Organ Donation and Transplantation

Human organs for transplants are scarce compared to the number of needy recipients. Perhaps that is why the "Transplant Group" in co-operation with the Danish Department of Health has arranged an essay competition for high school students. NB The subject is NOT organ transplants, but organ donation which must mean that the target group are potential donors, and the debate is sought limited to "shouldn’t we all donate?" rather than "why donate at all"?

However, if the Transplant Group succeeds in shifting the focus of the debate from the ethical aspects to the practical, from what we want to do to what we can do, we risk overlooking the calculations that show the limitations of the project.

Life itself, its origin and meaning, is probably the issue that has occupied Man the most, at all times and in all cultures. But whereas earlier times sought an answer to something that was "given" them by a detached power, sooner to be accepted than explained, today the situation is that Man rules and controls life, from creation to end.

Knowledge has replaced mythology, and that to such an extent that the only unanswered question regarding life and death is whether there is an afterlife. By this question, however, we move toward a subject that is not part of science, but part of the (Christian) ethics that has marked our western civilization.

However, even if also ethical questions and answers may vary from time to time, it is not a result of our getting "wiser"; instead, attitudes change. Thus in the question regarding organ donation there is no "correct" answer which we already know or will know because this answer reflects an attitude.

Attitudes, however, change. You have a point of view until you have another - a real sound attitude since too rigid a clinging to a principle may be absurd if the circumstances are changed.

But life itself? There cannot be two opinions as to whether we should respect life, especially human life (although generals and politicians may only have learned that recently)? Well, yes, there are several opinions because the question is, in fact, how do we best respect life? The crucial answer must be a weighing of whether we want to preserve and prolong already existing life (almost at any cost), or whether we will allow nature to take its course.

The transplant industry claims that it considers the interests of the individual and adduces the preservation of human life and an improvement of living conditions as its strongest arguments. In addition to transplantation of human organs, it seems that from now on also cloned organs will be part of the attempts to prolong human life.

Who would not give an organ to a near and dear one? All parents see it as their obligation to their offspring that they see to it that their children survive; and the ongoing concern for global issues leads to the idea that this obligation should be toward all humankind (a true Brotherhood of Man), especially if the donor is dying - it does not seem to be a sacrifice to will one's deceased body to somebody else. Since the time of Descartes, we have divided our existence into body and soul with the soul as the important one of the two. The soul holds our real existence, our identity; the body is a mere case or frame. Most likely, potential donors will donate an organ to relatives - even if the donor isn't dying - and at the same time perhaps feel the shame inside if one isn't willing to extend this generosity to all humankind if it is in one's power to save another person's life.

It is, however, interesting to see that the interest in an artificial prolongation of life rises in step with the neglect and ruthless exploitation of the world's resources, which will eventually lead to the extinction of humankind as a species. Besides this, access to necessities like water is dwindling, partly due to the increasing pollution, partly because of the profit seeking privatization that is allowed to gamble with basic elements of society (e.g. energy).

All in all, it seems that the transplant industry's alleged interest in preserving life and bettering the circumstances for others is nothing but a Faustian combination of regular business and a fascination of Man's technical prowess and power (especially in medical science): everything that can be implemented should be implemented, regardless of the long term consequences.

So far, the debate about organ transplants has mostly been going on in the western cultural hemisphere. But it may be useful to look at the issue from another culture:

When the aging Eskimo said, "I think I'll go outside for a while," and sat down on a floe to drift away into death, it had many reasons one of which was the respect for the survival of the community (one less unproductive mouth to feed), another a recognition of the cyclical course of life: something must die in order that something else may live. Another reason was a feeling of self-worth, expressed in a meaningful life, contrary to the shame it is to cling to a life devoid of meaning. There’s no doubt that the Eskimo's family loved the elder member, but nobody tried to stop him when he felt that his time had come; for it was his decision to close the circle, and they showed their respect for him by respecting his decision.

In a wealthier, industrialized society, we can afford to keep alive the people who only live biologically, i.e. breathe, but otherwise have no lives. And because of the plenitude in western industrialized societies many will claim that life may still be lived with a purpose even if an impediment hinder some of their actions. Even demented people are spared because of the feelings we have for them, first and foremost to "honor" them. But what we honor is really our own feelings and our own honor (not to let them down), not an assessment of their present situation. Just like we are forced to feel ashamed when not offering our organs to save the lives of other people, in the same fashion we push our feelings concerning our own mercifulness in front of us when not allowing a dying person to get to rest.

In the light of the above, it is no wonder that many people want to "repair" the damage in a sick person, or want a replacement of the organs that have failed due to an accident or old age. And it seems that it is only a question of time and money before literally everything can be replaced to ensure us eternal life.

When we look at the circumstances in which society lends a helping hand to ensure the continued life of an injured person, it isn't strange that both a sudden casualty and a gradual wearing down are sought remedied. Most sensitive is the case in which a young child is involved. Doesn't the child deserve a second chance? Especially if it is possible by insertion of an organ from another human being or even an implant of a cloned organ (the result is the same, so if we accept one, why not the other?)

However, before we embark on the discussion of what we "should" do, it is necessary to consider what we can afford. For even if something is possible, it isn't free, and we may find ourselves in the situation that we will have to set aside the majority of our public spending on repairing people and consider whether we want to give priority to ten or twenty cornea transplants over one heart transplant? It is understood that the discussion of possible transplants is not limited to the part of the population that can pay for the operation themselves; were that the case, the rest of us did not have to take part in it, let alone make laws regulating it. Unless, of course, that certain ethical questions should forbid the turning of human organs into "goods" that may be bought and sold. In other words, we are back to the weighing of "benefit" and "respect for life."

At the same time it is obvious that there must be standards to regulate how often and how thorough a "repair" the individual citizen can expect or demand - a "statement of recommendation", but by whom? Are we all to have two chances regardless of age? Or a multiple-journey ticket to life and a bonus system? What should be the average number of treatments? Should the "god", who rules in mysterious ways, be replaced by a congress resolution or a board of doctors? (Some Danish doctors want to strike smokers from the list of recipients because they feel that such do not deserve a second chance). What about race drivers? Or bungy-jumpers, sky-divers, or other people who live life dangerously? We must face the fact that not everyone can be given a second chance and that a certain amount of arbitrariness resting at least in part on private means will be introduced (note 1).

The fact that certain potential donors don't think more of their organs than mere "machinery" which they won't need in the hereafter, is not an argument in the debate about the ethically preferable solution – I just include it to make this presentation complete. Much more interesting is the question whether the rights of the individual are protected through life prolongation.

To answer this question fiction comes to our aid and offers insight. Both literary works and films have dealt with the issue, and since attitudes may change with the time, it is perhaps best to look at some contemporary works from the past century.

The film Groundhog Day paints a rather amusing picture of a serious situation: a reporter is trapped in a time warp, which means that he wakes up to the same day every morning. Instead of enjoying his eternal life, the reporter is loathed by his risk free life without responsibility; consequently, he kills himself every night trying to escape this deadlock situation.

In Aldous Huxley's Brave New World, human beings are not only predestined through their genetic coding, they also live all their adult lives as healthy, vigorous youngish creatures, but worst of all is the cynical and insensitive attitude expressed in the fact that all emotional reactions are provoked artificially through bio-chemical drugs. In a future in which cloning is not only possible, but likely - even wanted by some - transplants of cloned organs will be a natural part of the apparatus at our disposal to ensure life, but without regard for life quality.

In his short story The Patient Peter Seeberg writes about a patient who is not sure of his identity after a gradual replacement of all vital organs - he is no longer certain he is himself.

We may replace a kidney, a heart, we may get the dead child back via his cloned brother, we may recreate ourselves and eventually, little by little, if necessary, try from scratch once again with the cloned material we deposited in the gene bank right after birth. All by themselves, organ transplants open up to a long list of changes: first from donor to blood related recipient, then from dying donor to (any living) recipient, then from cloned spare parts to ourselves.

But if we add to the thought the rising number of people on this planet and the still more scarce resources and think globally of how wealth is to be distributed in the future, we are forced to realize that an increase in transplants in our part of the world will have to be paid for by the rest of the world.

By this time, the "Transplant Group" will probably raise its voice and remind us of the fact that the aim of the campaign is to enlist more donors, not to discuss whether it would be opportune and right to operate on people. But that is exactly the core of the matter. All previous easing of regulations show that once we start, it does not take long before the matter is turned upside down: abortion, commercials in TV, gene technology, pornography, etc., etc. Once we have started sliding there's no turning back. Changes in attitudes are easier accepted when introduced gradually, certainly, but the end result may not be the development we originally wanted; and instead of an active acceptance of the changes, we are raised (conditioned, rather) into tolerating a fait accompli.

But if we accept the change because of a change in attitude, what is then the problem? The problem is that once something is possible, it will be implemented; there is always somebody who is willing to do it illegally, somewhere. This goes for neutron bombs, biological weapons, poison gas, experiments on human guinea pigs. The Geneva Convention may have been signed, but is not respected if the temptation is big enough. And by condoning little slips and breaks, we gradually develop a callous attitude to change.

Who stand to gain anything from this? Probably not a Third World tempted to sell out of organs to survive only to die later from hunger, but most likely the criminal underworld, which will be given a new and profitable sales object (note 2). When the affluent world lends the Third World a helping hand, for instance by introducing medical treatment to let more people live, we forget that the rising number of people is our responsibility since we interfered in the first place. By spending time and energy trying to prolong our own lives we not only widen the gap between the Third World and us, we also make ourselves the judges of life and death by the meanest of arguments: the power of money (note 3). We may be in a position to afford taking care of ourselves, but perhaps only by means of organs bought in the Third World ; in contrast, the poorer part of the world will never be able to buy organs or have them implanted (note 4).

Moreover, what is life worth under such circumstances? Can we look ourselves in the eye and enjoy the extra life we have bought? Instead, should we not consider the point of view that although Man may well accomplish much, we abstain voluntarily from implementing all possibilities, especially the ones that run counter to nature?

In later years, a holistic perception of life has started to replace the dualistic attitude that has marked our culture for the past 500 years. In the rational thinking - which has brought us excursions to the Moon and a controlled recreation of life from its very beginning - there's no room for "superstitious" inclinations to there's more between heaven and earth than meets the eye. Now, however, it seems that there is a dawning recognition of Man's inability to speculate his way to a solution to all problems; we just have to accept that certain natural facts are what they are (quantum physics). We must watch and acknowledge. And listen and learn the way it has been practiced in other cultures whose values we have just started to respect.

Wouldn't I want to save my children by giving them my organs if necessary? Yes, of course, what else can I do, I love them? But I do not think that any restrictive laws built on blood relationship as the only legal criteria can be put into effect in a practical way – the loopholes are just too many. So, the question remains an either-or: yes or no to organ donation? And in that situation, I am forced to say "no".

March 2001
Erik Moldrup

Addendum:
Since the above article was written, the Danish paper Information has brought a series of articles on the problem of illegal organ transplantation and related issues (http://tema.information.dk/organer).
   It turns out that much of what might be feared in tomorrow's practice regarding the buying and selling of human organs is already taking place - and the direction is one way: from the Third World to the Western World.  Criminal organizations see to it that the supply is kept going.
   For years, hospitals in England have removed limbs and organs from deceased children without the parents' knowing anything about it, let alone giving their consent.  Some of these limbs have not been put to use, but are kept in store for future (scientific) use.  In one hospital were found thousands of human "parts" some of which were intended for use at a private company that develops medicine for transplants.  Quite a cynical thought, indeed, but that is the reality we are facing.

But if that is reality, how can we fight it?  Why don't we just accept the facts?

Well, that is what this article is all about.

March 2001
Erik Moldrup
 

Notes:
1. Any donation of organs must necessarily be anonymous; if not, a feeling of gratitude may easily interfere and ruin the joy of life for both parties.  But am I really to accept that I must risk donating my organs to anybody, including the neo-Nazi who just ran me over, but was injured himself in the process?  Should we divide potential recipients into groups of the morally worthy and unworthy?

2. The organ Mafia in the Third World is already in operation.  I saw a TV report on a Russian grandmother who had ordered her son to sell her grandson to the organ mob who would then have him “dissembled” into various “parts”. When arrested she did not show any sign of remorse, she just argued that the cost of living had risen.

3. To “sacrifice” a child to save its siblings resembles “eating the next person on the raft” to survive – survival, yes, but the conditions are inhuman and degrading.

4. The costs of possible organ transplants in the Third World will probably far exceed the general help offered by us – not to think of what could be accomplished for the same amount of money?