Ethical Issues about Extension of Life Flashcards
is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ.
organ transplantation
involves surgically replacing a failing organ with a healthy donor organ.
organ transplantation
The donor and recipient may be at the same location, or organs may be transported from a donor site to another location.
organ transplantation
organs and /or tissues that are transplanted within the same person’s body.
autografts
- Transplants that are recently performed between two subjects of the same species. It can either be from a living or cadaveric source.
allografts
allografts can come from what source (2)
living
cadaveric
Organs that have been successfully transplanted
heart, kidneys, liver, lungs, pancreas, intestines, thymus and uterus.
tissues that are referred as musculoskeletal grafts
bones, tendons
tissues including bones and tendons are referred to as
musculoskeletal grafts
are the most commonly transplanted organs worldwide
kidneys
kidneys are the most commonly transplanted organs worldwide, followed by the
liver
heart
are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold.
cornea and musculoskeletal grafts
Organ donors may be (3)
living
brain dead
dead via circulatory death
issue may be recovered from donors who die of (2)
circulatory death
brain death
Tissue may be recovered from donors who die of circulatory death, as well as of brain death – up to
___ hours past the cessation of heartbeat.
24
Unlike organs, most tissues (with the exception of ___) can be preserved and stored for up to five years
corneas
Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to
five years
Unlike organs, most tissues (with the exception of corneas) can be preserved and stored for up to five years, meaning they can be
banked
offer a great solution for many patients with organ failure and can improve their lifespan and quality of life
transplants
Undergoing an ___transplant can lengthen a person’s life and allow those with a chronic illness to live a normal lifespan.
organ
donor organs are often rejected by the host’s (recipient’s) immune system
transplanted organs rejection
recognizes that the new tissue is foreign, causing an inflammatory attack on the new tissue which if not stopped results in failure of the transplanted organ.
immunesystem
stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of protective T regulatory cells.
inflammatory cytokines
Multiple inflammatory cytokines stimulate ____ _ cells to attack the transplanted organ
cytotoxic T cells
Multiple inflammatory cytokines stimulate cytotoxic T cells to attack the transplanted organ while simultaneously inhibiting the action of
protective T regulatory cells
help suppress the immune system and protect the transplanted organ
conventional treatmentts
help suppress the immune system and protect the transplanted organ
however, they often have severe side effects.
conventional treatments
also reduce the amount of T regulatory cells in circulation, preventing the immune system from developing tolerance to the new organ.
immunosuppressive drugs
Natural interventions such as ___ and ___ may help lessen the inflammatory immune response and promote more successful transplant tolerance
circumin
omega-3 fatty acids
Help Prevent Organ Transplant Rejection
conventional medical treatment
Immunosuppressive drugs are under what kind of treatments
conventional medical treatment
example of immunosuppresive drugs
calcineurin inhibitors (e.g. cyclosporine)
May Be Beneficial for Organ Transplantation
natural interventions
a component of the spice turmeric, is a potent anti-inflammatory agent.
curcumin
Numerous studies demonstrate ____ability to inhibit inflammatory cytokines involved in transplant rejection. An animal study showed mice that had heart transplants survived significantly longer when treated with an immunosuppressive drug in combination with ___than the drug alone.
curcumin
found in fish oil, known for their anti-inflammatory properties, also suppress cytokines involved in transplant rejection.
omega-3 fatty acids
Many studies demonstrate their beneficial effects, including a study where kidney transplant patients supplemented with ___oil experienced better recovery of renal function after a rejection episode than control patients.
fish
has been shown to inhibit the activity of multiple inflammatory cytokines.
resveratrol
Animals who received a genetically incompatible liver transplant had reduced levels of cytotoxic T cells and survived significantly longer when supplemented with
resveratrol
is known to modulate the action of several inflammatory cytokines. In combination with vitamin E
Quercetin
has been shown in vitroto combat the hepatotoxic effects of cyclosporine, a common immunosuppressive drug.
quercetin
also inhibited T-cell proliferation, suggesting it may be effective in reducing transplant rejection.
quercetin
found heart transplant patients with the lowest blood levels of the active form of vitamin _ (1,25-dihydroxy vitamin _)were over 8 times as likely to die one year post transplant than those with the highest levels.
vitamin D
active form of vitamin D
1,25-dihydroxy vitamin D
seed extract has been shown to alter the ratio favorably and modulate immune response.
Grape
Higher ___ levels have been shown to be associated with increased mortality after transplantation.
homocysteine
. Several natural interventions can lower homocysteine levels, including
B complex vitamins
N-acetylcysteine
B complex vitamins
B6
B12
folate
such as those found in green andblack tea, cocoa, and pomegranate, have cardioprotective effects that may be beneficial after organ transplantation.
polyphenolsp
polyphenols is found in
green andblack tea, cocoa, and pomegranate
Steps in the process are as follows
1st step
Identification of the Potential Donor by the Hospital
Medical professionals at a hospital identify a potential candidate for donation. The nature of the injury leads a physician to determine the patient is brain dead or a potential donation after circulatory death (DCD) candidate.
what step
identification of potential donor by the hospital
2nd step in determining organ transplantation
evaluation of donor eligibility
Information is provided on the patient’s medical status and the recovery coordinator evaluates the patient. The evaluation includes a medical and social history and physical examination of the patient. This determines whether or not the patient is a suitable candidate for donation.
what step
evaluation of donor eligibioity
3rd step in organ transplantation
Authorization for Organ Recovery
If the patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation. If a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed. If the family consents, the legal next-of-kin signs a donor consent form.
what step
authorization for organization recovery
4th step in donor transplantation
medical maintenance of the patient
Once family consent or donor designation has been provided, the clinical coordinator, in concert with the hospital staff, maintains the patient medically. In some cases physician support is requested on a consultation basis.
what step
medical maintenance of the patient
5th step in organ transplantation
- Matching Organs to Potential Recipients
Information on the organs available for donation, the donor’s blood type and body size is provided to clinical coordinator. The computer then matches the donated organs to potential recipients. Recipient selection is based on blood type, body size, medical urgency and length of time on the waiting list. The heart, liver and lungs are matched by blood type and body size. In matching the pancreas and kidneys, genetic tissue type is also considered
what step
matching organs to potential recipients
6th step in organ transplantation
- Offering Organs Regionally, Then Nationally
A computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area. If a match cannot be made for a specific organ within this area, the organ is offered on a regional basis, then nationally, if necessary.
what step
offering organs regionally; then nationally
7th step of organ transplantation
- Placing Organs and Coordinating Recovery
When a recipient match has been found, the coordinator calls the transplant center for the patient who matches the donated organ(s). The patient’s transplant surgeon is responsible for making the decision whether to accept the organ. If the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list. This process continues for each organ until all of the organs have been appropriately matched with recipients. The coordinator then arranges for the operating room (for the recovery of the organs) and the arrival and departure times of the transplant surgery teams.
what step
placing organs and coordinating recovery
8th step of organ transplantation
Surgical Recovery of Organs
When the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure. In accordance with law, physicians recovering the organs do not participate in the donor’s care prior to the determination of brain death.
what step in organ transplantation
- Surgical Recovery of Organs
9th step in organ transplantation
- Preparing Recipients for Surgery
Once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital. Upon the organs’ arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed
what step
preparing recipients for surgery
10th step of organ transplantation
. Distribution of Organs
The coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients. Other organs are taken directly to the recipients by the surgical recovery teams.
what step
distribution of organs
raises a number of bioethical Issues
including the definition of death,
when and how consent should be given for an organ to be transplanted,
payment for organs for transplantation.
transplantation
a term sometimes used when you go to another country and pay for an organ transplant
transplantation tourism
the trading of human organs, tissues, or other body products, usually for transplantation.
organ trafficking
guiding principle for organ transplantation by WHO (4)
Autonomy
Beneficence
3. Non-maleficence
Justice
Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if:
(a) any consent required by law is obtained, and (b) there is no reason to beleive that the deceased person objected to such removal.
what principle
autonomy
Cells, tissues and organs may be removed from the bodies of deceased person for the for the purpose of transplantation if:
any consent required by law is obtained, and
there is no reason to beleive that the deceased person objected to such removal.
Physician determining that a potential donor has died should not directly involved in cell, tissue or organ removal from the donor or subsequent transplantation procedure; nor should they be responsible for the care of any intended recipient of such cells, tissues and organs.
what principle
beneficence
Cells, tissues and organs should only be donated freely without monetary payment or reward of monetary value. The prohibition on sale or purchase of cells, tissues and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income, or paying the cost of recovering, processing, preserving and supplying human cells, tissues and organs for transplantation.
what principle
beneficence
Minors and legally incompetent people no cells, tissues or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law. Specific measures should be in place to protect the minor and, wherever possible the minor assent should be obtained before donation.
what principle
non-maleficence
Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues and organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor.
what principle
non-maleficence
The allocation of organs, cells and tissues should be guided by clinical criteria and ethical norms, and financial or other considerations. Allocation rules, defined by appropriately constituted committees, should be equitable, externally justified and transparent.
what principle
justice
ethical issues for debate on organ transplantation
Is human body a commodity? How should decisions be made about who receive scarce organs?
Who should pay for transplants?
Should one person receive several organs or several persons receive one?
Should one person have second transplant when the first one fails or should a different person be given a first chance at a new organ?
Should organs be donated to those persons who have abused their bodies by drinking and smoking or only those whose organs are damaged by disease? Should state law maker be involved in transplantation?
medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ
organ transplantation
Occurs because the recipient’s organ has failed or has been damaged through illness or injury
organ transplantation
Transfer of a whole or partial organ from one body to another
organ transplantation
– a transplant of tissue from one to oneself (e.g. skin grafts, vein extraction, storing blood in advance surgery)
autograft
example of autograft (3)
skin grafts
vein extraction
storing blood in advance for surgery
transplanted organ or tissue from a genetically non-identical member of the same species
allograft
Most human tissue and organ transplant fall under this
allograft
a subset of allograft in which organs or tissues are transplanted from a donor to a genetically identical recipient (identical twin)
isograft
Anatomically identical to allografts, closer to autografts in terms of recipient’s immune response
isograft
isograft is anatomically identical to what
allografts
isograft is closer to ___ in terms of recipient’s immune response
autografts
Transplantation in which organs or tissues are transplanted from a donor to genetically identical recipient such as an identical twin
isografts
isografts are also known as
isotransplans
transplants that are always accepted
isografts
replacement of an individual’s defective organ with an organ harvested from another organ from another species
xenograft
source of organ for human use (2)
primates
pigs
genetic similarities to humans
primates
large availability
pigs
transplantation of living tissues, cells, and organs from one species to another
xenotransplantation
Genetically alter an animal organ with human genes to trick patient’s immune system into accepting it
xenotransplantation
– is an organ transplanted from one species to another
xenograft
refer to same species transplant
allotransplantation
disease transmission
xenozoonosis
sources for organ transplantation (4)
mandated choice
presumed consent
incentives
prisoners
voluntary donation
which source of organs?
mandated choice
a person is presumed to have consnted to organ donation in case of their accidental death
what kind of source
presumed content
1st step for organ transplantation
identification of potential donor by hospital
medical professional at a hospital identify a potential candidate for donation
what step for organ transplantation
identification of potential donor by the hospital
the nature of injury leads a physician to determine the patient (2)
brain dead
circulatory death candidate (DCD)
DCD means
donation after circulatory death
information is provided on the patient’s medical status
what step for organ transplantation
evaluation of donor eligibility
2nd step for organ transplantation
evaluation of donor eligibility
the recovery coordinator evaluates the patient. This determines whether or not the patient is suitable candidate for donation
what step for organ transplantation
evaluation of donor eligibility
recovery coordinator evaluates the following on whether the patient is suitable for donation (3)
medical history
social history
physical examination of patient
if a patient is a candidate for organ and/or tissue donation, at an appropriate time the legal next-of-kin is approached with the opportunity of donation
what step for organ transplantation
authorization for organ recovery
if a donor designation or individual authorization by the decedent cannot be identified, the family must give their consent in order for the donation process to proceed
what step for organ transplantation
authorization for organ recovery
if the family consents, the legal next-of-kin signs a donor consent form
what step for organ transplantation
authorization for organ recovery
once family consent or donor designation has been provided, the clinical coordinator in concert with the hospital staff, maintains the patient medically
what step for organ transplantation
medical maintenance of the patient
in some cases, physician support is requested on a consultation basis
what step for organ transplantation
medical maintenance of the patient
what information on the organs available for donation are known to be provided to the clinical coordinator
donor’s blood type
body size
after information on the organs available for donation are provided to the clinical coordinator, the computer then matches the donated organs to potential recipients
what step for organ transplantation
matching organs to potential recipients
recipient selection is based on ($)
blood type
body size
medical urgency
length of time on waiting list
used for matching heart, liver, and lungs
body type and body size
body type and body size were used to match
heart, liver, and lungs
in matching pancreas and kidneys, what is typed
genetic tissue type
genetic tissue type is used to match what organs (2)
pancreas
kidneys
a computerized list of waiting patients in the matching blood group is provided to the coordinator who seeks to match organs with recipients in the donation service area
what step for organ transplantation
offering organs regionally, then nationally
if match cannot be made for a specific organ in the area, the organ is offered on a regional basis, then nationally, if necessary
what step for organ transplantation
offering organs regionally, then nationally
when a recipient match has been found, the coordinator calls the transplant center for the patient whom atches the donated organ(s)
what step for organ transplantation
placing organs and coordinating recovery
the patient’s transplant surgeon is responsible for making the decision whether to accept the organ
what step for organ transplantation
placing organs and coordinating recovery
if the surgeon declines the organ for that patient, the coordinator contacts the transplant surgeon of the next patient on the list
what step for organ transplantation
placing organs and coordinating recovery
this process continues for each organ until all of the organs have been appropriately matched with recipients
what step for organ transplantation
placing organs and coordinating recovery
the coordinator then arranges for the operating room (for the recovery of organs) and the arrival and departure times of transplant surgery teams
what step for organ transplantation
placing organs and coordinating recovery
when the surgical team arrives, the donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure
what step for organ transplantation
surgical recovery of organs
in accordance with law, physicians recovering the organs do not participate in the donor’s care prior to the determination of brain death
what step for organ transplantation
surgical recovery of organs
once the recipients have been identified, they are called by their transplant surgeons for the final pre-operative preparations while the organ recovery process is occurring at the donor hospital
what step for organ transplantation
preparing recipients for surgery
upon the organs’ arrival at the transplant hospital, the recipients are taken to surgery and the transplants are performed
what step for organ transplantation
preparing recipients for surgery
the coordinator takes a sample of the lymph node tissue to a laboratory for tissue typing and subsequent matching with recipients
what step for organ transplantation
distribution of organs
other organs are taken directly to the recipients by the surgical recovery teams
what step for organ transplantation
distribution of organs
puts unfair pressure on economically disadvantaged people, wealthy people have unfair access
buying and selling of organs
compromises the donor and recipient safety
buying and selling of organs
due to limited resource, distributive justice is observed
organ allocation
distributive justice includes
how to fairly divide resources
equal access
maximum benefits
everyone should have to able access it equally
length of time
age of recipient
what part of distributive jsutice
equal access
reasons for equal access (3)
exclude individual worth from equation
exclude medical worthiness (smoking)
exclude social worthiness (prisoners)
maximize the number of successful transplants
medical need
probability of success
maximum benefit
reason for maximum benefit
limited resource should avoid waste
second transplant
factor in medical outcome
cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation
what WHO guiding principle
autonomy
cells, tissues, organs may be removed from the bodies of deceased person for the purpose of transplantation (2)
any consent required by law is obtained
there is no reason to believe that the deceased person objected to such removal
physician determining that a potential donor has died should not directly involved in cell, tissue, or organ removal from the donor or subsequent transplantation procedure
what WHO guiding principle
beneficence
Physician should not be responsible for the care of any intended recipient of such cells, tissues, and organs
what WHO guiding principle
beneficence
in general, living donors should be genetically, legally or emotionally related to their recipients
what WHO guiding principle
Autonomy, non-maleficence, justice
has informed, voluntary consent and professional follow up is ensured and organized
what WHO guiding principle
autonomy, non-maleficence, justice
no cells, tissues, or organs should be removed from the body of a living minor for the purpose of transplantation other than narrow exceptions allowed under national law
what WHO guiding principle
non-maleficence
specific measures should be in place to protect the minor, and wherever possible the minor assent should be obtained before donation
what WHO guiding principle
non maleficence
cells, tissues, and organs should only be donated freely without monetary payment or reward of monetary value
what WHO guiding principle
beneficence
the prohibition on sale or purchase of cells, tissues, and organs does not preclude reimbursing reasonable and verifiable expenses incurred by the donor, including loss of income or paying the cost of recovering, processing, preserving, and supplying human cells, tissues, and organs for transplantation
what WHO guiding principle
beneficence
capable persons must be allowed to accept or refuse recommended medical interventions
what WHO guiding principle
autonomy
medical practitioners should act in the best interests of the patient
what WHO guiding principle
beneficence
physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures, if the cells, tissues, and organs concerned has been obtained through exploitation or coercion of , or payment to, the donor or the next of kin of a deceased donor
what WHO guiding principle
nonmaleficence
the allocation of organs, cells, tissues should be guided by clinical criteria and ethical norms, and financial or other considerations
justice
defined by appropriately constituted committees, should be equitable, externally justified, and transparent
allocation rules
What applications of principles of bioethics
in choosing this, students are maximizing the life span for the most number of people. This related to the principle of Maximize benefits and minimize harm
Save the youngest
What applications of principles of bioethics
option values fairness, relates to principle Justice
draw straws (or any randomization techniques)
What applications of principles of bioethics
this option considers the special needs of vulnerable population. It relates to the principle Respect for persons
save the weakest
What applications of principles of bioethics
saving someone who may be able to save others benefits a larger number of people. This relates to the principle Maximizing benefits and minimizing harms
Save the most useful
What applications of principles of bioethics
honiring the dignity of human beings includes acknowledging their relationships. This relates the principle “respect for persons”, this approach also relates to Care, an additional principle which can be used alongside the other principles mentioned
respect relationship
ethical issues for debate
Is human body a commodity?
How should decisions be made about who receive scarce organs?
Who should pay for transplants?
Should one person receive several organs or several persons receive one?
Should one person have second transplant when the first one fails or should a different person be given a first chance at a new organ?
Should organs be donated to those persons who have abused their bodies by drinking and smoking or only those whose organs are damaged by disease?
Should state law maker be involved in transplantation?
