Ethical and Legal Issues of Organ Donation and Transplantation.

“Organ transplantation is an issue that must be dealt with sensitivity. Orienting society to accepting the ‘value of life after death’ will go a long way in strengthening transplantation as medical treatment. – Usha Raman 

INTRODUCTION 

The major cause for necessitous performance of Organ Transplant program is absence of cognizance among public in which there is lack of organ donation , but also lack of cognizance, positive view and incentive amongst medical practitioners.

WHAT IS ORGAN DONATION AND TRANSPLANTATION? 

NEED FOR ORGAN DONATION AND TRANSPLANTATION 

• More than 112,000 patients are in the National Transplant waiting list as of March 2020. Over 39,718 transplants were performed for patients in the year 2019.

• Over 20 people die each day waiting for an organ transplant. It is a need for Organ Donation and Transplantation in recent times.

ETHICAL ISSUES

The ethics for organ transplantation involves three conditions:
1. Medical Probity: Patients must be able to have some faith on doctors not to sacrifice the interest of one to another. Only individuals make sacrifices but not doctors.
2. Scientific Reasonableness: In each and every case the primary biology and technology must be adequately assured to offer a chance of favourable outcome.
3. Consent: The consent that donors give must be unforced and their willingness should be concerned.
Some of the Ethical issues that are involved in organ transplantation are beyond the boundaries of ethics. Some of the circumstances are causing ethical issues in organ transplantation are

§ When a donor is donating an organ or tissue it should not affect the health or body functions of the donor. 
§ The donation must be made unselfishness and the donation must be given without any pressure or coercion. 
§ The consent of spouse or children must be considered while donating an organ. 
§ Exploitation of organs must not happen in the case of donation. 
§ The next issue is ethical predicament of the physicians while deciding. Perhaps, Autonomy is the most common ethical predicament experienced during organ donation.[5]
• In relation to WHO Guiding Principles 9 and 11 three cases involve in ethical dilemmas. 
§ The first case involves in breach of deceased donor’s information and media reports. The media reported a donor’s information who was suffering in financial difficulty.[6] 
§ The second case deals with a request for directed but unqualified donation. In the second case the local authority allowed the directed donation to take place even if the donor’s name was not on the hospital’s transplant list. 

LEGAL ISSUES IN ORGAN DONATION AND TRANSPLANTATION

1. the efficacy in executing current law and
2. financial needs that makes people to donate their organs.
• Organ trafficking is on the rise worldwide. Numerous brokers, doctors and hospitals engaged in this illegal trade have been featured in high-profile media.[8]
• Organ trade means trading of human organs for transplantation illegally in red market for profit.
• LEGAL RULES GOVERNING ORGAN DONATION AND TRANSPLANTATION:
§ The Transplantation of Human Organs and Tissues Act, 1994 was the first legislation enacted for transplantation and donation of human organs of a living donor or deceased person.[9]
§ OBJECTIVES OF THIS ACT:
• The basic objectives of this act is to avert trading and illegal donation or give any promotions to human organs.[10]
• According to Sec.18 (1) of this act any person who renders his services to or to at any hospital and who, for purposes of transplantation, conducts, associates with or helps in any matter in, the removal of any human organ without authority shall be punishable with imprisonment for a term which may extend to ten years and with fine which may extend upto twenty lakh rupees.[11]

RECENT ISSUES REGARDING ORGAN DONATION AND TRANSPLANTATION

• In Asia the first bilateral lung transplant is performed on a patient of Covid- 19 at Chennai. This was the first transplant on Covid patient according to the MGM Healthcare facility in Chennai where the procedure was performed.[14]
• “ As the hospitals were busy in taking care of Covid-19 patients they didn’t have the capacity to be taking care of potential organ donors”, Givertz said.
• A Malaysian is ostensibly involved on organ trafficking by decoying poverty- stricken victims from around the world to sell their organs, according to report. A man had boasted to the UK paper that he had masterminded 45 illicit kidney sales the SUN reported.[15]
• Since organ transplantation surgeries have come to an almost halt during this Covid-19 , organ trafficking have temporarily declined. Due to ban in travels organ recipients are unable to travel abroad and access organs. As there is large number of unemployment many people are lured into selling of organ.[16]
• A man in west Bengal has been arrested for selling of kidney of his wife without knowing her. He has been charged for trading human organs and detaining a woman with criminal intention. Police reported that the man had sold the kidney to a businessman in Chhattisgarh.[17]
• Four people have been arrested in Lucknow for human organ trafficking. During the interrogation, the accused alleged that the used to lure people with money and alcohol and after their kidney has been removed they sell them at high prices outside the state.[18] 

CONCLUSION

• Organ donation depends on decision of individuals if anyone wants to be an organ donor they can register to be an organ donor and must inform this decision to their family and health care agents.
• Medical tourism which has been cheap in India also a major cause for organ trading. The gap between the organ donors and organ recipients is widening globally. Only the rich people are able to afford organ transplantation but poor’s are lured only for organ sale.

[1]https://www.organdonation.nhs.uk/helping-you-to-decide/about-organ-donation/faq/organ-donation-and-transplantation/
[2] https://www.britannica.com/science/transplant-surgery
[3]https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/organ-and-tissue-donation
[4]https://www.organdonor.gov/statistics-stories/statistics.html
[5]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779960/
[6]https://pdfs.journals.lww.com/transplantjournal/2018/07001/ethical_dilemmas_in_deceased_organ_donation_and.352.pdf
[7]https://pdfs.journals.lww.com/transplantjournal/2018/07001/ethical_dilemmas_in_deceased_organ_donation_and.352.pdf
[8]https://www.ajkd.org/article/S0272-6386%2809%2901177-9/abstract
[9]https://www.indiacode.nic.in/handle/123456789/1962?sam_handle=123456789/1362
[10]http://www.nhp.gov.in/donation-and-transplantation-of-human-organs-and-tissues_pg
[11]https://www.indiacode.nic.in/show-data?actid=AC_CEN_12_13_00014_199442_1517807323753&sectionId=6534&sectionno=18&orderno=23
[12]https://indiacode.nic.in/show-data?actid=AC_CEN_12_13_00014_199442_1517807323753&sectionId=6514&sectionno=3&orderno=3
[13]https://www.hindustantimes.com/mumbai-news/70-decline-in-organ-donations-in-mumbai-since-march-due-to-covid-19/story-JmE812Pw0dugJpnhyodNOM.html
[14]https://in.news.yahoo.com/chennai-doctors-perform-asias-first-113135786.html
[15]https://www.thestar.com.my/news/nation/2020/08/09/malaysian-allegedly-involved-in-organ-trafficking-says-report
[16]https://www.cfr.org/blog/evolution-human-trafficking-during-covid-19-pandemic
[17]https://www.ndtv.com/kolkata-news/bengal-man-arrested-for-selling-wifes-kidney-she-didnt-even-know-it-was-gone-1810546