at present
unemployed? Concerning merit should a retired
person who contributed a lot to the community be
given priority over a young person who has not yet
proven him or herself? Regarding demerit, for
example, should someone who previously abused
alcohol, smoked heavily or ate unhealthily be
denied a liver, lung or heart transplant?(cf.
Altman; Moss and Siegler) Many, however,criticize these and other criteria such as ability to
pay, race, religion, gender, and age, as involving
unfair discrimination. They are said to violate the
equal dignity of all human beings. Criteria such as
"social worth" are also seen by some to be too
difficult and subjective to apply efficiently and
reasonably.(cf. CHAC, 30 and 45; Appleton
International Conference, 6-7; Varga, 226; Garrett
et al., 216; Childress) Childress argues as well that
the criteria for selecting recipients should be open
and subject to public scrutiny.
(. , 226, ' 1986 112,. ,
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b) Using
Animals
The shortage of various human parts for transplant
purposes has in part motivated research in animal
to human transplants. The use of some animal
parts such as insulin extracted from animal
pancreases, catgut as absorbable sutures, and pig
heart valves, are already "accepted" medical
treatments. Attempts, however, to transplant a
baboon's heart to a human infant (Baby Fae) or a
pig liver to a dying woman, for example, have
aroused considerable controversy.(see LRCC, 18-
)
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7/28/2019 Organ and Tissue Transplants
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19; n. 4 below under "Some Cases..."; and Siegel)
Some argue that the present state of transplants
between species does not justify such experiments
which so far do not offer hope of therapeutic
benefit to the human recipients. Defenders of such
experiments argue that they can be justified if no
other alternatives are available and for the
knowledge gained. Some have questioned
whether such transplants involve irresponsible
meddling with nature. Various animal rights
groups have protested the sacrifice of animals
involved in this and other research, which uses
them as "mere means" to human welfare.
Concerning organ transplants from animals to
human beings research is being done with various
immunosuppressive agents with the hope of
finding a combination to overcome the rejection
problem.(Johnston) Attempts are also being madeto genetically engineer and breed new strains of
some animals such as pigs so that their organs can
be transplanted into humans with less risk of
rejection. If successful, the scientists involved hope
that this will overcome the large shortage of
human donor organs.(Reuter; Hanson)
Widely accepted directives for human
experimentation call for both adequate
preliminary animal experimentation to minimize
the risks to human subjects and that the welfare ofanimals used in research be respected.(e.g.
Helsinki Declaration of 1975, p. 1771) Pope John
Paul II in an address to a Congress of the Pontifical
Academy of Sciences said, "...animals are at the
service of man and can hence be the object of
experimentation. Nevertheless, they must be
treated as creatures of God which are destined to
serve man's good, but not to be abused by
him...."(p. 5) The Catholic Health Association of
Canada (CHAC) stipulates that animals involved in
research are to be properly respected and such
research "is to be allowed only when other
methods involving non-living subjects are no
longer helpful. When use of such subjects is
justified, pain relief must be used or suffering
reduced to a minimum."(60)
With respect to tissue transplants between
individuals of different species, Pope Pius XII on
( , 18-19, 4
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7/28/2019 Organ and Tissue Transplants
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May 14, 1956, spoke of the transplant of a cornea,
for example, as moral, if possible and warranted.
He, however, considered the transplant of the
sexual glands of an animal to a human being as
immoral. Thomas O'Donnell interprets the
condemnation of the latter as aimed at transplants
that would "envision an act of attempted
generation."(104-7)
The Sacred Congregation for the Doctrine of the
Faith excludes, among other things, attempts of
fertilization between human and animal gametes
and to gestate human embryos in the uteruses of
animals as contrary to human dignity. It considers
genetic interventions that are therapeutic, for
proportionate reasons, however, as licit.(SCDF
1987, 15-20; cf. CHAC, 60)
The Catholic Health Association of Canada (CHAC)
considers transplants from living animals to
humans as
...permissible as long as these can fulfill an
essentially beneficial human function in the
recipient. The human dignity of the recipient is not
to be compromised in any way and due respect is
to be paid to the non-human donor in the whole
transplant procedure.(46)
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c) Artificial Substitutes for Tissues and Organs
The shortage of various human parts for transplant
purposes has also in part motivated research in
the development of artificial and synthetic
substitutes for tissues and organs. There are a
number of substances that the human body does
not reject. A number of artificial replacement
technologies including false teeth, artificial limbs
and joints, hearing aids, synthetic lenses,
pacemakers, mechanical and synthetic heart
valves, genetically engineered insulin and growth
)
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7/28/2019 Organ and Tissue Transplants
17/32
hormone, and renal dialysis, are already routinely
used in treatment. Other technologies such as the
implantable artificial heart are still experimental or
are used temporarily with the hope of keeping the
person alive until a suitable human donor organ is
found.
Artificial replacement technologies are generally
very costly to develop. If they prove to be
successful and are mass produced, their long-term
costs can be significantly reduced. A number of
routinely used replacement technologies such as
long-term renal dialysis, however, remain
expensive. Some ethical questions concerning such
costs will be considered in section 3.d below.
Another issue is that the recipient of some artificial
parts may need to make certain psychologicaladjustments. Consider, for example, the
implantable artificial heart (also a heart transplant
from another animal species) in light of the
"popular belief that the heart is the center of
human emotions, the organ of love."(Varga, 239.
Cf. ibid, 238-41; LRCC, 20-22; and Thomas and
Waluchow, Case 7:3.)
The Catholic Health Association of Canada (CHAC)
states that artificial substitutes for tissues and
organs are permissible provided they "can fulfill anessentially beneficial human function in the
recipient" and the "human dignity of the recipient"
is not compromised in any way.(46)
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d) High Costs, Universality and Justice
The development and use of technology related to
organ and tissue transplants or artificial
substitutes is expensive. For example, estimates of
the costs of transplant procedures, without
complications, "range from $20,000-$30,000 for a
kidney, $60,000-$80,000 for a heart, and
$120,000-$150,000 for a liver."(Goddard) With
complications the costs can be much higher. Such
costs are beyond the means of many people, if
they are not covered by public funds, medical
insurance or charity. The demand for transplants
has also increased because they have become
quite effective. For example, the one-year survival
rate for all transplants is at least 70-80%; and the
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7/28/2019 Organ and Tissue Transplants
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five-year survival rate for heart and liver
transplants is 70% and 70-80%
respectively.(Goddard)
Today the issue of whether transplants and other
expensive medical technologies are cost-effective
and whether public funds should cover the costs of
all such procedures for everyone who could
benefit from them is being discussed a lot. It
should be noted, however, that the average cost
per life year gained from a transplant (e.g. kidney)
can be significantly lower than alternative
treatments (e.g. hemodialysis). In addition, the
recipient of a successful transplant often
contributes much more to the economy through
work, spending and paying taxes, than if they
would have died or remained ill.(Goddard)
Other questions include: Could the large sums of
money (or some of it) that is spent on developing
and using transplant technology and artificial
substitutes be better used to improve the health
and quality of life of more people if spent in other
ways (e.g. providing better access to primary
health care, improving education and preventative
health programs, improving the environment by
further reducing pollutants, etc.)? What percent of
health care dollars should be allotted to transplant
programs and related research? Broader questionsinclude: What per cent of public funds should be
spent on the good of health as compared to other
goods? Should government spending and public
health services be limited or reduced, or should
taxes be increased to provide for more people's
needs and/or wants? To what extent should
transplant services and organs be supplied to
people of other countries? There are no easy
answers to such questions of distributive justice
which, among other things, can affect who lives
and who dies. One can also ask how it affects us as
moral agents if we do not help or save all those we
can?(cf. Ashley and O'Rourke 1989, 308-10;
Engelhardt; Garrett et al., 216-19; and Thomas and
Waluchow, 132-4)
Parliament through the Canada Health Act (1985)
has committed Canada to providing "reasonable
access" to "medically necessary" hospital and
70-80%,
70% 70-80% ().
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7/28/2019 Organ and Tissue Transplants
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health services on a uniform basis. Reasonable
access, however, does not mean absolute access.
The term "medically necessary" is also open to
interpretation.(LRCC, 124-5)
The position of the Catholic Health Association of
Canada (CHAC) is: "Basic health care needs are to
be considered in the allocation of resources for
transplantations, especially when it is a question of
novel procedures involving scarce organs and
expensive, limited medical facilities."(45) With
respect to allocating resources in general it calls
for solidarity with sick persons, careful
stewardship of God's gifts and "active participation
in the formulation of policy for the equitable
distribution of health care funds in society as a
whole", among other things.(22-24)
(1985)
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4. Ethical Issues Regarding Procurement of Organs
and Tissues
a) Buying and Selling Human Organs and Tissues
Some argue in favor of allowing human organs and
tissues to be bought and sold to increase thesupply and to respect people's autonomy. Others
argue against such saying that to treat the human
body and its parts as commodities violates human
dignity.(cf. LRCC, 56-62; and May, 165-7) Human
tissues and organs are in fact being sold in some
places. For example, a French pharmaceutical firm
buys placentas from 110 Canadian hospitals to
manufacture vaccines and other blood products
(Aikenhead), and some living poor people in
countries such as India sell one of their kidneys for
$700 or so. In Bombay, for example, there have
also been some cases of kidnapping where victims
regain consciousness to find that one of their
kidneys was removed while they were
drugged.(Wallace; cf. Rinehart)
Concerning this whole issue some distinguish
between human waste products such as placentas,
body parts that regenerate such as blood, and
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7/28/2019 Organ and Tissue Transplants
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nonregenerative human organs such as kidneys.
Many distinguish profit making from covering the
donor's expenses. Paying for organs can constitute
unjust moral pressure on the donor. It could
invalidate any free consent or a contract. Some
also fear that the buying and selling of organs and
tissues, if it became widespread, would undermine
the altruism (giving motivated by love) and social
bonding now associated with transplants. It could
also lead to organs going to the highest bidder.
Equity would be violated with ability to pay rather
than medical need determining the distribution of
organs. Some others, however, argue that this
could be controlled by regulating sales, and that
totally forbidding the buying and selling of human
tissues and organs would drive the market
underground. Because of the controversy and
ethical problems surrounding the buying andselling of human body parts, some say that other
alternatives should be pursued to increase the
supply.(cf. LRCC, 78-86; and Garrett et al., 203-4)
A World Health Organization resolution in 1989
that was eventually supported by more than 151
nations in part, "Calls Upon Member States to take
appropriate measures to prevent the purchase and
sale of human organs for transplantation..."(LRCC,
162-3 and 202-3) With respect to blood
transfusions, Pope Pius XII said, "It iscommendable for the donor to refuse
recompense: it is not necessarily a fault to accept
it."(LRCC, 58) Concerning the Christian vision
which sees human life and the body as "a gift of
the Creator, which persons cannot dispose of as
they please", the German Bishops' Conference and
the Council of the German Evangelical Church say,
"This does not exclude compensation for the
expenses incurred by the donation of tissue and
organs, but it does forbid deriving profit from
it."(375; cf. Chilean Bishops' Permanent
Commission, 374). The Catholic Health Association
of Canada (CHAC) holds that the buying and selling
of human organs, tissues and blood "contradicts
the principle of charity which is part of the
necessary justification for such
transplantations."(46)
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7/28/2019 Organ and Tissue Transplants
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b) Media Publicity
Sometimes an organ or tissue is procured for a
person by publicizing their need through the
media. This could bypass the regular transplant
channels and their selecting recipients for an
available organ on the basis of greatest need and
greatest likelihood of benefit, and first come first
serve (see 3.a above). On the other hand, media
pleas frequently bring in more volunteers than
those required for the case being publicized.
Media publicity also increases public awareness of
the need for transplants and so in the long run
should increase the supply of donated tissues and
organs. Garrett et al. argue that at this stage of
medical history media publicity for a particular
case should be tolerated, but in time it should be
eliminated as much as possible.(212)
)
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(212.
c) Types of Consent (Voluntary or Expressed,
Family,
Presumed, Required Request, Routine Inquiry)
Voluntary or expressed consent involves a person
making known their free offer to donate one or
more of their organs and/or bodily tissue, after
they have died or while alive.(cf. 1.a and b above)
Concerning cadaver donation, a person canexpress their wishes by some form of advanced
directives, such as by filling out the Universal
Donor Card attached to their driver's license. Free
and informed consent is required when the
transplant is from a living donor. Previously
expressed voluntary consent regarding a deceased
donor is the ideal because it involves an act of love
and responsible stewardship over one's body. It
also communicates to others, including one's
family and health care professionals, one's wishes.
In the absence of clearly expressed voluntary
consent, the family or person lawfully responsible
for the body of the deceased may be approached
regarding donation. Proper respect involves due
consideration of the wishes of the deceased and
their loved ones.
Many potential organs and tissues for
transplantation (e.g. of brain-dead accident
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7/28/2019 Organ and Tissue Transplants
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victims) are lost because the person did not
previously express voluntary consent and their
families were not approached about donating.
Because of this and the shortage of organs and
tissues for transplantation, some have proposed
other models of consent including presumed,
required request and routine inquiry, to hopefully
increase the supply. Although only a minority of
deceased potential donors have signed donor
cards, surveys show that most people favor organ
donation. Some argue that it is ethical to presume
consent on their behalf, unless the person while
alive gave clear indications to the contrary, since a
transplant does not harm the donor after death
and it can benefit others. France, Belgium and
some other countries have various forms of
presumed consent legislation in place. People can
opt out by registering their intention not to be adonor. Questions concerning this approach
include: Should minors and the mentally disabled
be included? To what extent should health care
professionals check to see if the person has
expressed a wish not to donate? Can not this be a
form of exploiting human ignorance and weakness
(cf. people ignorant that they can opt out or too
lackadaisical to do so)?
Required request requires hospitals to develop
protocols to ensure that families of potentialdonors are actually asked to donate. Routine
inquiry requires hospitals to develop protocols to
ensure that families of undeclared potential
donors have the opportunity to donate - people
tend to react more positively when offered a
choice. Some have criticized these approaches as
not allowing professional discretion. Many health
professionals are reluctant to approach families
who have just lost a loved one about
transplantation. This is considered a major barrier
to increasing the supply of organs and tissues.
Most families though do not object to being
approached. Required request or routine inquiry
has been widely endorsed in the United States as a
preferred public policy option when compared to a
free or regulated market of organ and tissue sales
or a presumed consent approach. It is seen as
more respectful of altruism, familial sentiments
and religious interests. It can also help the
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7/28/2019 Organ and Tissue Transplants
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bereavement process by making something
positive come out of the death. Some significant
increases in organ and tissue donation have been
recorded where this policy is in place. A few
jurisdictions also allow presumed consent
following required inquiry if the family did not
object.
The Law Reform Commission of Canada
recommends maintaining and strengthening the
present express consent model in Canada with
hospitals implementing routine-inquiry protocols.
These, however, are to recognize professional
discretion not to ask in cases where this would
clearly be inappropriate.(LRCC, 39-46, 145-39, and
176-82; cf. Varga, 221-2; Garrett et al., 210-11;
Ashley and O'Rourke 1989, 310; and May, 167-8)
d) Fears, Confusion and the Need for Education
There is a need for education of the general public
and many health care professionals concerning the
whole area of organ and tissue transplants. Many
people are not well informed of the needs, the
shortage of organs and tissues, and the great
potential benefit of many people for transplants.
Many have unfounded fears or reservations or are
confused about some of the issues of being adonor. In a recent United States survey, "the two
most common reasons given for not permitting
organ donation were (1) they might do something
to me before I am really dead; (2) doctors might
hasten my death."(LRCC, note 226) This shows
ignorance of standard policy and procedure
concerning transplants. These include strict criteria
for determining total brain death and the
separation of the ill or dying patient's health care
team and the transplant team.
Although surveys show that most people think
transplantation is a good thing, only a minority
sign an organ donor card. Why? First of all, many
are not fully aware of the advantages of this type
of voluntary expressed consent.(see section 4.c
above) Some people may be unwilling to think
about their own mortality, an inevitable fact, or be
superstitious. For example, they may mistakenly
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7/28/2019 Organ and Tissue Transplants
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think that signing a donor card will increase their
chance of a fatal accident. Some may have
concerns about the mutilation of their body.
Organs and tissues, however, are carefully
removed and incisions are closed, so that it will
not be apparent to anyone viewing the body that
organs or tissues have been donated.(HOPE, 3)
Also,
Some people wonder what will happen to their
bodies if at death they donate an organ. The truth
is that every earthly body decays. Therefore, the
alternative is between an organ decomposing or
serving to keep an other human being alive. We
Christians believe, as St Paul tells us, that our
corruptible body will be transformed into a
spiritual body for the glory of God (cf. 1 Cor 15:35-
53)(Chilean Bishops' Permanent Conference, 375)
Some people may also not realize that they can
specify limits on an organ donor form regarding
the use of their body (e.g. which organs they may
or may not wish to donate). People should be
encouraged to consider organ and tissue donation
as a "legacy of love", as an incarnate form of
"CHARITY AFTER DEATH."(Wolak, 18)
Health care professionals also need to be educated
about the meaning of organ and tissuedonation.(CHAC, 43) Some have unfounded
reservations about approaching individuals or
families to consider organ and tissue donation. It is
important that some members of the health care
team be trained in approaching potential donors
and their families in a sensitive way. They need to
be able to provide the necessary personal and
social support regarding the grieving process.(cf.
Batten) Some health care professionals also need
to learn that properly respecting the dead human
body is a requirement of our humanness. Along
these lines some medical schools offer services of
remembrance and gratitude before and after
dissecting human cadavers.(Lynch, 1018) Care
needs to be taken, too, regarding the language
one uses about the dead. For example, "harvesting
the dead" connotes "taking" and is repugnant,
whereas "donation" connotes "giving" and is
dignified.(cf. Belk) In order to increase the
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, 375)
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7/28/2019 Organ and Tissue Transplants
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potential for transplants, some health care
professionals have a special responsibility with
regard to raising the general level of consciousness
of the needs. This should be done in a way that
always properly respects patients' rights of
confidentiality and that does not detract from
communicating other pressing health care issues.
"The public is entitled to be accurately informed
about the medical progress and implications of
transplantation."(CHAC, 47; cf. German Bishops...,
376)
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Conclusion
A number of the many ethical issues concerningorgan and tissue transplants have been treated in
this paper. These issues concern the donor, the
recipient, the allocation of limited resources, and
the means of procuring organs and tissues.
Although there have been some abuses in this
field, and there are some areas of controversy, I
would like to conclude with a positive note.
Organ donation, carried out under proper
conditions, is a beautiful and modern expression of
Christian charity: it gives dignity to the person who
in death becomes a life-support for another; it
shows noble concern for the respect of the life of
others; and it implies a sense of communion with
humanity. The Gospel proclaims that there is no
greater love than to give one's life for another (cf.
Jn 15:13). Jesus welcomes the good done to
another as though it were done to himself (cf.
Matt 25).(Chilean Bishops' Permanent
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7/28/2019 Organ and Tissue Transplants
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Commission, 375) 375).
Some Cases and Questions For Discussion
1. Don and Dan are identical twins. After Don
suffers kidney failure, Dan is requested by his
brother's wife to donate one of his healthy kidneys
to Don. Does Dan have any obligation to surrender
one of his healthy kidneys to his brother? Under
what condition would you defend Dan's decision
not to surrender his kidney.(From Ashley and
O'Rourke 1986, 172)
2. Is it ethical for a living person with two good
eyes to donate an eye to enable a blind person to
see?
3. Sally was 15 years old and had been a practisingJehovah Witness for several years. She lived with
her sister Jane, who was 18 years old and an
atheist, and mother, who had been a Jehovah
Witness but who renounced this following a legal
separation with her husband. Sally had only seen
her father, who was a devout Jehovah Witness, a
few times since the separation. Sally was involved
in a bad car accident and before lapsing into a
coma was heard to say repeatedly, "I don't want to
die. Please help me." The doctor said Sally would
die without surgery which required a bloodtransfusion. The surgery had a 90% success rate,
with a 5% chance of paraplegia and another 5%
chance of death. Sally's mother insisted that the
operation with a blood transfusion take place to
save her life. Her father strongly objected that this
would violate a sacred principle of Sally, an
avowed Jehovah Witness. Jane pointed out that
Sally was a minor and questioned whether her
commitment to the blood transfusion principle
could have been fully informed and voluntary. Her
parents were her legal guardians. The doctor went
before a judge to seek a resolution. If you were the
judge, what would be your decision?(condensed
from Thomas and Waluchow, 150-4)
4. Baby Fae was born with a severe heart defect
which would cause her death within a few weeks.
Her parents were poor and in a country without
universal medical insurance. Loma Linda Hospital
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7/28/2019 Organ and Tissue Transplants
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offered to cover the costs of transplanting a heart
from a baboon. The parents signed an elaborate
consent form which was never released. The
doctors did not consider the possibility of a human
donor, thinking the hopes of finding one were
almost nonexistent. It seems that they also did not
seriously consider a new form of corrective
surgery for this type of heart defect with a 40
percent survival rate after several years. Baby Fae
was reported in serious but stable condition for
two weeks following the operation, but died a
week later, apparently of complications related to
rejecting the baboon heart. Did the doctors act in
an ethical manner? Under what conditions, if any,
would a transplant of this nature be
acceptable?(cf. Ashley and O'Rourke 1986, 117;
and Thomas and Waluchow, 119-24)
5. Should public funds cover the related costs of
transplants for all people who can benefit from
them? Should taxes be increased to fund more
publicity of the need and so increase the supply of
organs and tissues for transplants, and to pay for
more transplants, so that more people can live
longer and healthier?
6. Mrs. Simpatico, a nurse, had cared for Joseph,
who was 30 years old, a few weeks before he died.
The hospital has a policy requiring nurses to askthe families of all dead patients for organ
donations. Both she and the family are very upset
about the death. She believes Joseph's young wife
and three children need comfort and not decisions
at this moment, so she does not ask for the organ
donation, even though the hospital has a long
waiting list. When the nursing supervisor discovers
this omission, she reprimands Mrs. Simpatico and
warns her: "One more incident like that and you
will be fired." Is the hospital's policy good? Was it
right for Mrs. Simpatico to make an exception in
this case?(adapted from Garrett et al., 221)
7. Two men on the same service are awaiting a
cornea transplant because of chemical burns on
their eyes. One is an alcoholic street person with
other serious health problems. The other is a
prominent lawyer with a wife and three children. A
donor's eye becomes available, and by coincidence
.
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7/28/2019 Organ and Tissue Transplants
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both men's cornea match the donor's. The
physician decides on the basis of "first come, first
served" and transplants the cornea to the
alcoholic. Is it ethical to do this when the alcoholic
has more serious health problems? Is there a
relevance to the patients' social
positions?(adapted from Garrett et al., 221)
8. Anissa is 17 years old when it is discovered she
has leukemia. Her primary hope for survival rests
on a bone marrow transplant, but there are no
likely donors for her unusual genetic
characteristics. Her parents decide to have
another child in the hope that the infant will
provide a tissue match (a 25% chance). Is it
ethically right to conceive a child for the purpose
of generating tissue for transplantation? If the
infant is a tissue match, is it right for the parents todecide for the infant?(adapted from Garrett et al.,
222)
9. In your opinion why do comparatively few
people sign the Universal Donor Card on their
driver's license?(adapted from Ashley and
O'Rourke 1986, 210)
10. After Ben, a 10 year old boy, is declared brain
dead in Alberta Children's Hospital, Dr. Mitchell
asks Ben's parents if they have considered organdonation. They consent because they think it is a
good way to deal with their grief and what Ben
would have wanted. As a result a few other
children are living normal lives: Kirsten of
Edmonton received Ben's heart; Stuart of Airdrie
and Amy of Calgary each received one of Ben's
kidneys; Johnny of Pittsburgh received Ben's liver;
and Steven of Lethbridge received Ben's cornea.
(This case is presented in the video, "Have You
Considered Organ Donation?"[1991, 11 minutes],
the Human Organ Procurement and Exchange
Program [HOPE], University of Alberta Hospitals.)
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7/28/2019 Organ and Tissue Transplants
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.)
References:
Aikenhead, Sherri (1993). "Sale of Human Placentas to French Pharmaceutical Firm Questioned" and
"Hospitals Should Inform Mothers if Placentas Traded - Commissioner," The Edmonton Journal, 3 Mar.
1993, A14, and 4 Mar. 1993, A11, respectively.
Altman, Lawrence K., M.D.(1990). "Should Alcoholics get new Livers?", The Edmonton Journal, 15 Apr.
1990, E6.
Appleton International Conference (1992), "Developing Guidelines to Forgo Life-prolonging Medical
Treatment," The Bioethics Bulletin, University of Alberta, Edmonton, Jan. 1993, 2-7.
Ashley, Benedict M., OP; and Kevin D. O'Rourke, OP (1986). Ethics of Health Care. St. Louis: Catholic
Health Association of the United States.
__________ (1989). Health Care Ethics, Third Edition. St. Louis: Catholic Health Association of the United
States.
Associated Press, "Brain-dead woman suffers miscarriage," The Edmonton Journal, 17 Nov. 1992.
Batten, Helen Levine (1990). "The Social Construction of Altruism in Organ Donation," Ch. 8 in Organ
Donation and Transplantation: Psychological and Behavioral Factors, ed. by James Shanteau and Richard
Jackson Harris. Washington, DC: American Psychological Association.
Belk, Russell W. (1990). "Me and Thee Versus Mine and Thine: How Perceptions of the Body Influence
Organ Donation and Transplantation," Ch. 12 in Organ Donation and Transplantation: Psychological and
Behavioral Factors, ed. by James Shanteau and Richard Jackson Harris. Washington, DC: American
Psychological Association.
Cefalo, Robert C.; and H. Tristam Engelhardt, Jr. (1993). "The Use of Fetal and Anencephalic Tissue for
Transplantation," Eike-Henner Kluge, ed., Readings in Biomedical Ethics: A Canadian Focus. Scarborough:
Prentice Hall Canada Inc., 367-78.
CFRN Television (1987). "A Second Chance" (Video, 50 minutes). Available from HOPE, University of
Alberta Hospitals, Edmonton.
[CHAC] Catholic Health Association of Canada (1991). Health Care Ethics Guide. Ottawa. References are
by page number.
Childress, James (1978). "Rationing of Medical Treatment," Encyclopedia of Bioethics. New York: The
Free Press, 1414-19.
Chilean Bishops' Permanent Commission (1991). "On Organ Transplants," Catholic International, 15-30
April 1991, 374-5.
Dailey, Thomas G. (1993). "Fetal Tissue Transplants: Some Ethical Questions." Edmonton: St. Joseph's
College Catholic Bioethics Centre, Jan. 1993.
7/28/2019 Organ and Tissue Transplants
30/32
Duncan, Glenn E. (1992). "Grim Harvest," The Catholic World Report, Aug. 1992, 16-22.
Engelhardt, H. Tristram (1987). "Allocating Scarce Medical Resources and the Availability of Organ
Transplantation: Some Moral Presuppositions," Thomas A. Shannon, ed. Bioethics, Third Edition.
Mahwah: Paulist Press, 565-79.
Garrett, Thomas M.; Harold W. Baillie; and Rosellen M. Garrett (1993). Health Care Ethics: Principles and
Problems. Englewood Cliffs: Prentice Hall, Ch. 9.
Gaylin, Willard, M.D. (1987). "Harvesting the Dead," in Bioethics, Third Edition, ed. by Thomas A.
Shannon. Mahwah: Paulist Press, 553-63.
German Bishops' Conference and the Council of the German Evangelical Church (1988). "Christians and
the Ethics of Organ Transplants," Catholic International, 15-30 April 1991, 373-6.
Goddard, Hans (1992). "No Easy Way to Figure Costs of Transplants," The Medical Post, 7 July 1992, 43.
Hanson, Mark J. (1992). "A Pig in a Poke," Hastings Center Report, Nov.-Dec. 1992, 2.
Helsinki Declaration of 1975, Encyclopedia of Bioethics, Vol. 1V. New York: The Free Press, 1978, pp.
1771-3.
[HOPE] Human Organ Procurement and Exchange Program (1993). Organ & Tissue Donation (pamphlet).
Edmonton: University of Alberta Hospitals.
John Paul II, Pope (1982). "Biological Experiments Should Contribute to the Well-Being of Mankind,"
L'Osservatore Romano, English weekly ed., 8 Nov. 1982, pp. 4-5.
Johnston, Cameron (1993). "Transplanting Animal Organs Into Humans Could Soon Become a Reality in
Canada," The Medical Post, 5 Jan. 1993.
Jonsen, Albert R. (1989). "Ethical Issues in Organ Transplantation," Ch. 9 in Medical Ethics, ed. by Robert
M. Veatch. Boston: Jones and Bartlett Publishers, 229-52.
[LRCC] Law Reform Commission of Canada (1992). Procurement and Transfer of Human Tissues and
Organs, Working Paper 66. Ottawa: Canada Communication Group - Publishing.
Lynch, A. (1990). "Respect for the Dead Human Body: A Question of Body, Mind, Spirit, Psyche,"
Transplantation Proceedings, Vol. 22, No. 3 (June), 1990, pp. 1016-18.
MacNeil, Archbishop Joseph N. (1986), excerpt in "Your Religion and Organ Donation" (pamphlet).
Edmonton: Lions Eye Bank.
May, William E. (1977). Human Existence, Medicine and Ethics. Chicago: Franciscan Herald Press, Ch. 7.
Moss, Alvin H.; and Mark Siegler (1993). "Should Alcoholics Compete Equally for Liver Transplantation?",
Eike-Henner Kluge, ed., Readings in Biomedical Ethics: A Canadian Focus. Scarborough: Prentice Hall
7/28/2019 Organ and Tissue Transplants
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Canada Inc., 85-94.
O'Donnell, Thomas J., S.J. (1976). Medicine and Christian Morality. New York: Alba House.
Post, Stephen G. (1991). "Fetal Tissue Transplant: The Right to Question Progress," America, 12 Jan.
1991, 14-16.
Reuter (1993). "Pigs Born with Human Genes," The Edmonton Journal, 12 Mar. 1993.
Rinehart, Dianne (1993). "Sold for Organs, Risk to Kids Grows," The Edmonton Journal, 22 Jun. 1993,
B14.
[SCDF] Sacred Congregation for the Doctrine of the Faith (1980). Declaration on Euthanasia. Battleford,
Sask.: Marian Press.
__________ (1987). Instruction on Respect for Human Life in its Origin and on the Dignity of
Procreation. Boston: St. Paul Editions.
Siegel, Lee (1992). "Use of Pig Liver Defended," The Press Democrat, 14 Oct. 1992, B4.
Thomas, John E.; and Wilfrid J. Waluchow (1990). Well and Good: Case Studies in Biomedical Ethics,
Revised Edition. Peterborough: Broadview Press.
Varga, Andrew C. (1984). The Main Issues in Bioethics, Revised Edition. Ramsey: Paulist Press, Chs. 11
and 12.
Wallace, Charles P. (1992). "Trafficking on Kidney Street: The Rich get Healthier from Trade in Human
Organs," Science and Medicine, 13 Sept. 1992.
Wolak, Richard, OMI (1990). "Donate Your Organs: Charity After Death: Everyone Should Plan to be an
Organ Donor," Our Family, July/August 1990, 15-18.
Suggested Reading/Viewing:
Ashley, Benedict M., OP; and Kevin D. O'Rourke, OP (1989), Health Care Ethics. St. Louis: Catholic Health
Association of the United States, especially re ethical methodologies, norms of Christian decision in
bioethics, and organ transplantation.
Catholic Health Association of Canada (1991). Health Care Ethics Guide. Ottawa, especially pp. 42-47.
Human Organ Procurement and Exchange Program [HOPE] (1991). "Have You Considered Organ
Donation" (Video, 11 minutes). Edmonton: University of Alberta Hospitals. HOPE also has available other
relevant videos and up-to-date educational literature.
Law Reform Commission of Canada (1992). Procurement and Transfer of Human Tissues and Organs,
Working Paper 66. Ottawa: Canada Communication Group - Publishing.
Thomas, John E.; and Wilfrid J. Waluchow (1990). Well and Good: Case Studies in Biomedical Ethics,
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Revised Edition. Peterborough: Broadview Press, Cases 7:1, 7:3, 8:4, 9:1, 10:1, 10:2, and 12:6.
Author's (Paul Flaman's) Home Page