Policies
that guide the distribution or allocation of organs have always been
controversial. Please read the articles below and discuss how organs
should be allocated in the US and why? As you read, please consider how you selected the organ recipient in the previous blog post.
Ethics of Organ Transplants (About.com summary)
The Waiting Game (PBS)
Distributing Donor Organs (PBS)
United Network for Organ Sharing (UNOS)
About Organ Allocation (Transplant Living)
Organ Allocation Issues (Miracosta College)
Controversies in Organ Donation (Nephrology, Dialysis, Transplantation Journal)
Infant Heart Transplant Controversy (US News)
Human Organs for Sale (New Internationalist)
Do US Hospitals Push Organ Black Market (CBS News)
So What About Mickey Mantle (Wordpress Donate Life Blog)
Natalie Cole Kidney came From Deceased Fan (CNN)
Jobs Travel to Transplant Mecca Shows System Flaws (Bloomberg)
Britain to Outlaw Most Private Organ Donations (Yahoo! News)
Due November 16, 2012
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20 comments:
I see why organ donating is such a controversial subject. The people making the decision have a hard decision but i believe that to decide an order they must have these qualities:
1. There blood types much match obviously or their body will kill the organ.
2.The people who have waited the longest get priority of people who just got on the waiting list.
3. Now obviously if hypothetically there is a group of people who have been waiting the exact same amount of time the choice because very difficult. Now like i stated in the last article i believe the person who has the biggest family gets priority. This is because their life has an effect on more immediate family members. So they have more to lose. Obviously it would look unfair, the decision isn't easy but really the best in my opinion is who's lives or backgrounds will be the most affected.
The doctors being a part of a black market really caught my attention. I never really imagined a hospital being corrupt in a way but the fact is its real. If doctors are making up to tens of thousands for doing transplants, of course they're going to be caught up in something evil as organ trafficking. I see why any individual might do something like that but we hold doctors to a higher standard and give them our trust. So for them to secretly take kidneys and what not is terrible.
This in turn would change the decision making in who gets what organ. Because chances are if there willing to traffic organs they will take bribes and things of that nature.
In a perfect world no one would be shorted a transplant but obviously this world we live in isn't perfect. In fact it could be worse then what we perceive it at. So the way i would choose an individual needing a transplant is believing that the hospital is not apart of any sort of black market.
After reading through the articles, I think that UNOS has a pretty good system set up for organ allocation in the U.S. Organ transplants are such a controversial topic that no matter how good the system seems to be, there are always going to be issues. It's easier to look at from a non-emotional perspective and say how organs should be allocated, but when you know someone who needs a transplant-your position on the subject could change completely.
UNOS has a system for matching organs from donors to recipients that from what I can tell, seems pretty effective. They make sure the blood type and tissues from the donor match the recipient. Then they take into account how long the recipient has been on the waiting list and their immune status and medical urgency. They also check to see what the distance between the potential recipient and the donor is. They make sure all of these areas are covered and then select the best match.
I think that the UNOS system of allocating organs in the US works well. They do their best to save lives and not discriminate in the process.
I feel that it should first and foremost be taken into consideration how sick the patient is and why they need the transplant. Then the issue of how long this person has been waiting for the organ transplant and the lifestyle that the person lives is also important.
I am sure that medically all necessary precautions in regards to blood and tissue matches are always taken into consideration. Ethically it ultimately comes down to who "deserves" it and who can afford it.
I do not feel that it is unethical to allow people that can afford to travel to be placed on multiple lists. Just as with other luxuries, it's within their means and I don't think that they should be criticized for it. They are sick just like other people they just have more of the means to help them get better.
People should not be paid for their organs, hence the word "donation". They are donating their organs at their own free will and should not be compensated. If they were to allow that then there would be people all over the world trying to give up an organ just to get the cash, in the end causing a whole other ethical issue.
I do not feel that people in our prisons systems deserve transplants if they are in there for certain crimes or for life. If the system is going to use money to get inmates transplants then they should us that money for an honest citizen instead. After assisting other people that are not in an institution, if there’s anything left then it can be taken into consideration. They are being punished, no sense in punishing someone who has done nothing wrong and needs the help.
In the previous blog I chose the scientist that was close to discovering a cure for AIDS. I made that decision based on the fact that I felt she had the most to offer to society and that her death would have been the greater loss. She had more to offer the whole world. I would choose the same way if it came down to a child and Steve Jobs.
In these types of scenarios we have to separate our feelings from it. We can't look at things and say, "well that's not fair" or "they have more of a life to live." Everyone has a right to live; sometimes a choice has to be made as to who gets to live. The truth is life isn't fair; it's what you make it.
People can say, "Who are we to choose who lives and who dies?" When the reality of it is; if no one makes a choice then everyone dies and that seems even less fair to me.
I think that allocation should go by way of urgent need. The more urgent your case is, the quicker you should get the heart. However, if you and another person have the same need and were put on the list at the same time, then that is a tough call. It should go to whomever it is closest to.
It seems as though the policies on allocating an organ are as fair as can be for all. There are always going to be controversies with the outcome but overall the guidelines are in good standing. I agree with how they have developed a point system to where they can determine the urgency of the patient. They also have it to where they’ll start placing the organs locally, nationally or regional.
I do agree with U.S. Dept of Health and Human services and the way their organ allocation system works. Basically it depends on the urgency of the patient and then they distribute closest to home. How I made my decision on the previous blog was entirely different from how they make their decision. I basically chose the 12yr old because of her age, but it could have been anybody that would have taken her place.
I read an article in my economics class and essentially, it said that by creating a legal market, might completely eliminate the present shortage of human organs for transplant. When I first started in on the article, I couldn’t believe that it was even being suggested, and it seemed so grossly immoral, but after reading the entire article, It makes perfect sense to me and I am now a strong advocate for the creation of a legal market. But there are many serious objections to turning human body parts into commodities for purchase and sale. I don’t entirely recall the way it would function, bur I remember feeling very upset that we do not currently have something like this in effect right now. People would no longer die waiting for an organ that never comes, and the absence of a shortage would completely eliminate the need for an illegal black market. Objections were that morally, people feel that by turning human organs into commodities will commercialize human beings and diminish the special nature of human life. I disagree, I feel that it would ensure that quality by preventing unnecessary death. The other objection is that that it will drive up the cost of healthcare because currently, the dying donate their organs for free. In this new market system, the organs would be sold and would therefore carry a higher price tag. However I think that this an initial problem that could be worked out. I read that the Obamacare price tag just went from $940 billion to $1.76 trillion. I don’t know anything about politics, but I think that MAYBE something can be worked out there to compensate this supposed increase in the cost of transplants. Not putting into action a program like this is operating under emotional reasoning. I think that the positive outcome gives enough reason for a legal market. It is argued that the poor or uninsured would be left out, but I feel that there would be kinks in the system that would have to be ironed out, but that is no reason to eliminate the possibility of a good system as a response. This is equated to throwing the baby out with the bathwater. Many of the current systems we have in place right now are broken and need to be reformed, but not eradicated. Just because there are problems within a system does not justify throwing out the system all together. 5000 people die annually waiting on transplant lists, and this number could be reduced to ZERO with a legal market.
With all of this said, how should organs be allocated within our existing system? I think that the severity is the number one contributing factor to be considered, among many others. If a person that is near death is lower down on a wait list than another individual that is next in line, but that person next in line can go another year before they REALLY need the transplant, it should be the person that really needs the organ now. If there are many people that need it now, I think that their contribution to society should be considered next. If an individual that has no family and no job and is a waiter or janitor, I think that the brain surgeon with 3 children should get the organs first. But so many times, these decisions are not that easily made. The PBS article referred to the actions taken by doctors to keep them organs viable long enough to get permission for transplantation from the families as “mutilation of the dead.” They are dead, and they have the power to give life to others that are still holding on. I believe that the actions of the doctors is justified because they are not harvesting the organs, they are maintaining viability until they can get consent, and I think this is perfectly okay. I have family members waiting for kidneys, and if my parents passed I would not be upset if doctors were to do such a thing. I don’t believe there is anyone I know that would object to this either; I do not feel it is wrong.
The Other PBS article calls for a “Standardized medical criteria for placing patients on transplant waiting lists,” and “Standardized criteria for defining a patient's medical status.” Although these measures have good intentions, I do not feel they are appropriate, because patients' cases are not standardized. There are so many factors in choosing a recipient that we cannot standardize allocation criteria, it should be taken on a case by case basis. Again, the reason there is such a dilemma over who will receive the organs is because of a shortage. This is exactly why there should be a legal market for organs. The miracosta article brought up an excellent point that a agree with 100% It says that “if we are going to give transplants only to those who had no hand in their problems, then we would have to say that people who need heart transplants must not have been work-a-holics, cigarette smokers, or have had poor dietary habits. When someone needed a liver transplant due to hepatitis C, we would have to explore the way in which the hepatitis C was contracted to see whether any choice was involved.” I know that there is a criteria similar to this in selection. Fr instance, a surgical team or an ethics committee would never give a heart transplant to someone who has a history of drug abuse because they are not going to waste a donation on someone that is just going to go out and destroy it with drugs, and I completely agree. I am not saying that an alcoholic with a cirrhotic liver should be left to die, but they would certainly be much lower down in the selection than a young child with a genetic disorder. The idea of considering whether lifestyle choices were a factor in the degradation of their condition should definitely be considered when selecting a candidate because it will help to determine who will make the most of such a gift and who may simply choose to waste it. I also agree with China's system from newint.org, they say that in China, organs are taken from executed prisoners. I don’t see any moral issue with this either because it is decided to take someones life and actively execute another human being, so who is to say that this is okay, but using their organs to save someones life is crossing the line? So I think that this should be a global standard as well. With the shortage globally, I think that we should exercise every possible resource, but without hastening the death of dying patients. Concern for that patients dignity and right to life is and should be still held to a certain standard.
In my opinion doctors are people that everyone puts there whole trust in. They are people that are educated to do what they think is healthier. Everyone looks to them to see the truth or for answers. They are put in so many types of situations that I think that is why they go crazy sometimes and do dumb things liek give in to people. I know that every family member would do anything in their power to try to save their loved ones. Sometimes life is not fair. For me no matter if you make a list, choose by age, sex, ethnicity, amount of family. No matter if you look at all that, unless you know every single person and how they truly are you will know who deserves what. That is my honest and true opinion on the matter. I have an aunt that needs a kidney. She has been on the waiting list for years and she has not given up yet and keeps fighting to stay alive each and everyday. It is so hard to see her go through all of that and not being able to do anything about it. At the end of the day I just feel that people do not go for whats fair anymore. They go for what they feel. If it was between my aunt and someone my age they would pick the younger one because, they would feel that I deserve it more cause I havent lived everything she has. The way I see it is that she has been fighting all this time through all the suffering everyday she wakes up to the day she lays down. Her body has gone through hell and for what, for someone to just say they were born later than you so they deserve it. Who are they to chose that for someone? No one. So for that reason I don;t believe there is ever going to be a right way to do things. Or at least there will just never do it the right way.
The Usnews article brought up an issue that I have no idea of how to address or get around. “5 minutes should elapse between the time the heart stops and the organ retrieval begins. More recently, however, it's been suggested that cardiac death becomes irreversible after just one minute.” This is an issue that cannot easily be rationalized or thought through, it is no longer an issue of black an white, but a solid gray area where nothing is certain. I have absolutely no idea what should be done in these cases. The issue is even further complicated when Truog says "If death means irreversible loss of cardiac function and that heart beats in someone else's chest, it's not irreversible, is it?" There really is no right answer here. I do not feel that money or someones ability to pay for treatment should be a factor in our existing system. Just because someone can afford better care does not mean that they should be higher up on the list and get their number called faster. But try telling this to our politicians, who have the best healthcare in the country, which is privatized, and they do not have to pay for it. Dick Cheney underwent a heart transplant surgery not too long ago and he didn't pay a dime for it. I do not feel that this is an ethical example or organ allocation.
I believe as I pick this donor base off age; how the US is choosing organ donors by how sick they may be or perhaps some other factors I believe before government had a say in regulating how disburse organs were to be allocated ; we go back to the system of picking donors from the region in where the organ is located. I think that they should leave it up to that region or area, so that first the time transferring the organ has more of chance of being valuable since time is huge issue.
Also I believe I think as a country we need to relearn how to take the stigmatism out of being a donor and also make it to not be so hard if for a private donator to help but perhaps sanction it government wise in that form. I believe here in the United States its unfortunate that its somewhat has pick up a huge bad wrap as being money driven.
I know I wouldn't mind be an honor donor but I don't feel here in the United States, hospitals will find it easy for them to like work on you a little less knowing your about to check out. For example they stated in one of the articles that they give 5 minutes allotment time before they consider a stop heart; however they were stoping it sometimes at 3 to help preserve the organ; it's things like this that makes me not want to be a organ donor.
Choosing a recipient for a transplant is a very difficult decision. I think that several factors should be considered:
1. Compatibility- The closest match should get priority.
2. Who is in the most urgent need? The person who is the most critical should be first on the list.
3. Who is most likely to follow through with post transplant treatment?- Many factors can affect this- (a)If a patient doesn't have insurance to cover the cost of anti-rejection medications, they are less likely to take the meds. This could lead to problems with the transplant and it could fail. (b) If a patient doesn't have the mental capacity to understand and follow directions, it could lead to the organ failing.
4. Location- Who is closest patient to the donor organ? It should go to the closest person. The faster it gets into a patient, the more likely it is to be successful.
I think that UNOS does have a pretty efficient and fair system in place. It can sometimes be hard to separate personal feelings from logical reasoning when it comes to a decision like this.
Chelsea Holgate
I believe the US has initiated a routine that works well. I believe the consideration of compatibly is key and is the main primary factor for which organ recipient should be chosen. I initially chose my recipient in the previous post mainly based off of the patients age and profound benefit to society. I did not really analyze the fact of compatibly of hers vs the other patients. I also feel that expenses for organ donating and receiving is high and that those whom don't have the ability for funds should receive grants to aid in the organ donating. I did not choose my candidate based on her financial situation vs the others, I solely chose her based on her potential help to society and how she has a huge impact on the study of cells.
Organs should be allocated fairly.. in America those who can afford means security even with organ donation. I believe that it is time that US government do something about organ donation or organ being sold legally because there are alot of people who really need it but cannot afford to do so.
Also with the new healthcare they are starting to impose the allocation of organ transplant to those who are healthy and can most likely live after the operation for a long time. i think it is not fair and everyone should benefit from it not just the few or the privilege.
Organ allocation is pretty sensitive topic and most people tend to strongly feel one way or the other about it. I think organs should be located based on criterion chosen by doctors. After all, they know better. While organs should be awarded based on urgency, it's good to consider all the factors in place. For example, it would be meaningless to give an organ to a person that does not pass all the blood and tissue type test, or anyone who who remotely or barely matches that organ because unless there is 100% match between the donor and the recepient, there is a chance of rejection of that organ. Why risk that? Why waste a heart, a kidney or a liver? Why not make sure that every organ given to a person works perfectly? This can be done if doctors only allow to give organs to people who match the organ 100% or the person who matches the closest since there can never been 100% match. So this would minimize the amount of organs rejected. I do agree with some of the articles that organ donation facilities should be independent on each other regarding how they collect and distribute organs. This is for many reasons: one, it's more convenient to for people to donate to a nearby center, two, it's more convenient for recipients to acquire organs from a nearby centers in case of extreme urgencies, and three in case there is ever a fire, or natural calamities, not all the organs would be lost at once.
The organ donation is a hard decision to make whose going to get the organs and why should they get the organ its like where playing god. There are a lot of things to consider. You need to consider blood type, if the organs going to make it to the place its needed because you only have so much time. But I feel the most important thing with blood type of course should be will the person take care of the organ, If I give a heart to someone who drinks every night till they cant even walk and I know he would change then in a couple of months he is going to die of liver failure so it would have been a mistake to give it to him because he needed it know when someone else could have it and they could have came up for a cure for AIDS.
The issue of allocation of transplantable organs in the U.S. is a difficult one because demand far exceeds supply. Only about 20% of the population are organ donors, largely because people fear the will be prematurely pronounced dead so that their organs can be procured for transplantation. Since transplantable organs are a scarce resource, decisions must be made as to who is to receive a transplant and then unfortunately, who does not. When viewing this ethical dilemma about who receives organ transplants, it is imperative to always keep in mind that there is a shortage of viable/transplantable organs. Ideally of course, it would be great if everybody could have the transplant they need. Since they can not, I think people should also be ranked according to necessity, and whether or not they can wait longer for another available organ. Say a teen can live another 2 years without a lung transplant and another person of much greater age, say in their 60’s, may only live another month, then I believe the adult should get the transplant. However, life expectancy needs to also be considered, for example if that 60-year old can only be expected to live another year vs. twenty more years, well then I am not nearly as convinced. Of course these are just hypothetical(s), and there is and should be governing committees that make such evaluated decisions.
Moreover, I feel people’s behavior should also be a determinant. If one has not taken good care of themselves and led a healthy lifestyle (especially if they knew better) then they should not be at the top of a public transplant list. For example, if one has ruined their liver through drinking or lungs through smoking, they should not be on the list at all, especially if they continue to behave the same. Where it is fair to base the decision off of age/health. There is a national database that matches organs donor organs to recipients. However, state laws govern postmortem organ donations under the Uniform Anatomical Gift Act. This law bases decisions on factors such as urgency of need, closeness of biological match, and geographic proximity to help determine who gets the organs. I feel the current system does a really good job of matching organ donors to recipients. However, it might be more fair to those living in states with smaller populations to allocate organs on a regional basis rather than state. Because organs for transplant are time sensitive this probably cannot be done to make it more fair on a truly national level. The United Network for Organ Sharing or UNOS, does match on a national level, however to ensure viability of the organs, in most cases organs would not be transported from say Maine to New Mexico. Overall the current system in place is a very good one and at most only minor tweaks to the system could be made for the better. Additionally, considering that only 20% are organ donors, I think that a greater campaign to further public awareness about the benefits of organ donation is in need.
After reading these articles, I think I am leaning more towards UNOS. It seems they have a pretty strong grasp on what should be done. The United Network for Organ Sharing (UNOS) maintains a centralized computer network, UNetSM, which links all organ procurement organizations and transplant centers. Most candidates, except those with living donors, wait for an organ due to the shortage of donor organs. Because each candidate's situation is unique, waiting times can vary, depending on a number of factors, such as those described in this section. UNOS member organizations, transplant candidates, recipients and donor family members work together to develop organ allocation policies that give every transplant candidate an opportunity at receiving the organ they need.
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