Transcript Organ Donation - Universidade Nova de Lisboa

Legal and ethic issues
Organ Donation
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Organ donation is the donation of biological
tissue or an organ of the human body, from a
living or dead person to a living recipient in
need of a transplantation. Transplantable
organs and tissues are removed in a surgical
procedure following a determination, based on
the donor's medical and social history, of
which are suitable for transplantation. Such
procedures are termed allotransplantations, to
distinguish them from xenotransplantation, the
transfer of animal organs into human bodies.
What we think about…
The main problems…
Religion
 Cultural objections
 Living donors: those who volunteer a
kidney or parts of their liver or lungs are
understandably reluctant - they must
undergo potentially life-threatening
surgery and put their own future health
at risk.
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Organ Donation
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In Portugal, Linhares Furtado was responsible for the first transplant, in 20th July 1969, in
Coimbra.
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Today there are transplantion of these organs and tissues:
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Lung;
Pancreas;
Blood vessels;
Intestines;
Ossicles of the ear;
Skin;
Heart;
Heart valves;
Corneas;
Bone marrow;
Liver;
Kidneys;
Tendons;
Meninges;
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Main Ethical Principles
.
Principle of body Inviolability: reflects the membership of
the body to personal identity, and as such, deserving of
dignity and the unavailability of the human person. Thus, any
intervention in bodily integrity is both an intervention in
personal integrity.
Principle of Solidarity: argues that being a man is
eminently social and bearer of the possibility of making a set
of sacrifices according to the good of the community, that in
these sacrifices should include organ donation. Since these
do not involve compromising the integrity of life.
Principle of Totality: it is believed that as the whole body,
each part thereof to be evaluated according to the whole.
And so, each party (member, organ or function), may be
sacrificed for function of the body, since this is useful for the
welfare of the whole organism.
Ethical Principles
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Informed Consent
Equality of access to patients in the transplant
services;
Transparency of rules for allocation of organs
and tissues;
Setting safety standards;
Gratuity of donations;
Good information for all involved;
Confidentiality;
Punishments in case of violation.
Ethical Issues Regarding the
Donor
From the Deceased
 From Living Persons (Adults, Mentally
Disabled, Minors)
 From Anencephalic Infants
 From Human Fetuses
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Living Donnors
Portuguese legislation only authorizes
the harvesting of living regenerative
substances. However, although this
prohibition is absolute for minors and
others incapable, by way of exception is
allowed organ donation and nonregenerative substances, where there is
a kinship to the third degree.
Living Donnors
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Compatibility Testing
Several tests are done to confirm the compatibility of the
donor organ and recipient.
They are absolute contraindications for donation patients
who have:
Uncontrolled infection,
HIV
HTLV 1/2
Malignant neoplasm except: primary tumor of the CNS,
basal cell carcinoma, carcinoma "in situ" of the uterus.
Deceased Donors
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“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.” Pope Pius XII 1956
Deceased Donors
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But….
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.
Anencephalic Infants
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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 the widely 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.
Human Fetuses
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Is it ethical to transplant brain or other
tissues from human fetuses to benefit
others (e.g. those suffering from
Parkinson's Disease)?
Minors and Unable
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Lei n.º 12/93, de 22 de Abril
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COLHEITA E TRANSPLANTE DE ÓRGÃOS(versão actualizada)
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CAPÍTULO II
Da colheita em vida
Artigo 6.º
Admissibilidade
4 - São sempre proibidas a dádiva e a colheita de órgãos ou de
tecidos não regeneráveis quando envolvam menores ou
outros incapazes.
5 - A dádiva e a colheita de órgãos, de tecidos ou de células
regeneráveis que envolvam menores ou outros incapazes só
podem ser efectuadas quando se verifiquem os seguintes
requisitos cumulativos:
a) Inexistência de dador capaz compatível;
b) O receptor ser irmão ou irmã do dador;
c) A dádiva ser necessária à preservação da vida do receptor.
Minors and Unable
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Artigo 8.º
Consentimento
3 - Tratando-se de dadores menores, o
consentimento deve ser prestado pelos pais,
desde que não inibidos do exercício do poder
paternal, ou, em caso de inibição ou falta de
ambos, pelo tribunal.
4 - A dádiva e colheita de órgãos, tecidos ou
células de menores com capacidade de
entendimento e de manifestação de vontade
carecem também da concordância destes.
5 - A colheita em maiores incapazes por razões
de anomalia psíquica só pode ser feita mediante
autorização judicial.
Types of Transplantation
Autoplastic transplantation: when tissues
are transplanted in the same body, from
one place to another;
 Heteroplastic transplantation: is the
transplantation of organs or tissues from
one body to another. It can be homologous
if it occurs between individuals of the same
species;
 Xenotransplantation: is the
transplantation of organs or tissues
between individuals of different species;
Legislation
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Convention for the Protection of Human Rights and
Dignity of the Human Being approved in Oviedo in
1997 and rulling in Portugal after 2001.
This Convention looks for a bigger harmonization of
existing rules in different european countries
seaching for a wider protection and avoid some
bioethic issues.
It was complemented by na important adicional
Protocol on this field: Additional Protocol About
Transplantation of Organs and Tissues of origin
human (Committee of Ministers on 8 November
2001, in force since 1May 2006);
Lei n.º 12/93, de 22 de Abril
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Regulates the harvesting and the
Transplantation of Organs and Tissues of
Human Origin. Also regulates the
admissibility of the information, consent
and the right to assistance and
compensation.
This law provides the anonymity of the
donor and recipient, prohibiting the
disclosure of the identity of both.
 It was amended by Lei 22/2007, de 29 de
Junho and Lei 12/2009, de 26 de Março.
Constituição da República
Portuguesa
Principle of Equality (13º)
 Right to Life (24º)
 Right to Humane Treatment (25º)
 Right to Health (64º)
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Legislation
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There are two main systems for voluntary systems:
"opt in" (anyone who has not given consent is not a
donor) and "opt out" (anyone who has not refused is
a donor).
In Portugal the donation of organs after death is
considered a presumed, meaning that any national
or foreign citizen resident in Portuguese territory is
considered donor since its birth. But those interested
in do not donate their organs after death should
register for free at any health center thus making his
name be recorded in the National Register of nondonors (RENNDA)Decreto‐Lei 244/94, de 22 de
Abril,
Numbers….
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Data from the Council of Europe put
Portugal on the world leader in liver
transplantation, after overtaking the
United States, and the second position
in the case of kidneys. The data show
good results also in the collection, which
today is around 30 donors per million of
habitants. Gift of Life will be expanded
this year with the creation of crossdonation.
But…
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“Every day in Europe, twelve people die
waiting for a transplant. This translates
to around 4 000 deaths per year. The
level of donations has remained largely
static for the past five years, and 56 000
patients are on organ transplant waiting
lists.”
How to distribute these limited
resources? Which are the criteria
for selection??
On what basis should this person
rather than that person be
chosen to receive a given organ?
A widely used and approved criterion of
selection is to give priority to those who
have great need and who are expected to
benefit greatly.
 The first registered on the waiting list
 With regard to who will likely benefit more
from receiving 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.
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"The day will come when my body will lie upon a white sheet, neatly
tucked under four corners of a mattress, located in a hospital busily
occupied with the living and the dying. At a certain moment a doctor
will determine that my brain has ceased to function and that, for all
intents and purposes, my life has stopped." "When that happens,
do not attempt to instill artificial life into my body by use of a
machine. And don't call this my deathbed. Let it be called the Bed of
Life, and let my body be taken from it to help others lead fuller
lives."
 "Give my sight to the man who has never seen a sunrise, a baby's
face or love in the eyes of a woman. Give my heart to a person
whose own heart has caused nothing but endless days of pain.
Give my blood to the teen-ager [sic] who was pulled from the
wreckage of his car, so that he might live to see his grandchildren
play. Give my kidneys to one who depends on a machine to exist
from week to week."
 "Take my bones, every muscle, every fiber and nerve in my body
and find a way to make a crippled child walk. Explore every corner
of my brain. Take my cells if necessary, and let them grow so that,
someday, a deaf girl will hear the sound of rain against her window.
Burn what is left and scatter the ashes in the winds to help the
flowers grow. If you must bury something, let it be my faults, my
weaknesses and all prejudice against my fellow man. Give my sins
to the devil. Give my soul to God. If by chance you wish to
remember me, do it with a kind deed or word to someone who
needs you. If you do all I have asked, I will live forever”
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“Black Market”
Organ traffic is the third most lucrative
crime in the world.
 Organ trafficking occurs especially in some
Asian countries with a particularly
permissive legislation.
 Many people travel to get a transplant,
without questioning how the agency
obtained the organ and without knowing
that the operation hasn’t any medical
guarantee, since neither the giver nor the
receiver is followed later.
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Did you Know??
The latest option available on Facebook
allows users to enter in your profile if
you are donating organs, in order to
facilitate the supply and demand. This
new possibility was announced
yesterday, on the official social
network.DN, 02 Maio 2012
 http://www.youtube.com/watch?v=5qRg
vSWAiN4&feature=related
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Any doubts?