Reuse of cardiac organs in transplantation: an ethical analysis

Abstract

BackgroundThis paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.”MethodsMedical, legal, and ethical analysis, with a main focus on ethical analysis.ResultsFrom the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse.ConclusionWe conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.

The Ethical Acceptability of a Recipient’s Choice of Donor in Directed and Nondirected Transplantation: Japanese Perspective

“…The relationship between recipient and donor in living organ transplantation that is directed is basically a gift relationship. 10 As the relationship between the two is a gifting relationship, it would follow that a recipient should be allowed to refuse a donor's gifting act. This conclusion does not change even if the act could be regarded as a kind of contractual relationship, as donors are given the freedom to choose the recipient with whom they can enter such a contract.…”

Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

“…For instance, according to Robert Nozick who, while partially criticising Locke’s ownership theory, defended the notion of property rights as self-ownership: ‘The central core of the notion of a property rights in X … is the right to determine what shall be done with X, the right to choose which of the constrained set of options concerning X shall be realized or attempted.’13 Based on the premise of such rights combined with the principle of autonomy and respect for the individual’s right of self-determination, including around issues of bodily integrity, retransplantation (into A) is ethically permissible. ‘Permissibility’ in this sense is grounded in B’s right to self-ownership of the organ as well as his right to disclaim it, or his right to donate the organ 14…”

“…It is not unnatural to add to this relationship an understanding specifically about organ restitution. Whether or not directed donation should be permitted in deceased donor organ transplantation is a controversial topic, and we have a negative opinion regarding this issue 14. However, organ transplantation between living persons, in contrast, is essentially based on ‘directed’ donation.…”

Uterine transplantation: legal and regulatory implications in England

“…The possibility of the live donor changing her mind after retrieval and requesting the uterus back (organ restitution), perhaps even once it has served its required ‘purpose’, is one which needs consideration from a legal standpoint. The ethics surrounding the issue of organ restitution have been addressed previously 28,29 …”

“…The ethics surrounding the issue of organ restitution have been addressed previously. 28,29 For UTx, there exists the notion of whether donation of such an organ is a 'loan for use' contract. Human tissue has been recognised as being the subject of property rights by legal scholars in the UK and USA.…”