Nursing Ethics and Medical Futility on Organ Transplant


The first successful organ transplant was undertaken in 1954 between two identical twins. Since then organ transplant has become one of the most important procedures to treat diseases that are otherwise considered untreatable. Organ transplantation provides patients with a gift of life when vital organs fail. Organ transplant requires other people – to dead or alive – to donate organs to the organ recipient. However, the organs available cannot meet the demand. This has led to a significant increase in waiting list for organ transplants. However, organ transplant faces several ethical issues that the medical profession has to tackle

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. Prior to discussing the ethical issues surrounding organ transplant, it is vital to provide a concise definition of organ transplant. Organ transplant refers to a surgical operation where a failed or damaged organ in a human is removed and replaced with a new organ. An organ refers to a body of specialized cells and tissues that perform a certain function within the body collaboratively. Some of the major organs in a human body include heart, eyes, kidney, liver, and skin. A graft is similar to an organ transplant. However, in grafting, a certain tissue is surgically re-implanted to replace certain tissues within an organ. Therefore, grafting does not involve the surgical removal of a whole organ. It is not possible to transplant all organs.

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Ethical Issues

Shortage of Organs

The major ethical dilemma on organ transplantation comes from the shortage of available organs. Therefore, not all people who need an organ transplant ultimately ends up getting on. According to the United Network for Sharing (UNOS) website (, the U.S. has more than 80,000 people who are waiting for organs.

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. The number of people waiting for organs has increased since the number of people who need organs has increased whereas the number of donations has remained static. Victims of car crashes that render them brain dead are the major source of organ. However, the number of car crashes has decreased significantly (Catalano, 2011).

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Therefore, it is vital for organ transplant to have distributive justice. The number of organs available must be fairly distributed to patients that need the organs. For organ transplant to have distributive justice, all patients must have equal access to the available organs. Length of waiting time and age are the major criteria of distributive justice. People who have waited for organs for a long time should have the first priority of receiving organs. In addition, organs should be distributed from the youngest to the oldest. The distribution process should also not be biased on sex, income, race, or geographical distance from the available organ. The individual worth should not also be a factor in the distribution of organs. However, in some instances certain unethical medical professionals consider the individual worth when distributing organs. This makes more worthy individuals receive organ donations faster than less worthy individuals. This is despite the fact that individual worth does not affect the medical need.

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For organ transplantation to have distributive justice it must provide maximum benefit. This ensures that organ transplants maximize the number of patients who receive successful transplants. Medical need and the probability of a successful transplant are the major factors that influence maximum benefit of organ transplants. The sickest people should have the first priority of receiving organ transplants. In addition, organs should be given to people who are likely to live for the longest period after receiving the transplant.

The current organ transplant in the U.S. gives transplant centers to prerogative of determining the criteria they would apply to allocate the available organs fairly. There are politics and biases in the ranking systems of the transplant centers. Despite the benefits of organ transplantation, all people do not believe that there is a necessity to increase the number of organ transplants. These people believe that organ transplantation facilitate improper medicalization of the society.

From the above explanations some of the major ethical questions raised by organ transplantation include, should a patient who has already received one organ transplant receive a second transplant, should people whose organ failed due to their lifestyles have the chance to receive organ transplant, should organ transplants be given to suicidal individual, should patients who have children have a higher priority of receiving organ transplants than single patients, should condemned prisoners be given organ transplants? (Bedford & Jones, 2013).

Donor Organs

Increasing the number of organs one of the major methods that parties may use to avoid ethical issues that arise due to the shortage of organs. However, various parties fear that policies implemented to increase the number of organs may lead to the rise of other ethical issues. The policies may lead to organ farming and declaration of patients as dead premature so that the medical professions may harvest organs from the patient. Therefore, medical professionals should ensure taking organs from an individual is within certain ethical boundaries. However, the major issue is how to define the boundaries. People have different definitions of where the boundaries should lie (Butts & Rich, 2013).

Under the contemporary organ donation practices, when people die, their organs may be donated if they consented to the donations prior to their death. The consent for donation usually appears on the individual’s driving license. A persons is termed as dead when either the heart stops or the brain ceases to function. Upon death, organs are taken from the individual. The individual may be kept on life support to facilitate the removal of the organs. If an individual’s wishes on organ donation are not known, medical professions should consult a family member to obtain consent for the removal of organs. There is a certain hierarchy that is used in determining the family members that have the authority to give consent. They should ask the spouse of the deceased person. If the individual does not have a spouse, they should ask an adult child of the deceased. If the deceased individual does not have adult children, they should ask their parent. If they did not have a parent, should ask an adult sibling. Finally, if they do not have an adult sibling, they should ask the legal guardian. A single donor may provide organs to many different people. The number of organs that can be taken from the deceased individual depend on the cause of death or the number of organs that are not damaged.

Five major strategies help to increase the number of donors. However, the strategies are generally controversial. Education on the importance of organ transplant may help to increase the number of donors. Mandated choice would also help in increasing the number of donors. Under this strategy, all individuals would be required to provide their wishes on organ transplants. When the individuals die, they wishes would be upheld regardless of the views of their family members. However, this policy requires people to have huge trust in the medical system. People must trust that health care providers would provide them with the best care regardless of their wishes on organ transplantation. Texas enacted this policy in the 1980s. However, 80% of people chose not to have organs harvested upon their death. Therefore, this policy did not increase the number of donations. This led to its ultimate repeal (Peirce & Smith, 2013). Presumed consent may also help in increasing the number of organ donations. This policy is used by several European countries. In presumed consent, the organs of an individual are harvested upon their death unless they stated that they should not be donated while they were living. People who support presumed consent claim that it is the duty of every individual to donate organs since upon death they do not need them anymore. However, parties against presumed consent cite various religious or cultural reasons to support their views.

Relevant authorities may also use incentives to increase the number of organ donations. They may provide incentives in various forms. They may provide assistance to meet the funeral costs of an individual who has donated organs. They may also provide financial incentives or donate to charity when the organs of the deceased individual are harvested. Providing financial incentives to families of deceased individuals is one of the most contentious issues. Various people claim that the incentives are coercive and unfair. They claim that various people may be influenced to donate if the incentive is attractive enough. Harvesting organs from prisoners sentenced to death may also help in increasing the number of donors. Parties that favor this policy claim that despite the fact that execution may be ethical wrong, taking organs from the prisoners is not unethical (Peirce & Smith, 2013).  

Living Organ Donation  

An individual who has a damaged organ may seek donation from a living donor. This enables the individual to bypass the waiting list. Living donations has several benefits. It facilitates the pre-arrangement of donation. This enables the patient to commence taking anti-rejection drugs prior to the organ transplant. This increases the chances of the organ transplantation being successful. In addition, since a significant proportion of living donors are genetically related to the patient, the chances of the organ transplants being successful are higher (Peirce & Smith, 2013).

However, living donations may have several health consequences. It may lead to infection, pain, or health complications in the future. In addition, living donations may make family members feel pressured to donate an organ to a sick family member. Donor may not also have advocates who would provide them with guidance during the process of organ donation (Peirce & Smith, 2013).

Financial incentives and education are some of the major strategy that may help in increasing the number of living donations. However, paying people to donate their organs is one of the most ethical issues facing organ transplantation. This is due to the fact that it may disregard patient safety. It may also involve provision of attractive financial incentives to economically disadvantaged people. In essence, the practice of offering financial incentives turns the body of the donors into a money making pool. In addition, this practice would make wealthy people have improved access to the organs. This would make the organ transplants lack distributive justice (Sarnaik et al., 2013).


Organ transplantation helps in improving the health of people who have terminal illnesses. However, it is vital for medical professionals to ensure that the organ transplantations adhere to certain ethical standards. They must ensure that the right people receive organ transplants. They must also ensure that the organs are taken from the right people. It would be unethical to coerce people to donate their organs.

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