6) Ethical Issues in Donation & Transplantation

• Fetal tissues transplantation is a type of organ transplantation.
• Yulia Peeva, PhD, is an Associate Professor in the Department of Public Health, Faculty of Public Health, Medical University - Plovdiv.
• The first transplant assumed as such is immortalized in a painting of Fra Angelico, where we can see the saint Cosma and the Saint Damian transplanting an Ethiopian's leg.
• Buddhism allows cadaveric transplants, but every single person is allowed to decide on his own.
• The schools of Islam have their own rules which must be fulfilled for cadaveric donations.
• Some schools of Islam permit live donations and some permit cadaveric donations, excluding transplantation of organs upon which the life depends such as heart and liver, as it kills the soul.
• Tibetan Buddhists believe in consciousness after death, and such a person/body cannot be disturbed, hence cadaveric transplants are not possible for them.
• Gasparo Tagliacozzi observed immune reaction in 16th century.
• The first bone marrow transplant was performed in 19th century.
• Eduard Zirm performed the first corneal transplant (restoring sight) in 19th century.
• The first human kidney transplant from dead donor was performed in 1936.
• The first successful human to human bone transplant was performed in 1978.
• Joseph E. Murray, from Brigham and Women’s Hospital (Boston, USA), performed the first successful kidney transplant in 1954.
• Christiaan Barnard performed the first heart transplantation in 1967.
• In 1969, in Portugal, the first transplant was made by Linares Furtado, in Coimbra, (kidney transplant).
• Baltimore Hospital pioneered “domino chain”, a process initiated when an altruistic donor donates an organ to a patient who has a willing but incompatible donor.
• Transplantation is a combination of medical and other activities of obtaining organs, tissues and cells from human cadaver or living person and their implantation to other person for treatment, as well as obtaining organs, tissues and cells from animals and their implantation in human body.
• A donor is a person from whom it has been taken grafting material.
• A recipient is a person who receives a transplant.
• Organ Transplant replaces a failing organ with a healthy organ.
• A doctor will remove an organ from another person and place it in your body.
• Human fetal transplantation is still experimental.
• Neurotransplantation of embryo- and fetal tissues obtained from aborted embryos for treatment of some neurological diseases is allowed after having a consent of the woman.
• According to the World Health Organization (WHO), illegal organ trade occurs when organs are removed from the body for the purpose of commercial transactions.
• Fetal tissues transplantation may raise ethical issues such as whether fetal rights are violated, if there is a moral danger that the potential of fetal tissue donation will encourage elective abortions, and what criteria should be used to select fetal tissue transplant.
• Orthodox Jewish (not reformed and liberal ones) does not allow the transplantations, which are terminating human life by human extraction.
• Christianity supports donation.
• Amniotic cells and blood stem cells from the umbilical cord of the newborns are allowed for transplantation after having a consent of the mother.
• Jehovah's Witnesses cancelled the prohibition of transplantations in 1967, but it is not clear, how to perform it, when blood transfusion is forbidden.
• Potential organ recipients are kept on a waiting list up to October 5, 2022, with a need for transplantation of 901 organs, including 802 kidneys, 37 livers, 33 hearts, 18 lungs, 9 pancreases, 2 small bowels, and 295 transplants performed.
• In Bulgaria, a law for transplantation was declared in 2003, which includes a declared living refusal for donation and in case of not expressing any will, after the death a consent is obtained from the relatives.
• Organ traffic is the third most lucrative crime in the world, especially in some Asian countries with a particularly permissive legislation.
• Ethical issues in donation and transplantation include financial advantageous of transplantation, family acceptance of death taking a while, habits and rights, human body is not a property, unity of soul and body, biological ethic, and neutral value of such procedure.
• Fetal tissues transplantation is the implant of tissue from an aborted fetus to a patient for treatment of disease.
• Using fetal tissue for transplantation may be able to overcome the failures of traditional medical and surgical therapy to ameliorate several diseases, most notably Parkinson’s disease and insulin-dependent diabetes mellitus.
• Advantages of living donor transplantation include decreased waiting list, better timing for procedure, lower immune reaction and lower rejection rate in case of relatives.
• The transplantation program in Bulgaria started in 1968 with renal transplantations to a child and adult woman.
• The ratio between transplantations from deceased and living related donors is approximately 1:0.9.
• Disadvantages of living donor transplantation include huge pressure on prospective donors, exploitation of donors, insufficient knowledge and awareness of donors and their families about this possibility, risk of nephrectomy (kidney disease), and the donor lives with one kidney.
• The Principles of the Convention on Organ and Tissue Transplants apply to the field of organ and tissue transplants, respecting its main objectives: protecting the dignity and integrity of the human being and protecting the rights and fundamental freedoms, with regard to advances in Medicine and Science.