Ethics in Organ Donation

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Despite of the laws and regulations in place in the system are has been recent instances of illegal organ trade in two high profile hospitals of India.

Apollo Hospital

In June 2016, the Delhi police arrested three kidney donors who claimed to have been lured to sell their kidneys for some Rs 3 lakh ($4,500). Two other arrested were assistants of the transplant surgeon in the Apollo hospital of Delhi. It was found that these assistants drew up an elaborate fake documentation and got donors for patients who were willing to pay for the organs.

The hospital denied role in the scam saying they were victim of a well-orchestrated operation to cheat patients and the hospital. This fake documentation were used to dupe the hospital by passing off the victims as relatives of the recipients, which is permissible under Indian law. But this incident questions the internal assessment committee of such transplants in the hospital as the process of organ procurement involves an extensive set of documents along with an affidavit which is to be screened by the committee.

It also questions the involvement of the transplant surgeons in the scam. However they get a benefit of doubt as not being directly involved in the screening of the documentation and their role being limited to carrying out the transplant itself. This questions the ethics of the doctors as well as the institution which is considered to be best among private hospitals.

Another such incident happened just after the Apollo scam in July, 2016, in Mumbai at the Hiranandani Hospital in Powai.

Hiranandani Hospital

Police foiled the attempt of a 42-year-old man trying to pass off a woman as his wife and have her kidney donated to him. A case was registered against the man, who was to receive kidney, his son, the three middlemen and the woman posing as his wife, under the Indian Penal Code along with the Transplantation of Human Organs Act, 1994.

Another high profile hospital was under the scanner for an illegal practice of organ donation. This brings in light the loopholes present in the organ transplant law, which have been exploited by racketeers, especially by kidney racketeers. The provision that allows unrelated person to donate out of love and affection is utilized by such unscrupulous individuals to bypass norms and carry out the scandal. This highlights the basic problem of the perpetual shortage of organs. There is a huge demand-supply gap which fuels a murky black market of organs.

Ethical Issues

Organ Shortage

The primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs. In India around 200,000 people need a kidney every year but only 3% of the demand gets satisfied. Out of this 200,000 in need of a kidney, around 15,000 can afford treatment but only 7,000 can afford transplants. Even if transplant is affordable it is very difficult to find a matching donor. This supply-demand gap for organs paves way for the illegal transplant and trade of human organs.

Due to this shortage another issue comes into picture which is of the concept of distributive justice - how to fairly divide resources. This concept states that there is no right way to distribute organs but rather many ways to justify giving an organ to one particular person.

One distributive justice criteria is equal access which says that patients would be objectively allocated the organs. It is aimed to limit the bias and unfair distribution based on race, sex, income level and geographic distance from the organ. The criteria here are:

- Length of waiting time (i.e. first come, first served)

- Age (i.e. youngest to oldest)

There is a social bias as well where the slippery slope of determining an individual’s worth and whether or not someone is worthy of a medical procedure which is taken care in this criterion. It is believed to be a valuable medical procedure and worth offering to those who need it. However, in a country like India it is very difficult to achieve this due to the various disparities present in the society. Because of which organ donation loses its credibility and we have very few voluntary donors.

Another distributive justice criterion is maximum benefit. It aims to maximize the number of successful transplants. For example:

- Medical Need, i.e. the sickest person is given the first opportunity for a transplantable organ

- Probable success of a transplant, i.e. giving organs to the person who will be most likely to live the longest

Its supporters believe that organ transplants are medically valuable procedures and should avoid wasting organs as they being scarce resources. But this theory raises doubts on the biases it brings in to maximize the success. Because the success cannot be gauged so objectively when there is a human life involved. However old a person might be but he has a right to his remaining life and hence cannot be left to die in order to save a younger person’s life.

To bridge the supply-demand gap of organs, medical experts believe that cadaver donations should be encouraged. They suggest that a brain-dead patient can be a source for the much required organs. This brings another ethical issue of whether think practically and approach the already grieving families for organ donation.

Donor Organs

The problem of shortage of transplantable organs can be solved by increasing the number of donor organs. However, it could lead to another set of malpractices like organ farming or premature declarations of death in order to harvest organs. So there is a need to define an ethical boundary to limit the source of transplantable organs. The three sources within this boundary can be:

- Cadaveric donors

- Living Donors

- Alternative Donors

Cadaveric organ donation

With a person’s consent, post his death, his organs can be removed and donated to the patients with dysfunctional organs. Even a brain dead person, i.e. brain function ceases, can also donate his organs. Sometimes, the deceased person can be kept on life support to preserve his organs until they can be removed. However, this is at the discretion of the family members of the deceased. If