The Ethics of Organ Donation

Medical ethics is grounded on four principles. These principles are autonomy, beneficence, justice and nonmaleficence. Autonomy addresses the ability for one to do what he or she wants to do with his or her body. In brief, it is called self-governance. If someone decides that they would like to donate an organ, then they have all the right to do so. However, in doing so the benefits, risks and all other pertinent information must be shared with them. Benefits of organ donation are not monetary gains. Offering of an attractive compensation to someone that is far from being realistic amounts to undue influence. This is like forcing someone to do it. It is like a deal that is too good to walk away from. There are many people who are in dire economic situations and may be attracted to these offers, not because they want to be a good Samaritan or their brother’s keeper, but because they can do with the money.

Persons who are vulnerable can be easily influenced to participate without thinking about the risks associated. In any organ donation process, all information must be made publicly available.

The next principle of beneficence speaks about doing good. The welfare of any potential donor should be central to the process. The recruiters should ensure that the process meets international standards and that donors are cared for using the most current and acceptable standard of care.

Nonmaleficence states that we should act in ways that do not inflict evil or cause harm to others. We should not cause avoidable or intentional harm. This includes avoiding even the risk of harm.

Notwithstanding this, there are numerous risks associated with transplant surgery. These include organ failure, infections and even death. Donors must be informed on what will be done to reduce these risks. Answers should be provided for the following questions. Who will take the responsibility should complications arise? Should the other kidney fail down the road, what care will be offered to the person and for how long? Should other complications occur who will compensate the donor? Will the procedures be done safely?

The principle of justice must not be overlooked in the discussions. Will the recipients on waiting lost have a fair chance to be selected? How will the waiting list be made up and how will one decide who gets an organ first? These are very complex questions and at times are hard to answer, but the process must aim to be as fair and just as possible.

Finally, the sale of organs in most places is illegal and unethical. Organ donation is an altruistic act, carried out after voluntary, informed consent, without undue influence and coercion and with proper systems in place to ensure the protection of both the donor and the recipient.

Dr. Rosmond Adams, MD; MSc (Public Health); M.S (Bioethics) is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is a lecturer of medical ethics and Research Methods.

He is the Head of Health Information, Communicable Disease and Emergency Response at the Caribbean Public Health Agency (CARPHA). He is also a member of the World Health Organization Global Coordination Mechanism on the Prevention and Control of NCDs.