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According to the UnitedNetworkforOrganSharing (UNOS), more than 112,000 people are currently on a waiting list for a lifesaving organ.
On average, 18 people die every day while waiting for one of these precious organs. Today a potential donor can help up to nine individuals.

While the nation’s AssociationofOrganProcurementOrganizations has made great strides in addressing the shortage of transplantable organs, the number of people on the waiting list for an organ is still growing exponentially.

This unfortunate phenomenon has caused many organ procurement activists to push for more aggressive organ recovery policies.

One example is the effort of stateSen. LuciaGuzman of Colorado to change the state’s organ donation registry from a volunteer system to a system where everyone is assumed an organ donor unless they opt-out of the program.

Other states have experimented with rapid organ recovery procedures.

Most notable in recent years is a reinvigorated focus on the practice of organ donation following a cardiac death, instead of the more common brain death protocol.

While all of these approaches deserve consideration for how they contribute to reducing the shortage of organs, Christian ethicists can never lose sight of the needs of the patient who is donating the organs in the first place, particularly when working with living donors.

In early February, a bill was proposed in the Maryland House of Representatives that is dangerously close to violating several classic principles of medical ethics in general and transplant ethics specifically.

On Feb. 1, stateRep. DanMorhaim presented House Bill 449 which, if enacted, would allow the proxy of a patient diagnosed with a persistent vegetative state to authorize the donation of a kidney or the smaller lobe of the patient’s liver to another individual.

The bill has already received an icy reception from patient rights groups and Catholic bioethicists.

Some have argued that the bill will open the doorway to human body farming or seeing all patients who have a “life not worth living” as potential donors.

Most ethicists see these sensational responses as unproductive, but the responses do illustrate a core uneasiness with the proposed bill, and they push serious ethicists to explain why the bill is fraught with moral difficulties.

Part of the problem with any discussion of organ donation is that much of the population is unaware of organ donation recovery procedure or how donor patients are managed in hospital ICUs and ERs.

Organ donors fall into three categories: brain-dead donors, patients who donate after a cardiac death or living donors.

The first two categories are donors who are legally dead, while the latter is typically a patient who donates a kidney, small lobe of the liver or a single lung and then continues to live a normal life.

What the public often does not understand is that living donors are viewed by transplant programs and organ procurement organizations as patients who must be cared for accordingly.

Historically, medical professionals have adhered to the Hippocratic charge to “Do no harm” and provide beneficence to one’s patient.

Organ donation from living donors must justify the same cost-benefit ratio that any other surgery or intervention would provide the patient.

Therefore, donating an organ can be a purely altruistic process for the donor, but for the medical professional, the patient must receive a personal benefit from the donation that outweighs the negative of losing an organ.

Often the benefit that donors receive is the altruistic feeling of helping another or being able to help extend the life of one’s family member or close friend.

Keeping these close relationships outweighs the pain of surgery. Therefore, the pain of surgery is morally justifiable because the benefits outweigh the possible harm.

In this line of thinking, it would be wrong for a physician, who is charged with respecting her patient’s autonomy and protecting her patient from harm, to conduct a medical procedure (organ recovery) that has no benefit to the patient.

Such a practice would turn living donors into a means to an end and in essence treat them as things, not persons.

House Bill 449 holds the potential of doing the same thing. The bill proposes a procedure in which a patient’s family member or close friend can be named the patient’s proxy and authorize a non-vital organ donation.

While the bill respects patient autonomy by discussing the patient’s verbal wishes or assumed wishes (which would have been discussed prior to incapacitation), it does not address the issue of patient beneficence or the medical best interest of the patient.

This proposed procedure would enable medical professionals to remove organs from a mentally incapacitated patient without a therapeutic value or possible future beneficence.

Unlike the above illustration, a patient in a persistent vegetative state cannot interact with loved ones or know he has saved their life. In essence, that patient would be treated like an object, not a person.

While the Christian ethics community should continue to work with UNOS and local organ procurement organizations in developing practices that help reduce the number of people on the national waiting list, they cannot support policies or practices that treat any living human being as less than a person.

It remains to be seen if House Bill 449 will ever be law. Either way, Christian ethicists need to become more engaged in the discussion of new organ donation policies.

MontyM. Self is the oncology chaplain for the Baptist Health Medical Center – Little Rock in Arkansas and an adjunct instructor of ethics at the University of Arkansas at Little Rock.

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