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Acta bioethica

versión On-line ISSN 1726-569X

Acta bioeth. vol.24 no.2 Santiago dic. 2018

http://dx.doi.org/10.4067/S1726-569X2018000200219 

Originales

Ethical Disputes over Living Organ Transplant and the Applicable Solutions to These Disputes in China

Disputas éticas sobre el trasplante de órganos vivos y soluciones aplicables a esta disputas en China

Disputas éticas sobre transplante de órgãos vivos e as soluções aplicáveis a estas disputas na China

Tongwei Yang1 

Yijin Wu2 

1China. Shandong University, School of Medicine Correo electrónico: wuyijin9972@126.com

2China. Qufu Normal University, School of Translation Studies/Center for Medical Humanities in the Developing World Correo electrónico: wuyijin9972@126.com

Abstract:

Objectives: In this study, we examine the ethical issues concerning living organ transplant in China. We attempt to review and analyze the ethical disputes that the living organ transplant faces in China and try to find applicable solutions to these disputes. Design: Ethical Analysis. Setting: Living organ transplant in China. Results: The ideal approaches to solving the ethical disputes involve (1) preventing disease, strengthening physical fitness, and improving the health of the national citizen; (2) encouraging the citizens to donate their organs after death; and (3) developing new technologies for organ transplant. Realistic approaches to addressing the ethical disputes over the living organ transplant include choosing the lesser of two evils, reducing the harm to the donor as much as possible and improving the transplant quality. Conclusions: The living organ transplant in China is an expedient measure instead of an ideal option and should be conducted under strict laws and regulations.

Key words: living organ transplant; ethical disputes; organ donors; organ recipients

Resumen:

Objetivos: Neste estudo, examinamos as questões éticas relativas ao transplante de órgãos vivos na China. Vamos tentar rever e analisar os conflitos éticos que o transplante de órgãos vivos enfrenta na China e tentar encontrar soluções aplicáveis a estas disputas. Projeto: Análise ética. Configuração: Transplante de órgão vivo na China. Resultados: As abordagens ideais para resolver os conflitos éticos envolvem (1) prevenção de doenças, fortalecimento da aptidão física e melhora da saúde do cidadão nacional; (2) incentivar os cidadãos a doar seus órgãos após a morte; e (3) desenvolvimento de novas tecnologias para transplante de órgão. Abordagens realistas para enfrentar as disputas éticas sobre o transplante de órgão vivos incluem escolher o menor de dois males, reduzindo o dano ao doador o máximo possível e melhorar a qualidade do transplante. Conclusões: Transplantes de órgãos vivos na China é uma medida conveniente ao invés de uma opção ideal e deve ser conduzida sob estritas leis e regulamentos.

Palabras clave trasplante de órganos vivos; disputas éticas; donantes de órganos; receptores de órganos

Resumo:

O artigo traz à discussão a compreensão atual do comportamento ecológico do ser humano, a partir de uma relação de dominação utilitária do ambiente em contraste com a sua compreensão do ponto de vista ecológico, a qual responde a um modelo natural que faz parte de relações de seu funcionamento no ecossistema. A este respeito, é colocado em discussão o paradigma de crise ambiental, em que tal comportamento supõe um problema grave da sociedade. Para os autores, a questão está intimamente ligada ao sistema produtivo e econômico que promove a artificialização do ser humano, criando falsas necessidades que, por meio de seu consumo, garantam a sustentabilidade do modelo econômico. É realizada uma reflexão crítica a partir da educação, no sentido de uma nova compreensão do comportamento humano, cuja perspectiva ecológica impulsiona novas relações ecossistêmicas baseadas na cooperação.

Palavras-chave: transplante de órgãos vivos; conflitos éticos; conflitos éticos; doadores de órgãos; destinatários do órgão

Introduction

The organ transplant technology is known as the frontier of medicine in the 21st century. As the most effective method for treating the end-stage organ failure, organ transplant has revitalized many critically ill patients. Currently, there are a large number of patients waiting for kidney, heart and lung transplant in China(1). In recent years, China has been increasing fund for clinical research on organ transplant. Also, the ethical issues on organ transplant has drawn much attention from both ethicists and transplant professionals. In 2000, Chen Zhonghua started to perform the living organ transplant in China and proposed two strategies to facilitate living organ donation, that is, home self-rescue and mutual rescue between families. In 2004, the proportion of living organ transplant in organ transplant was only 0.32% and increased to 24.7% in 2007(2). Researchers propose that living organ transplant has a good number of advantages. For example, liver is an organ with high regenerative capacity; specifically, after living organ transplant, the partial livers of both the donor and recipient will grow and remodel to form complete organs. In terms of the survival rate and transplant rejection, the living organ transplant is more felicitous than the cadaveric organ transplant. There are a great number of touching stories about living organ donation in China. For example, a father donates part of his liver to his son; a husband donates a kidney to his wife. However, there also exists questionable attitude toward the living organ transplant. For example, Shi (2016) argued that living organ transplant could cause an irreversible damage to the donor’s body(3).

In this study, we attempt to review and analyze the ethical disputes that the living organ transplant faces in China and try to explore applicable solutions to these disputes.

The Ethical Disputes over the Living Organ Transplant

The complexity of social morality makes living organ transplant full of disputes. Some scholars show positive attitudes toward living organ donation, however, others express negative attitudes toward living organ donation. Here, we will elaborate on the views of the opponents and proponents.

The Solution to the Ethical Disputes of Living Organ Transplant

Chen (2008) argued that living organ transplant was at the expense of fresh blood, pain, or even life(11). Whether in the past, present or future, at home or aboard, it is just an expedient method instead of the mainstream of organ transplant(11). Objectively speaking, procuring organs from living people is a reluctant action. It is a kind of helplessness. Huang (2014) reported that although living organ transplant is not encouraged by the state, we have no alternative but to do(12). He also stated that cadaveric organ donation should be encouraged and living organ donation as a kind of charitable behavior needs to be controlled(12). It is clear that the living organ transplant involves not only the ethical values, but also the ethical dilemmas. We argue that living organ transplant should be treated objectively rather than being absolutely forbidden, and it should be dealt with under the guiding principle on life ethics including voluntariness, gratuitousness and respect. In this sense, we propose three ideal approaches to solving the ethical disputes of the living organ transplant.

First, people should strengthen physical activity habit and prevent illness or disease actively. The Nationwide Body-building Program (2016-2020) issued by the State Council in June, 2016 claims that the national citizen’s awareness about physical fitness will be improved markedly by 2020, the number of people participating in physical fitness will increase obviously and the physical quality of the general public will be strengthened steadily. In addition, attention should be paid to the early diagnosis and treatment of the disease(13). For example, the liver cancer can be diagnosed and treated at an early stage, which is one of the most important approaches to improving the liver cancer survival rate.

Second, the government should encourage the citizens to donate their organs after death. Increasing cadaveric organ donation is the key to decreasing the number of living organ donation, which is the most effective approach to ethical dispute resolution of living organ transplant. In recent years, Chinese government has taken a range of measures to increase cadaveric organ donation. In 2013, with the support and supervision of the Red Cross Society of China, the organ donation online system and Chinese organ allocation and sharing system were launched, which could boost the donation rates and monitor the equitable distribution of donated organs(14). To better manage organ donation and transplantation, the committee of organ donation and transplantation was jointly established by the Red Cross Society of China (RCSC) and the National Health and Family Planning Commission (NHFPC) on March 7, 2014(14). As of December, 2015, there were in total 5734 cases of cadaveric organ donation in China, and 15,722 organs including liver, kidney, heart, lung and pancreas were donated(15). It indicates that more and more Chinese citizens are willing to donate their organs after death. With the gradual establishment of the social donation system and the rapid progress of the transplant technologies, the number of cadaveric organ donation will increase remarkably.

Third, new technologies should be developed for organ transplant. Recently, the researchers at Harvard University claimed that they were able to make some human tissues with blood vessels by 3D printing technology. Jennifer Lewis, the research team leader said: “we believe the progress we made today is vital, and I think it will eventually make artificial organs(16)”. It is hoped that 3D printing technology can embed the blood vessel structure into the artificial organs, and these blood vessels will grow with other human tissues together. In October 2015, the world top journal Science reported that the gene of porcine endogenous retrovirus (PERV) can be successfully inhibited by using CRISPR/Cas9 gene editing technology(17). It indicates that human beings have made a great progress in the study of xenotransplants. However, there are still many barriers to overcome in the course of studying xenotransplants. After these technological difficulties are solved, the lack of available organs for transplant will cease.

Interpretation of the legal provisions on China’s living organ transplant

Regulations on Human Organ Transplant enacted in 2007 stipulate that the living donor should only be limited to the recipient’s spouses, lineal relatives, and collateral relatives by blood up to the third degree of kinship or people who have proof of having kinship to the donor due to assistance or other reasons(19). It ensures that the potential living donor is the recipient’s relative and thus would reduce the possibility of organ trading. It is well known that the living donation is harmful to the donor’s health, and thus living organ donation will not occur unless there is deep affection and profound love between the donor and recipient. To better implement Regulations on Human Organ Transplantation, the Ministry of Health issued Several Provisions on Regulating Living Organ Transplantation in 2009, which made more detailed and definite provisions on the living organ transplant. Based on the ethical analysis above, we try to interpret these provisions.

Conclusion

The living organ transplant is full of ethical dilemmas. It is an kind of reluctant action because of the lack of cadaveric donors. Thus, living organ transplant should be conducted under strict laws and regulations. Realistic approaches to addressing the ethical disputes of the living organ transplant include choosing the lesser of two evils, reducing the harm to the donor as much as possible and improving the transplant quality. Informed consent from the donor is the cornerstone of the living organ transplant. However, it is unknown to what extent donors are willing to donate their organs of their own free will instead of catering for their family interests. How to avoid turning “an act of great virtue” into “acting out of duty”? How to guarantee that the donor has sufficient psychological preparation and decision-making space instead of being forced by the family and social pressure? These issues are more complex, and we will explore them in another paper.

Financiamiento

The research was funded by a grant (16CZXJ01) from Shandong Social Science Research Council.

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Received: February 09, 2018; Accepted: April 03, 2018

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