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Legal andethicissues OrganDonationSara CRUZ Discente nº933
OrganDonation • Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and social history, of which are suitable for transplantation. Such procedures are termed allotransplantations, to distinguish them from xenotransplantation, the transfer of animal organs into human bodies.
Themainproblems… • Religion • Cultural objections • Living donors: those who volunteer a kidney or parts of their liver or lungs are understandably reluctant - they must undergo potentially life-threatening surgery and put their own future health at risk.
OrganDonation • In Portugal, LinharesFurtado was responsible for the first transplant, in 20th July 1969, in Coimbra. • Todaythere are transplantionoftheseorgansandtissues: • Lung; • Pancreas; • Blood vessels; • Intestines; • Ossicles of the ear; • Skin; • Heart; • Heart valves; • Corneas; • Bone marrow; • Liver; • Kidneys; • Tendons; • Meninges;
MainEthicalPrinciples .Principle of body Inviolability: reflects the membership of the body to personal identity, and as such, deserving of dignity and the unavailability of the human person. Thus, any intervention in bodily integrity is both an intervention in personal integrity.Principle of Solidarity: argues that being a man is eminently social and bearer of the possibility of making a set of sacrifices according to the good of the community, that in these sacrifices should include organ donation. Since these do not involve compromising the integrity of life. Principle of Totality: it is believed that as the whole body, each part thereof to be evaluated according to the whole. And so, each party (member, organ or function), may be sacrificed for function of the body, since this is useful for the welfare of the whole organism.
EthicalPrinciples • InformedConsent • Equality of access to patients in the transplant services; • Transparency of rules for allocation of organs and tissues; • Setting safety standards; • Gratuity of donations; • Good information for all involved; • Confidentiality; • Punishments in case of violation.
EthicalIssuesRegardingtheDonor • From the Deceased • From Living Persons (Adults, Mentally Disabled, Minors) • From Anencephalic Infants • From Human Fetuses
LivingDonnors Portuguese legislation only authorizes the harvesting of living regenerative substances. However, although this prohibition is absolute for minors and others incapable, by way of exception is allowed organ donation and non-regenerative substances, where there is a kinship to the third degree.
LivingDonnors • Compatibility TestingSeveral tests are done to confirm the compatibility of the donor organ and recipient.They are absolute contraindications for donation patients who have:Uncontrolled infection,HIVHTLV 1/2Malignant neoplasm except: primary tumor of the CNS, basal cell carcinoma, carcinoma "in situ" of the uterus.
DeceasedDonors • “A person may will to dispose of his [or her] body and to destine it to ends that are useful, morally irreproachable and even noble, among them the desire to aid the sick and suffering. One may make a decision of this nature with respect to his own body with full realization of the reverence which is due it....this decision should not be condemned but positively justified.” Pope Pius XII 1956
DeceasedDonors • But…. • The use and possible use of cadavers and "neomorts" (brain-dead individuals maintained on life support) for a variety of purposes (transplants, research, training medical students), perhaps even a considerable time after the person's death, has provoked ethical and legal debate. Various concerns include respect for the dead and their wishes, respecting the family's wishes, benefitting others and the common good. In light of this, anyone considering donating their organs and/or body after their death, highly commendable in itself, may wish to specify certain limits.
Anencephalic Infants • Anencephalic infants are born with a major portion of the brain absent. If born alive they die within a few days, although in rare cases some survive for weeks or months. They can suck and cry and some argue that their degrees of consciousness or unconsciousness may vary. According to the widely accepted criteria of death as irreversible cessation of all brain functions, they are living human beings/persons. To increase the likelihood of procuring viable organs from them, some would like to redefine death in terms of partial brain death so that they could be considered dead (although still breathing spontaneously...), or for them to be exempt from the total brain death criteria, or to consider them non-persons. Many others, however, argue that partial brain death criteria are invalid in light of our present knowledge and/or such an arbitrary move would endanger other classes of living human beings and lead many more people to refuse to sign organ donor cards. Although extraordinary means of prolonging the life of anencephalic infants do not need to be used, they should be given the normal care of dying persons.
Human Fetuses • Is it ethical to transplant brain or other tissues from human fetuses to benefit others (e.g. those suffering from Parkinson's Disease)?
MinorsandUnable • Lei n.º 12/93, de 22 de Abril • COLHEITA E TRANSPLANTE DE ÓRGÃOS(versão actualizada) • CAPÍTULO II Da colheita em vidaArtigo 6.ºAdmissibilidade 4 - São sempre proibidas a dádiva e a colheita de órgãos ou de tecidos não regeneráveis quando envolvam menores ou outros incapazes. 5 - A dádiva e a colheita de órgãos, de tecidos ou de células regeneráveis que envolvam menores ou outros incapazes só podem ser efectuadas quando se verifiquem os seguintes requisitos cumulativos: a) Inexistência de dador capaz compatível; b) O receptor ser irmão ou irmã do dador; c) A dádiva ser necessária à preservação da vida do receptor.
MinorsandUnable • Artigo 8.ºConsentimento • 3 - Tratando-se de dadores menores, o consentimento deve ser prestado pelos pais, desde que não inibidos do exercício do poder paternal, ou, em caso de inibição ou falta de ambos, pelo tribunal. 4 - A dádiva e colheita de órgãos, tecidos ou células de menores com capacidade de entendimento e de manifestação de vontade carecem também da concordância destes. 5 - A colheita em maiores incapazes por razões de anomalia psíquica só pode ser feita mediante autorização judicial.
TypesofTransplantation Autoplastic transplantation: when tissues are transplanted in the same body, from one place to another; • Heteroplastic transplantation: is the transplantation of organs or tissues from one body to another. It can be homologous if it occurs between individuals of the same species; • Xenotransplantation: is the transplantation of organs or tissues between individuals of different species;
Legislation • Convention for the Protection of Human Rights and Dignity of the Human Being approved in Oviedo in 1997 and rulling in Portugal after 2001. • ThisConvention looks for a biggerharmonizationofexisting rules in differenteuropean countries seaching for a widerprotectionandavoid some bioethicissues. • Itwascomplementedby na important adicional Protocolonthisfield: Additional Protocol About Transplantation of Organs and Tissues of originhuman (Committee of Ministers on 8 November 2001, in force since 1May 2006);
Lei n.º 12/93, de 22 de Abril • Regulates the harvesting and the Transplantation of Organs and Tissues of Human Origin. Also regulates the admissibility of the information, consent and the right to assistance and compensation. This law provides the anonymity of the donor and recipient, prohibiting the disclosure of the identity of both. • ItwasamendedbyLei 22/2007, de 29 de Junho and Lei 12/2009, de 26 de Março.
Constituição da República Portuguesa • Principle of Equality (13º) • Right to Life (24º) • Right to Humane Treatment (25º) • Right to Health (64º)
Legislation • There are two main systems for voluntary systems: "opt in" (anyone who has not given consent is not a donor) and "opt out" (anyone who has not refused is a donor). • In Portugal the donation of organs after death is considered a presumed, meaning that any national or foreign citizen resident in Portuguese territory is considered donor since its birth. But those interested in do not donate their organs after death should register for free at any health center thus making his name be recorded in the National Register of non-donors (RENNDA)Decreto‐Lei 244/94, de 22 de Abril,
Numbers…. • Data from the Council of Europe put Portugal on the world leader in liver transplantation, after overtaking the United States, and the second position in the case of kidneys. The data show good results also in the collection, which today is around 30 donors per million of habitants. Gift of Life will be expanded this year with the creation of cross-donation.
But… • “Every day in Europe, twelve people die waiting for a transplant. This translates to around 4 000 deaths per year. The level of donations has remained largely static for the past five years, and 56 000 patients are on organ transplant waiting lists.”
How to distribute these limited resources? Which are the criteria for selection??
On what basis should this person rather than that person be chosen to receive a given organ? • A widely used and approved criterion of selection is to give priority to those who have great need and who are expected to benefit greatly. • Thefirstregisteredonthewaitinglist • With regard to who will likely benefit more from receiving a transplant, medical criteria such as blood and tissue typing (i.e. who is less likely to reject the transplant), and the absence of other life-threatening diseases, are used.
"The day will come when my body will lie upon a white sheet, neatly tucked under four corners of a mattress, located in a hospital busily occupied with the living and the dying. At a certain moment a doctor will determine that my brain has ceased to function and that, for all intents and purposes, my life has stopped." "When that happens, do not attempt to instill artificial life into my body by use of a machine. And don't call this my deathbed. Let it be called the Bed of Life, and let my body be taken from it to help others lead fuller lives." • "Give my sight to the man who has never seen a sunrise, a baby's face or love in the eyes of a woman. Give my heart to a person whose own heart has caused nothing but endless days of pain. Give my blood to the teen-ager [sic] who was pulled from the wreckage of his car, so that he might live to see his grandchildren play. Give my kidneys to one who depends on a machine to exist from week to week." • "Take my bones, every muscle, every fiber and nerve in my body and find a way to make a crippled child walk. Explore every corner of my brain. Take my cells if necessary, and let them grow so that, someday, a deaf girl will hear the sound of rain against her window. Burn what is left and scatter the ashes in the winds to help the flowers grow. If you must bury something, let it be my faults, my weaknesses and all prejudice against my fellow man. Give my sins to the devil. Give my soul to God. If by chance you wish to remember me, do it with a kind deed or word to someone who needs you. If you do all I have asked, I will live forever”
“BlackMarket” • Organ traffic is the third most lucrative crime in the world. • Organ trafficking occurs especially in some Asian countries with a particularly permissive legislation. • Many people travel to get a transplant, without questioning how the agency obtained the organ and without knowing that the operation hasn’t any medical guarantee, since neither the giver nor the receiver is followed later.
DidyouKnow?? • The latest option available on Facebook allows users to enter in your profile if you are donating organs, in order to facilitate the supply and demand. This new possibility was announced yesterday, on the official social network.DN, 02Maio2012 • http://www.youtube.com/watch?v=5qRgvSWAiN4&feature=related