Practical Ethics

Umbilical cord blood donation: opt out or work on Sundays?

Umbilical cord blood (UCB) contains haematopoietic stem cells, which can be used for the treatment of several lethal disorders, including leukaemia and several types of anaemia. Other sources of haematopoietic stem cells are bone marrow and ordinary peripheral blood. Unlike bone marrow donation, which requires general anaesthesia, UCB donation does not cause any inconvenience or significant risks for the donor. Peripheral blood contains very few stem cells. Another major advantage of using UCB stem cells is that less genetic similarity is required between donor and recipient. This increases the chance of finding a ‘match’ and thus of the transplantation being successful.

The Future of Making Organs for Self-Transplantation

Scientists have been able to create a new windpipe using stem cells. They took a windpipe from a dead patient, removed all the cells, and placed stem cells from a patient onto the remaining scaffolding to create what was in effect a new windpipe, with the patient’s own cells. The patient had an irreparably damaged her windpipe from TB.

The significance of this is that it opens the door to creating whole organs, like kidneys, livers and perhaps even hearts and lungs. This is a radical advance because up until now, stem cells have only really been useful to replace tissue, or bits of the body without a complex organized structure. But this means we could potentially replace any part of the body with a person’s own stem cells. New livers for people with liver failure, new kidneys from those with kidney failure – and because the cells would come from the patient, there would be no rejection. Indeed, this patient has shown no signs of rejection.

Does this raise any ethical issues?

Status quo bias and presumed consent for organ donation

Yesterday the UK organ donation taskforce released its report on a presumed consent (opt-out) system for organ donation. To the consternation of the chief medical officer and the Prime Minister the taskforce advised against the introduction into the UK of such a system.

In an editorial in today’s Guardian, it was observed that both the low rates of consent in the UK – and the taskforce’s response to the question of presumed consent may represent an irrational preference for the default position. They may both be examples of the status quo bias.

Death Fiction and Taking Organs from the Living

By Julian Savulescu and Dominic Wilkinson

Imagine you could save 6 lives with a drop of your blood. Would you have a moral obligation to donate a drop of blood to save six people’s lives? It seems that if any sort of moral obligation exists, you have a moral obligation to save six lives with just a pinprick of your blood.

But every day people do far worse than failing to give a drop of blood to save 6 lives. They choose to bury or burn their organs after their death, rather than save 6 lives with these organs. And it would cost them nothing to give those organs after their death. Our failure to give our organs to those who need them is among the greatest moral failures of our lives. At zero cost to themselves, not even having to endure a pinprick, many people choose to destroy their lifesaving organs after their death.

Finding holes in the brain: to test or not to test for Creutzfeldt-Jakob?

A new test for carriers of variant Creutzfeldt-Jakob disease is under development, but it raises an ethical problem: should we test for untreatable deadly illnesses? And might it reduce the amount of blood donations?

The paradox of organ donation consent

In Australian newspapers today a Melbourne intensive care physician, Jim Tibballs is reported as criticising current organ donation guidelines on the grounds that donors are not actually dead at the time that organs are removed. Other doctors have called Professor Tibballs’ comments “irresponsible” on the grounds that they might cause a significant fall in organ donation rates.

Radical organ retrieval procedures

I wrote recently about the controversial news that surgeons in Denver had taken organs, including the hearts, from newborn infants who had died in intensive care.
In recent years the retrieval of organs from patients whose hearts have stopped (so-called donation after cardiac death, DCD) has become more popular. In part this is because of the problem that there is a shortage of organ donors who are brain dead. It is also because of the recognition that when patients die after removal of life support, their organs may still be viable for transplantation.

When the heart stops: harvesting organs from the newly (nearly) dead

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

“Reanimation” and Taking Organs from Living People

One of the greatest fears associated with organ transplantation is that the person from whom organs are taken is not really dead.

That nightmare was almost realised in France last week when a French patient “came back to life” after 30 minutes of unsuccessfully heart massage. In 2007, in order to address the shortage of organs for transplantation, French authorities allowed the trial of using people whose hearts have stopped beating, but who have not met brain death criteria for being dead, as organ donors. These are called Non-Heart Beating Donors. Organs can also be taken from such donors in the UK. Such patients’ hearts have stopped beating but they have not met brainstem criteria for death.

Setting a Minimum Price for the Sale of Organs

Professor Maqsood Noorani, a leading surgeon made the headlines asking for legalisation of the sale of organs to prevent the exploitation that exists in the black market. Yet his comments show that he is uneasy with the concept of a market in organs. He believes that the sale of organs in richer nations would 'tarnish the process', and suggests that even in poorer countries accommodation or education should be offered in exchange instead of cash. 

When two people want to freely exchange some good or service, we need good reasons in a free market to prevent the exchange. Moreover, when it comes to a market in organs, the good in question is life saving. Why then should we prevent such exchanges when there are willing buyers and sellers?