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Part A: Introduction
- The University of Akron Press
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Part A: Introduction Silke Schicktanz, Claudia Wiesemann Organ transplantation is a thrilling new option of modern surgery yielding hope for chronically ill patients, and, at the same time, stirring controversial ethical questions on human identity and the meaning of the human body. Being a global and transnational endeavour, organ transplantation raises universal ethical concerns and, yet, has to be adapted to culturally mediated believes. Case studies are particularly apt to illustrate the range of global and local, ethical, social, and cultural problems associated with this new form of treatment. The value of case studies for medical ethics teaching has been sufficiently demonstrated. They stimulate ethical debates by calling for a combination of concrete problem solving and abstract principled reasoning . Through case studies, students will learn, firstly, to develop sensitivity for ethical problems and to describe an ethical conflict, secondly , to identify and analyse the underlying ethical principles and values which are relevant to the case and, thirdly, to stimulate ethical decision -making in the practice of health care. Thus, case studies serve as a valuable instrument for health-care ethics education. We have collected a wide range of cases from different regional, cultural , or religious backgrounds. The cases cover a multitude of topics such as living and post-mortem donation, xenotransplantation, or organ trafficking. For further discussion, each case ends with possible solutions to the problem. In real life, there is often more than one solution to a conflict. Thus, it is important to be able to give good arguments for one’s choices. Students should learn how to develop a position on an ethical problem and how to justify it. To encourage and inform these deliberations, we will give a brief introduction into the ethics of organ transplantation. This does not cover all sorts of ethical problems related to organ transplantation but will provide basic information to start with in class-room discussions. For an in-depth reading we have compiled a list of open-access sources and basic books at the end of this introduction. Introduction 4 1. Definition and medical practice of organ transplantation Organ transplantation is the surgical replacement of a malfunctioning organ by another human organ. Kidney, heart, pancreas, liver, or lung have already been successfully transplanted, as well as organ parts or tissues such as bones, cornea, skin, or bone marrow. Even the transplantation of several organs at once has been ventured (so-called multiorgan transplantation). More recently, and still rarely, extremities such as hand, arm, or foot, and even a face were transplanted. In general, three types of grafts are distinguished: 1. auto-grafts which originate from the recipients themselves (e.g., in the case of skin or bone transplantation), 2. allo-grafts which are transplants between genetically non-identical humans, 3. xeno-grafts which are living animal organs or tissue transplanted into humans. Most organ transplantations are of allogenic origin. From dead donors any kind of organ or tissue can be transplanted (so-called cadaveric or post-mortem donation). Kidney, lobes of liver or lung, and bone marrow can be donated by living donors, too. Life-long immunosuppression in the recipient is a necessary condition for all transplantations between human beings except for monozygotic twins. Thus, the side-effects of these drugs such as infectious diseases or cancer have to be taken into account. Success rates The kidney is the most frequently transplanted type of organ. Thanks to modern efficient immunosuppressive drugs, a transplanted kidney can function up to 20 years or longer. Since organ transplantation has entered into medical practice nearly thirty years ago, statistics are available that demonstrate the success of organ transplantation with regard to organ survival and life expectancy of the recipient. The largest data bank for organ transplantation provided by the US Dept. of Health and Human Services1 shows that 5-year-survival rates for kidneys are fairly good and vary slightly according to living (79%) or post-mortem donation (67%). The 5-year-survival rate in heart transplantation is 71%, for 1 see http://optn.transplant.hrsa.gov/ [44.200.27.175] Project MUSE (2024-03-29 11:45 GMT) Introduction 5 liver, it is about 65% (for living as well as post-mortem donation). For lungs, 5-year-survival rates are worse (post-mortem donation 46%, living donation 34%). Given the good results of organ transplantation, surgeons all over the world deplore an “organ shortage”. This means that more patients with organ failure are in need of an organ than organs are available through donation...