– FAUSTO GOMEZ OP
In our second column for O Clarim, we reflect on living donors of organs, and on the recipients of donated organs.
- DONORS OF ORGAN: LIVING DONORS
On the part of the living donor, the two principal ethical issues are related to bodily integrity and consent to donate. First question connected with living donors of organs: May we be living donors of our bodily organs, for instance, a kidney?
As a human person, I am an individual and a person, and a member of the human family. As an autonomous individual, I am indivisible and unique: I am body-soul, or incarnate spirit. I am an individual person and, therefore, not only an autonomous but also a (heteronomous) relational human being. I am a member of the human family. I am united to others in love and solidarity.
As a Christian, I am the steward of my life, which belongs to God, and a disciple of Jesus in the Church, which is the community of faith, hope and love. I am by nature and faith related to other human beings – creatures and children of God like me. As a good steward – a custodian, and an administrator – I have to take proper care of my life and health. Generally, good stewardship requires me – positively – to care for my whole body and all its organs, and – negatively – not to mutilate my body or any of its healthy parts or organs. Circumstantially, however, I may allow the mutilation or removal of an organ, if this organ is an obstacle to my integral health (for instance the cutting of a gangrened foot): the part is for the whole and, therefore, subordinated to the whole – my life and also my health (ethical principle of totality/integrity, also applicable to autoplastic transplants).
Regarding the body as integral whole, ethicists distinguish between anatomical integrity (physical integrity, all organs of the body are respected) and functional integrity (efficient functioning of the body, the functions of the body are respected). While anatomic integrity is not required to live a basically healthy life, functional integrity is. Hence, our ethical responsibility concerns functional integrity, which is considered as “the key factor in addressing the morality of transplants between living persons” (Benedict M Ashley, OP and Kevin D. O’Rourke, OP). A good example is the removal of one kidney: this removal does not damage seriously an essential function of the body. Only one healthy kidney is necessary to live a normal life. The second kidney “is not necessary for personal or pro-creational identity or for functional integrity and the long-term risk for renal failure or hypertension is low” (Bioethicist Angeles Tan Alora, MD). Hence, as CCC avers (no. 2296), “it is morally inadmissible to bring about the disabling mutilation or the death of a human being even in order to delay the death of other persons.”
Exceptions to organ donation: the brain and the gonads cannot be donated for transplant for “they are connected respectively with the personal and procreative identity of the person,” with “the uniqueness of the person” that medicine is obliged to respect and safeguard” (New Charter for Health Care Workers, 2016).
I may donate a kidney. But I am not really obliged to do so. It is not a question of justice – even in the case of possible relatives of the donor – but of solidarity or love, which for me may weigh more than the possible presumably minor risks involved in the removal of my kidney. The free and generous gift of an organ to a recipient may truly be considered good and beneficial to the donor, the recipient and humanity at large. St John Paul II considers organ donation a heroic gesture of sharing.
The second question: Must I – must you – give informed consent for organ donation? The donor must be able to give a free and informed consent. To be able to do so, I, the donor, must be informed adequately and truthfully on the nature of the procurement of my organ, the effects of the medical-surgical intervention, the implications and possible consequences of the donation for my life and my health.
2. ORGAN TRANSPLANT: THE RECIPIENT
The first question to be answered is the following: Is the donated kidney beneficial to the recipient? The transplant of the kidney – or another organ – appears as beneficial: there is no better therapeutic alternative; the benefits of the transplant outweigh the burdens and risks involved for the recipient; the kidney to be received is compatible with the recipient’s body; there seems to be a good prognosis for the recipient of the organ.
The second question we face is this: Does the recipient consent freely to the transplant of the organ? After being duly informed, and after understanding well the information given, the recipient gives free and informed consent.
Another important question: Who should receive the available organ? There is no major ethical problem regarding related recipients. There should not be big problems concerning non-related donors who choose whom to give their gift. The problem arises when the organs are donated to a center, or to a public hospital, which distributes available organs for transplants. The legal and ethical issue then refers to the allocation of organs for transplants.
Considering the scarcity of organs and the long lists of potential recipients, who should receive the organ: a member of my community, a citizen of my country, or a citizen from another country? Are we for local, or for national boundaries for the recipient of a kidney, or for unrestricted international boundaries? Some prefer no boundaries, while others argue for restricted national boundaries; still others are for regional boundaries – though not exclusively – like the Scandinavian countries. Although no boundaries is the ideal to be sought, we may argue in favor of national boundaries partly open to foreigners: charity begins at home, but does not end there. This is the current general policy in many countries, including Macau.
What matters most is that there is – within the country or within the region, or within the world social justice – no discrimination against groups of people by reason of their ethnicity, their religion, their gender, their age, or their socio-economic status. Within a country, all citizens are fundamentally equal in rights and dignity, and, therefore, must be treated equally: equal cases deserve equal treatment!
Who would accept the organ better (“medical utility”)? Who is the neediest among the needy? Need and the therapeutic criterion should help decide who the recipient must be. How about the norm, “first-come-first-served”? How about using the method of lottery? In any case, the ethical principle of distributive justice – equitable distribution of benefits and burdens – ought to be taken into consideration. It is important – even necessary – that competent authorities, after due public discussion, come out with clear criteria and policies regarding the allocation of organs.
We close this section with an enlightening text from John Paul II (August 29, 2000): “From the moral standpoint of view, an obvious principle of justice requires that the criteria for assigning donated organs should in no way be ‘discriminatory’ (i.e. based on age, sex, race, religion, social standing, etc.) or ‘utilitarian’ (i.e. based on work capacity, social usefulness, etc.). Instead, in determining who should have precedence in receiving an organ, judgment should be made on the basis of immunological and clinical factors. Any other criterion would prove wholly arbitrary and subjective, and would fail to recognize the intrinsic value of each human person as such, a value that is independent of any external circumstances.”
Follow
