Ethical aspects of organ transplantation.

Organ transplantation is one of the most exciting modern medical phenomena. Not a month goes by without news of some new development in this area. As an example of how far we have come, Dr. Starzl – one of the leaders in the field – has removed the liver, spleen, pancreas, small intestine and part of the large intestine with subsequent replacement by transplantation in an extensive operation with impressive results. We have indeed reached a stage where the ability of surgeons and their colleagues is quite remarkable. However, as in many other disciplines, progress in the area of ethics has not kept up with that of science and medicine, and this discrepancy creates serious problems. Perhaps we can learn from past mistakes. Let us begin with a historical survey: About 90 years ago Professor Carrel transplanted a heart into a dog, thereby demonstrating the surgical techniques necessary to connect blood vessels. Over a period of several decades other researchers attempted to transplant organs, but they met with no long-term success, principally because of immunological problems. By the middle of this century several attempts to transplant kidneys had failed, even in cases involving close relatives. A breakthrough occurred during the 1950’s when Professor Merrill overcame the immunological rejection by transplanting the kidney of an identical twin, an experiment which earned him the Nobel Prize. For a number of reasons, the kidney is an excellent organ to transplant. First, since a person has two kidneys, the removal of one does not threaten the life of the donor. Secondly, the kidney is less delicate than the liver and heart; a kidney removed from a dead donor, even according to the conventional definition of death (i.e. the heart is no longer beating), may survive in the recipient. Thus the complicated subject of defining brain-death is avoided.