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Multi-Organ Transplant
Bioethics
What Should I Know about Organ Transplantation Ethics at UHN?
What is “Ethics”?
What is “Bioethics”?
What is “Organ Transplantation Ethics”
Where Can I Learn More?
What Should I Know about Organ Transplantation Ethics at UHN?
The Multi-organ Transplant Program (MOT) at UHN is committed to doing what is right, fair and ethical. MOT practices reflect ethical standards used by many transplant programs in North America. MOT works closely with UHN’s Bioethics Program. The Bioethics Program and MOT work together to develop ethical policies and guidelines such as the “Ethical Guidelines for the Evaluation of Living Organ Donors”. The Bioethics Program teaches and lectures on transplantation ethics at various hospitals as well as at national and international transplantation and bioethics conferences. The Bioethics Program works closely with the University of Toronto Joint Centre for Bioethics (JCB). The members of the JCB offer advice and ideas on ethical issues in health care. Each year clinical ethics fellows work for several months with the UHN Bioethics Program. These fellows often receive training and education in transplantation ethics.
What is “Ethics”?
Ethics is the study of what ends we should choose and pursue and what principles ought to govern these choices and pursuits. There are two common approaches to determining the right way to act. The first approach determines the morally right action on the basis of its consequences. Many people who take this approach consider the morally right action to be the one that will produce the greatest amount of benefit or happiness. The second approach determines the morally right action on the basis of its intrinsic features. Many people who take this approach agree that certain actions are morally wrong in and of themselves such as lying, murder, or harming the innocent. They often consider an action morally right if it follows a moral rule such as “Always tell the truth” or “Respect all persons”.
What is “Bioethics”?
Bioethics is a branch of ethics concerned with the ethical issues that arise in the field of medicine. Some hospitals, including UHN, employ health care professionals who are trained in bioethics. These Bioethicists help patients, families and health-care professionals deal with difficult ethical issues in patient care. They have special training in ethics, philosophy and conflict resolution, providing confidential consultation and mediation. A Bioethicist assists individuals and groups in solving complex ethical problems so that patients can make free and informed decisions about treatment in view of what is important to them in their lives.
What is “Organ Transplantation Ethics”?
The ethical issues that arise in organ transplantation can be divided into three areas: definitions of death, organ recovery and organ allocation.
Definitions of Death
A person must be pronounced dead before it is morally acceptable to remove his or her organs for the purpose of donating them. There are two main definitions of death. The first is the brain based definition. It states that a person is dead when he or she has permanently lost his or her brain function. The second is the heart based definition. It states that a person is dead when he or she has permanently lost heart and lung functions. The concept of death has cultural, religious, political, and philosophical aspects.
Organ Recovery
Deceased Organ Donors
In Canada, a person must give consent for his or her organs to be removed after death for the purpose of donating them. If a person’s wish is unknown, the family may give consent on his or her behalf.
Living Organ Donors
The first successful organ transplant took place in 1954, when a healthy identical twin donated a kidney to his brother. Several questions are considered when deciding whether to accept a person’s offer to donate an organ, including: Will the donor operation carry an acceptably low risk for the person? Is the person making a free and informed decision to donate? Will the person have the necessary support following the donation? The most important moral requirement in deciding whether to accept a person’s offer to donate an organ is that the total expected benefit resulting from the transplantation is greater than the total expected harm.
Organ Allocation
Organs from Deceased Donors
In Canada, as in most Western countries, there are more people in need of organs for transplantation than there are organs available. It is generally considered morally right to give organs first to the people who are the sickest and have waited the longest. In Ontario, the Trillium Gift of Life Network manages the list of people who are in need of organs.
Organs from Living Donors
A living donor usually chooses the recipient of his or her organ. Most often the recipient is related to the donor by blood or friendship, as when a person donates an organ to a relative or a close friend. Occasionally, a person will offer to donate an organ to a recipient who is neither related by blood nor friendship, as when a person donates an organ to a stranger. These “unrelated” or “anonymous” donors usually offer their organs to those recipients whom the transplant centre determines most in need. UHN will evaluate both related and unrelated donors as potential donors. In Canada, it is illegal to sell one’s organs.
Organ Transplant Organizations
Trillium Gift of Life Network – Trillium Gift of Life Network is Ontario’s operational service agency on organ and tissue donation.
Canadian Council for Donation and Transplantation – The Canadian Council for Donation and Transplantation is a non-profit organization that was established to help coordinate and improve federal, provincial, and territorial activities related to organ donation and transplantation.
United Network for Organ Sharing – The United Network for Organ Sharing is a non-profit organization in the United States that collects and manages data on every organ transplantation in the country and assists the organ matching and placement process. This site contains helpful information on organ donation and transplantation, including news, statistics and patient information documents
Patient Advocacy Organizations
Kidney Foundation of Canada – Established in 1964, the Kidney Foundation of Canada has helped millions of Canadians suffering from kidney failure and related illnesses. This site has many useful links for health care professionals and the public.
National Kidney Foundation – The National Kidney Foundation, Inc., a major volunteer organization in the United States, seeks to prevent kidney and urinary tract diseases, and to increase the availability of organs for transplantation.
Further Reading
For Adults (Transplantation Ethics)
The Report of the Citizens Panel on Increasing Donation Rates (2007). This report includes several recommendations for increasing organ donation rates in Ontario based on the views and opinions of Ontario citizens.
Veatch M. Robert, Transplantation Ethics, Georgetown University Press, 2000. This book offers a general and systematic overview of organ transplantation ethics.
The Ethics of Organ Transplants. The Current Debate, ed. Arthur L. Caplan & Daniel H. Coelho, Prometheus Books, 1998. This book includes many articles covering major ethical issues in organ transplantation such as whether organs should be taken automatically from the deceased and whether people should be allowed to sell their organs.
For Children (General Information on Transplantation)
Karen Walton, How Will They Get That Heart Down Your Throat?: A Child's View of Transplants, E. M. Press, 1997. This book tells the story of a kindergarten teacher who underwent a heart transplant in May of 1995. In doing so, the book provides information about the process of organ donation (ages 9-12).
Ramona Wood, Now Caitlin Can: A donated organ helps a child get well, Abc Press, 2004. This book shows how the loss of a sibling can help other people (ages 4-8).
