This book analyzes the reasons for organ shortage and ventures innovative ideas for approaching this problem. It presents 29 contributions from a highly interdisciplinary group of world experts and upcoming professionals in the field. Every year thousands of patients die while waiting for organ transplantation. Health authorities, medical professionals and bioethicists worldwide point to the urgent and yet unsolved problem of organ shortage, which will be even intensified due to the increasing life expectancy. Even though the (...) practical problem seems to be well known, the search for suitable solutions continues and often restricts itself by being limited through disciplinary and national borders. Combining philosophical reflection with empirical results, this volume enables a unique insight in the ethics of organ transplantation and offers fresh ideas for policymakers, health care professionals, academics, and the general public. (shrink)

This book deal with ethico-legal issues. Muslims believe that everything they own has been given to them as an amanah from Allah. Would it constitute a breach of that trust to consent to enrol oneself as an organ donor? Cloning could rectify the problem of infertile couples, but such technology could also be abused with dire consequences. While euthanasia may apparently alleviate the suffering of the terminally ill, would that not compound their agony in the life hereafter? The author (...) sheds light on these issues and acquaints the reader with the latest Islamic rulings on these biotechonological manipulations. (shrink)

Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders (...) issued fatwa, or religious rulings, in favor of organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthcare outcomes, prevent poor people from being coerced into selling their organs to rich recipients, and protect the solidarity and progeny of Bangladeshi families. (shrink)

In this paper, changes in identity and selfhood experienced through organ transplantation are analyzed from a phenomenological point of view. The chief examples are heart and face transplants. Similarities and differences between the examples are fleshed out by way of identifying three layers of selfhood in which the procedures have effects: embodied selfhood, self-reflection, and social-narrative identity. Organ transplantation is tied to processes of alienation in the three layers of selfhood, first and foremost a bodily alienation (...) experienced through illness or injury and in going through and recovering from the operation. However, in cases in which the organ in question is taken to harbor the identity of another person, because of its symbolic qualities (the heart) or its expressive qualities (the face), the alienation process may also involve the otherness of another person making itself, at least imaginatively, known. (shrink)

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a (...) racket of human traffickers who lure rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies. (shrink)

Today, the frequency and the rate of success resulting from advances in medicine have made organ transplantations an everyday occurrence. Still, organ transplantations and donations modify the subjective experience of human beings as regards the image they have of themselves, of body, of life and of death. If the concern of the quality of life and the survival of the patients is a completely human phenomenon, the fact remains that the possibility of organ transplantation and its (...) justification depend a great deal on the culture in which we live. The exploration of the philosophical tradition allows for a reconsideration of organ transplantation. If we listen to people who have experienced the decline of one of their organs and their own rebirth through the organ of someone else, we arrive at the conclusion that they went through an extreme experience in which nothing appeared as before. All those experiences intensify philosophical questionings on the meaning of life with respect to self fulfilment. The concept of nature as the experience of others can be an authentic source from which to nourish our thoughts about organ transplantation. However, and this is our hypothesis, we need something more if we are to decide something about our own life. We need a hermeneutical stance in relation to ourselves and to our world. Philosophical counselling, as a long established tradition originating with Pythagoras and later reframed by the German philosopher Achenbach could be useful in inspiring a reflection on the good life, chiefly as it takes the form of a Socratic dialogue. (shrink)

A social scientific interpretation of the development of global ethics is offered. Both spontaneous and intended mechanisms of the construction of such an ethics within the broader processes of globalization are analyzed, and possible theoretical foundations are suggested. The scientific and technological achievements that gave rise to the medical procedure of organ transplantation generated new questions and challenges that theologians, scholars of religion, natural scientists, and social scientists are now trying to resolve.

There is strong sentiment for a policy which would exclude foreigners from access to organs from American cadaver donors. One common argument is that foreigners are free riders; since they are not members of the community whichgives organs, it would be unfair to allow them toreceive such a scarce resource.This essay examines the philosophical basis for the free rider argument, and compares that with the empirical data about organ donation in the U.S. The free rider argument ought not to (...) be used to exclude foreign nationals because it is based on fallacious assumptions about group membership, and how the giving community is defined. Polls show that even among the seventy-five per cent of Americans who support organ donation, only seventeen per cent had taken the small step of filling out donor cards. Therefore, it goes against logic to define the giving community as coextensive with American residency, while excluding foreigners who might well have become donors had they lived in countries which provided that option. (shrink)

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a (...) racket of human traffickers who lure rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies. (shrink)

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a muslim believes that whatever he owns or possesses has been given to him as an amānah from Alla¯h. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Sharā'ah emphasizes the sacredness of the human body. Would it (...) not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation?In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidlines based on the original sources of Islam, namely, the Qur'n and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will. (shrink)

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a muslim believes that whatever he owns or possesses has been given to him as an amānah from Alla¯h. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Sharā'ah emphasizes the sacredness of the human body. Would it (...) not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation?In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidlines based on the original sources of Islam, namely, the Qur'n and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will. (shrink)

Organ transplantation has given hope when formerly death was inevitable. But the replacement of vital organs highlights major moral and philosophical problems in medicine concerning the role of physicians and nurses, patient autonomy, and respect for the dying and the dead. These include the morality of excising organs from a healthy donor, and related problems regarding an individual’s consent to have organs removed for the benefit of others. These problems are not restricted to live organ donation: cadaveric (...) organ removal raises problems over the definition of death, and raises further questions of fundamental moral and philosophical concern over the procurement and distribution of organs. Guiding decisions in these areas is a mass of empirical knowledge, scientific theory, and philosophical beliefs concerning what it means to say that someone is dead or alive, or whether given persons are competent to make a decision, or whether other considerations should override a competent decision. These questions call for investigation of conceptual matters and moral principles, and are by no means exclusively determined by medical expertise. (shrink)

According to the International Register of Organ Donation and Transplantation, Japan is one of the countries with the lowest number of registered deceased donors. In 2019, Japan was ranked 61st out of 70 countries. The authors of this article have decided to explore the reasons for this phenomenon. In the first part of the work, religious influences (Shinto and Buddhism), the tradition of gotai manzoku, the importance of altruism and the family in the perception of death and (...) class='Hi'>organ transplantation by the Japanese are considered. The second part of the article presents the arguments of Alan Shewmon, who believes that brain death is not death in the biological sense. Undermining the brain’s death criterion raises doubts concerning death of patients in irreversible coma, what in result discourages transplantology in Japan. In the third part, the authors compare the results of JOTN, IRODaT and the Fact Book of Organ Transplantation 2018 in Japan from 2010 to 2018. The aim of the article is to explain the cultural determinants of transplantology in Japan, taking into account the influence of philosophical and bioethical aspects of human death. (shrink)

The ability to keep someone alive by replacing one or more of their major organs is an astounding achievement of 20th-century medicine. Unfortunately, the current supply of transplant organs is much lower than the need or demand for them, which means that thousands of people die every year in the U.S. alone for lack of a replacement organ.

Written by a sociologist and a biologist and science historian, this text considers the social aspects of organ transplantation and chronic hemodialysis. Their research, begun in 1968, focused on the experience of research physicians engaged in this work, the "gift- exchange" social dimensions of these practices, and the impact of these technologies on society as a whole. This reprint of the 1978 edition includes a new introduction by the authors. c. Book News Inc.

As of 2009, the number of donors in Japan is the lowest among developed countries. On July 13, 2009, Japan's Organ Transplant Law was revised for the first time in 12 years. The revised and old laws differ greatly on four primary points: the definition of death, age requirements for donors, requirements for brain- death determination and organ extraction, and the appropriateness of priority transplants for relatives.In the four months of deliberations in the National Diet before the new (...) law was established, various arguments regarding brain death and organ transplantation were offered. An amazing variety of opinions continue to be offered, even after more than 40 years have elapsed since the first heart organ transplant in Japan. Some are of the opinion that with the passage of the revised law, Japan will finally become capable of performing transplants according to global standards. Contrarily, there are assertions that organ transplants from brain- dead donors are unacceptable because they result in organs being taken from living human beings.Considering the current conditions, we will organize and introduce the arguments for and against organ transplants from brain- dead donors in contemporary Japan. Subsequently, we will discuss the primary arguments against organ transplants from brain- dead donors from the perspective of contemporary Japanese views on life and death. After introducing the recent view that brain death should not be regarded as equivalent to the death of a human being, we would like to probe the deeply-rooted views on life and death upon which it is based. (shrink)

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999, which instituted a 90-day comment period for the amended Organ Procurement and Transplantation Network Final Rule, a comprehensive set of guidelines that would affect how organs are allocated throughout the country. Barring further legislative action, the Final Rule, which has been over five years in the making, will be effective on March 16,2000.The Final Rule, issued by the Department of Health (...) and Human Services pursuant to the National Organ Transplant Act, was originally publishedApril 2, 1998. It provided a number of substantive changes to the process through which organs are allocated by the United Network for Organ Sharing, a private, non-profit organization charged with administering the national organ transplantation network. (shrink)

On December 17, 1999, President Clinton signed the Ticket to Work and Work Incentives Improvement Act of 1999, which instituted a 90-day comment period for the amended Organ Procurement and Transplantation Network Final Rule, a comprehensive set of guidelines that would affect how organs are allocated throughout the country. Barring further legislative action, the Final Rule, which has been over five years in the making, will be effective on March 16,2000.The Final Rule, issued by the Department of Health (...) and Human Services pursuant to the National Organ Transplant Act, was originally publishedApril 2, 1998. It provided a number of substantive changes to the process through which organs are allocated by the United Network for Organ Sharing, a private, non-profit organization charged with administering the national organ transplantation network. (shrink)

A series of papers in Philosophy, Ethics and Humanities in Medicine (PEHM) have recently disputed whether non-heart beating organ donors are alive and whether non-heart beating organ donation (NHBD) contravenes the dead donor rule. Several authors who argue that NHBD involves harvesting organs from live patients appeal to.

Countries throughout Asia promote themselves as leading destinations for international travelers seeking inexpensive healthcare. India, Indonesia, Malaysia, Singapore, the Philippines, and Thailand are all trying to attract greater numbers of what their promotional campaigns call “medical tourists.” Government tourism initiatives, hospital associations, medical tourism companies, and individual hospitals advertise hip and knee replacements, spinal surgery, cosmetic surgery, and other medical procedures. In contrast to most nations marketing treatments to international patients, the Philippines differentiates itself by selling “all inclusive” kidney transplant (...) packages. Patients from other countries travel to the Philippines and receive kidneys purchased from poor individuals. (shrink)

Originally published in 1990, this study of the moral problems bound up with transplant therapy addresses a finely balanced distinction between ethical issues relating to its experimental nature on the one hand and those which arise when transplantation is routine on the other. Among the issues examined are proposals for routine cadaveric harvesting, criteria for organ and tissue procurement from living donors, foetuses, non-human animals and current ethical problems with artificial implants. Written as a contribution to practical philosophy, (...) this book will interest ethicists and health care professionals. (shrink)

Assessments of the acceptability of new transplantation practices require a pinpointing of not only the meaning of death, but also the timing of death. They typically perceive elective ventilation as occurring just prior to death and non-heart-beating donor protocols as operative just after death. However, such practices in fact highlight the general vagueness and ambiguity surrounding these issues in both law and ethics. Supply-side dilemmas in transplantation lend real urgency to this "life or death" debate.

A quiet revolution is occurring in the field of transplantation. Traditionally, transplants have involved solid organs such as the kidney, heart and liver which are transplanted to prevent recipients from dying. Now transplants are being done of the face, hand, uterus, penis and larynx that aim at improving a recipient's quality of life. The shift away from saving lives to seeking to make them better requires a shift in the ethical thinking that has long formed the foundation of (...) class='Hi'>organ transplantation. The addition of new forms of transplants requires doctors, patients, regulators and the public to rethink the risk and benefit ratio represented by trade-offs between saving life, extending life and risking the loss of life to achieve improvements in the quality of life. (shrink)

In their book Spare Parts, published in 1992, Fox and Swazey criticized various aspects of organ transplantation, including the routinization of the procedure, ignorance regarding its inherent uncertainties, and the ethos of transplant professionals. Using this work as a frame of reference, we analyzed articles on organ transplantation published in internal medicine and transplantation journals between 1995 and 2008 to see whether Fox and Swazey’s critiques of organ transplantation were still relevant.

The ethical and social issues raised by transplants are so interrelated that the thread of any problem eventually leads to the whole tangled ball. This article, however, limits discussion to topics involving living donors in the United States. This restriction is not dictated solely by space constraints. Rather, the rise in the number of living donors gives a particular urgency to questions about informed consent, donor protection, and recipient needs. How we resolve conflicts of interest, address issues of consent, and (...) define the scope of autonomy will shape the policies and practices that determine whether donors are protected and whether lives are lost or saved. (shrink)

Two experiments investigated whether moral evaluations of organ transplantation influence judgments of death and causation. Participants’ beliefs about whether an unconscious organ donor was dead and whether organ removal caused death in a hypothetical vignette varied depending on the moral valence of the vignette. Those who were randomly assigned to the good condition were more likely to believe that the donor was dead prior to organ removal and that organ removal did not cause death. (...) Furthermore, attitudes toward euthanasia and organ donation independently predicted judgments of death and causation, regardless of experimental condition. The results are discussed in light of the framework of motivated reasoning, in which motivation influences the selection of cognitive processes and representations applied to a given domain, as well as Knobe’s person-as-moralist model, in which many basic concepts are appropriately imbued with moral features. On either explanatory framework, these data cast doubt on the psychological legitimacy of the mainstream justification for vital organ procurement from heart-beating donors, which holds that neurological criteria for death are scientifically justified, independently of concerns about organ transplantation. These data suggest that, rather than concluding that organ removal is permissible because the donor is dead, people may believe that the donor is dead because they believe organ removal to be permissible. (shrink)

The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives to include certain other relatives such as grandparents, grandchildren, and first cousins. The Act was also revised to allow (...) individuals to prioritize family members in receiving their organs after their death. The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind, saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor’s post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means. (shrink)