British Section of the World Federation of Doctors Who Respect Human Life

Sir, Not satisfied with their recently gained right to create human-animal hybrids, scientists and those who lobby on their behalf are now pushing for a system of presumed consent with respect to the use in cloning of previously obtained tissue (letters, Jan 21). This is an outrageous presumption that should not be permitted. Those who donated tissue for medical research, and naturally those from whom tissue was taken without consent, cannot have envisaged that it would be used to create human or animal-human embryos for destructive research, and might understandably have been repulsed at the prospect.

There is plenty of evidence that research using adult stem cells will realise true therapeutic benefits, possibly surpassing the potential of embryonic stem cells without posing any of the ethical dilemmas. How edifying it would be if scientists were to declare a respect for human life, from the time of its conception, as did their medical colleagues in the Declaration of Geneva in 1948.

Dr Paul King
School of Biological and Chemical Sciences, Birkbeck, University of London

Sir, The memory of some scientists in this country is very short. The Alder Hey scandal involved the retention of organs from children without consent and the public was rightly outraged; the proposals by Lord Patel and others to bypass proper consent in order to use human tissue to create cloned human or animal-human embryos contravenes every protocol put in place post Alder Hey. Informed consent remains a fundamental pillar of medical ethics, one which the stem-cell imperative cannot overturn.

Josephine Quintavalle
Director, Comment on Reproductive Ethics

Commentary

Michael Potts

Philosophy, Ethics, and Humanities in Medicine 2007, 2:17

Published: 24 August 2007

Abstract (provisional)

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit. Verheijde, Rady, and McGregor attack the deception involved in NHBD, arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent. Such honesty about NHBD should be welcomed. However, NHBD violates a fundamental end of medicine, nonmal eficience, "do no harm." Physicians should not be harming or killing patients, even if it is for the benefit of others. Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

Read the original at news.com.au.

CHINA'S military is harvesting organs from unwilling live prison inmates, mostly Falungong practitioners, for transplants on a large scale - including to foreign recipients- according to a study.

The report's authors - Canada's former secretary of state for the Asia Pacific region David Kilgour and human rights lawyer David Matas - implicated dozens of hospitals and jails throughout China in July, after a two-month investigation.

Chinese officials denied those allegations.

J Med Ethics 2005; 35: 406-409

The "standard position" on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though "brain dead" patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US "whole brain" criterion and the UK "brain stem" criterion. Then we answer their arguments in favour of removing vital organs from "brain dead" and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to "letting nature take its course", arguing that, unlike "allowing to die", it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation.

By Jennifer Lahl

Today's LA Times is covering a story on four Japanese gang figures who received liver transplants at UCLA. The story raises all of the ethical issues surrounding organ donation and transplantation. How do we ethically share organs which are scarce and precious and needed for saving lives?

Access to organs has always raised ethical problems. Who is our neighbor, and how far do we need to open our borders and let people into the donor pool? The story states that these were Japanese bad dudes and one in particular, Tadamasa Goto, was allowed into the states in exchange for leads and information on Japanese criminal gangs. While here, he was in need of a liver transplant and the story goes that he "got a liver and was laughing back to where he came from." Laughing mainly because in exchange for useless information he got away with a life saving liver transplant. He took cuts and jumped the line.

Who's worthy of the much needed organ has also been part of the debate. Does the alcoholic in need of a liver transplant get put to the bottom of the list over a person who's had a chronic liver disease from birth? Or in this case, does the law abiding citizen get to move to the head of the line over the law breaker? The argument has often been that the system needs to be blind to criteria of worth because this is so subjective and slides us into suggesting people have a duty or obligation to die because their life is not worth living or their life is not worth saving. We certainly wouldn't suggest the converse. That we begin killing those on death row for their organs. Often blind lotteries are suggested after the medical criteria has been assessed. Does the organ match the recipient? When directly competing for the much needed organ, all things being equal, who needs the transplant most urgently?

And this debate often boils down to a discussion on the allocation of scarce resources. Fact is, we don't have enough organs to meet the needs of those waiting on lists for a transplant. This story states that 100 people died waiting on the list, while the bad guys got away with organs. So how do we divvy them up fairly?

What often makes people really queasy is just feeling that the current organ donation program isn't fair. Justice matters. One comment in the LA Times piece states what many people feel. They've chosen to opt out of the DMV pink dot organ donor program because the system is corrupt. The United Network of Organ Sharing should take notice that ethics do matter and that people do have an innate sense of injustice. Once the ethics are shored up, public confidence will be restored and people will probably be glad to put that pink dot back on their license.