1、Unit TenUnit TenText A Organ Transplantation:Ethical Dilemmas and Policy Choices Outline Background informationGlobal analysis of the textDetailed study of the textText structure analysisReference answers to the exercisesBackground informationIntroduction to the topicBackground informationTransplant
2、ation is the transfer of a tissue or organ,alive or dead,within an individual,between individuals of the same species,or between individuals of different species.Background informationIn most cases,human material for transplantation is obtained from a deceased donor.Successful programs for the procu
3、rement of human material for transplantation from deceased donors from various cultural,religious and economic backgrounds constitute potential models.Background informationThe need for communities,including health professionals,to become better educated about transplantation is widely recognized as
4、 a key to the success of such programs.However,despite the frequent use of materials donated from deceased donors,the donation of materials from living donors is necessary for some types of transplants or to compensate for the limited supply of material available from deceased donors in order to mee
5、t patient needs.Living donation is thus practiced despite the fact that it involves risks for the donor that may not be negligible.Background informationThe procurement of human material for transplantation from deceased or living donors and the subsequent allogeneic transplantation entail ethical a
6、nd safety risks for both the donor and the recipient.Health authorities must provide effective oversight of all aspects of transplantation in order to control these risks.Background informationThis oversight is also essential for gaining public support by developing and justifying trust in the procu
7、rement organization,particularly since donations are often motivated by altruism and generosity.In addition,the decision to be a donor is often based on the understanding that a contribution to the availability of transplant resources may someday benefit the health needs of the donors family.(http:/
8、www.who.int/transplantation/donation/en/index.html,http:/www.who.int/topics/transplantation/zh/)Background informationThe History of Transplantation Throughout history people have always been intrigued by the possibility of transplanting organs and tissues from one body to another.During the 15th ce
9、ntury we can find references in historical medical literature of attempted blood transfusions as well as the transplantation of teeth(presumably from cadavers).A skin transplant and a corneal transplant were reported in medical journals dating as far back as 1880.Background informationOf course,thes
10、e early attempts at transplantation were usually unsuccessful.It was not until early in the 20th century that transplantation offered the promise of renewed health and life envisioned by our ancestors.Background informationThe Timeline of Transplantation:p1906 First corneal transplant by Austrian op
11、hthalmologist Dr.Edward Zimp1908 First skin allograft by Swiss surgeon Jacques Louis Reverdinp1908 First successful cadaver knee joint transplant by Dr Eric Lexerp1911 Initial use of homologous vein tissue in arterial reconstruction.p1918 First blood transfusionp1949 Establishment of US Navy Tissue
12、BankBackground informationp 1955 Initial fresh heart valve allograft put into descending aortap 1955 Frozen venous allograft for femoral artery bypass p 1962 First fresh heart valves implanted into cardiac positionp 1962 First successful cadaveric kidney transplant by Dr.Joseph Murray and Dr.David H
13、ume in Boston,MA.The recipient had normal kidney function for 21 monthsp 1963 First liver transplant performed by Dr.Thomas StarzlBackground informationp 1963 First lung transplant performed by Dr.James Hardy at the University of Mississippi Medical Center,Jackson,MSp 1967 First heart transplant per
14、formed by Dr.Christian Bernard at Groate Shure Hospital,South Africa.The recipient had normal heart function for 19 monthsp 1967 First successful pancreas transplant performed by Dr.Richard C.Lillehei at the University of Minnesotap 1968 Brain death criteria createdBackground informationp 1968 The U
15、niform Anatomical Gift Act.Legislation allows gift of organs to othersp 1971 Frozen heart valves used in allograftp 1971 Introduction of cryopreserved human skin allograftsp 1972 The Uniform Anatomical Gift Act establishes the Uniform Organ Donor Card as a legal document in all 50 states making it p
16、ossible for anyone 18 years or older to legally donate his or her organs upon deathBackground informationp 1972 End Stage Renal Disease Act paves way for Medicare coverage of all kidney transplantsp 1974 First use of cryopreserved venous allograftp 1978 Cyclosporin begins testingp 1979 Living relate
17、d pancreas transplanted,Minneapolis,MNp 1981 Brain death criteria expanded by Presidents Commission for Study of Ethical Problems in Medicine and Biomedical ResearchBackground informationp 1981 First heart and lung transplant performed by Dr.Norman Shumway at Stanford University Medical Center,Stanf
18、ord,CAp 1982 Barney Clark receives the first permanent artificial heart at the University of Utahp 1983 FDA approval of cyclosporine,the most successful anti-rejection medication developed to datep 1984 First heart/liver transplant performed by Dr.Starzl at the Childrens Hospital of PittsburghBackgr
19、ound informationp 1984 Baby Fae receives a walnut-sized baboon heart in an operation at Loma Linda University Medical Center.She was the first infant to receive an animal organ.Baby Fae lived for 21 daysp 1984 National Organ Transplant Act(Public Law 98.507)establishes nationwide computer registry o
20、perated by the United Network for Organ Sharing(UNOS).The Act also authorizes financial support for organ procurement organizations and outlaws purchase or sale of organsBackground informationp 1985 New York State,Oregon,and Pennsylvania pass Required Request Law.Mandates all potential organ and tis
21、sue donors be approached for donation.Soon thereafter,all remaining 47 states follow suitp 1986 Consolidated Omnibus Budget Reconciliation Act passed.Requires all potential donors to be approached,superseding state laws and adding hospitals must comply to receive Medicare benefitsp 1988 FDA approval
22、 of Viaspan or UW solution,greatly extends preservation time for liversBackground informationp 1988 Joint Commission on Accreditation of Health Care Organizations sets donor identification and notification standards Requires the hospitals to have policies and procedures in place for the identificati
23、on,referral and procurement of organs and tissuesp 1989 Dr.Thomas Starzl at the University of Pittsburgh reports clinical success of promising new anti-rejection drug,FK-506Background informationp 1989 First liver transplant from a living related donorp 1990 Lung transplantation attempted as cure fo
24、r Cystic Fibrosis.p 1990 Dr.Joseph Murray(performed first kidney transplant)awarded Nobel Prize for Medicinep 1990 Dr.Thomas(pioneered bone marrow transplants as a cure for leukemia)awarded Nobel Prize for MedicineBackground informationp 1990 First successful heart related lung transplantp 1991 Firs
25、t attempt at partial lung transplantp 1991 First successful small intestine transplantp 1996 U.S.surgeons at Barnes Hospital in St.Louis,University of California,San Francisco,and Stanford University Hospital perform split-liver transplantshttp:/ informationGlobal analysis of the textOrgan transplan
26、ts are faced with a series of challenges:outdate of relevant policies,insufficient organ supply,disputable organ procurement policies etc.The first human context to consider is the dignity and integrity of the human body and the second is the obligations and limits of medicine.Besides,such questions
27、 as,“whose wishes should finally prevail in determining whether organs are taken or not and what is the meaning of autonomy”should also be listed as elements while considering organ transplants.Many individuals have given themselves(literally)to save the life of another,and yet the unequivocal prote
28、ction of those who are not-yet-dead(but would be useful if they were)has been called into question.(Para.3)Detailed study of the textpMeaning:Many people have donated their organ(s)to save other people.However,questions remain about the best way to protect those who are close to death.Protection is
29、necessary because the persons death will benefit others through transplanted organs.Detailed study of the textpunequivocal:pletely clear and without any possibility of doubt.pExample:To such a rude question,his answer is an unequivocal“no.”pcall something into/in question:to cast doubt on somethingp
30、Example:These findings call into question the legitimacy of the proceedings.“The human body(dead or alive)has not been reduced to mere property,and yet the desperation of watching thousands of individuals die every year while whether monetary incentives should be used in an effort to increase organ
31、supply.(Para.3)Detailed study of the textpMeaning:The human body cannot be considered as property.However we feel despair when we notice many people die every year while waiting for suitable organs.This situation has aroused a debate about whether money could be given(to donors)in order to increase
32、the organ supply.Detailed study of the text“The Other bills offered tax credits to individuals who donate organs(or credits to their surviving families)or reimbursement of the costs incurred by living donors.(Para.4)Detailed study of the textp Meaning:Other bills offered tax deduction to organ donor
33、s(or the donors family members)or compensation for the costs incurred by living donors.Detailed study of the textDetailed study of the textptax credit:an amount of money on which you do not have to pay taxpExample:The president proposed to provide tax credits to businesses that allow workers time of
34、f.preimbursement:compensation paid(to someone)for damages or losses or money already spent etc.pExample:He received reimbursement for his travel expenses.has endorsed the idea of a pilot program that would partially reimburse surviving families for the funeral expenses.(Para.4)Detailed study of the
35、textpMeaning:.has approved of the idea of a trial activity that would partially compensate the surviving families for the funeral expenses.Detailed study of the textp endorse:approve ofp Example:The plan does not explicitly endorse the private ownership of land.p pilot program:activity planned as a
36、test or trialp Example:Under a pilot program New Zealand will grant visas to 5,000 guest workers this year.And yet,it suggests that an individuals body has meaning only because it is useful;that the body is a tool individuals have rather than what individuals are.(Para.5)Detailed study of the textpM
37、eaning:The statement that organs are no use to dead individuals implies that human bodies are utilitarian but not connected to our inner beings.In the case of organ transplantation,this“violation”is done to one person,living or dead,in order to save another with possibilities both for great charity
38、and great coercion that this intervention entails.(Para.6)Detailed study of the textpMeaning:In the case of organ transplantation,this“violation”is done to one person,living or dead,in order to save another,which might mean great charity to the person who receive the organ and great oppression to th
39、e organ donor.p coercion:the act of compelling by force of authorityp Example:He claimed he had only acted under coercion.Detailed study of the textAnd yet,if saving the most possible lives while inflicting the least harm on the living were the only significant human obligation,then our policy on or
40、gan transplantation(not to mention human experimentation)would be very different.(Para.7)Detailed study of the textpMeaning:Our policy on organ transplantation would be different,and human experimentation would also be different,if the only criteria for our actions were to save the maximum amount of
41、 people through the minimum amount of harm to the living.p inflicton:to make someone suffer by imposing an unpleasant circumstancep Example:That pitiful man inflicted a great deal of suffering on his wife and children.Detailed study of the textThe obligation to heal as fundamental as it is to the go
42、od life and good society exists in concert(and sometimes in conflict)with other human values.(Para.7)Detailed study of the textpMeaning:The obligation to heal is essential to a good life and a good society,but it works together with and sometimes against other human values.p in concert:jointly,toget
43、her.This expression uses concert in the sense of“an agreement of two or more persons”.p e.g.:When the mind is in concert with the body,one can accomplish a great deal.Detailed study of the textDoes autonomy mean having the right to dispose of ones body(or enter into contracts for ones body)in any wa
44、y an individual sees fit?(Para.8)Detailed study of the textpdispose of:to get rid of,throw outpExample:The Green Box project aims to collect unwanted mobile phones and electronic accessories,and dispose of them in an environmentally friendly way.proposals to compensate individuals for providing orga
45、ns potentially entail their right to sell their organs to the highest bidder.(Para.9)Detailed study of the textpMeaning:The proposals to compensate organ donors could lead to organ donors selling their organs to those who give the highest price.Detailed study of the textpentail:v.to make it necessar
46、y to do somethingpExample:This complex plan for rescuing the pregnant woman entails considerable risks.this means that their claims can neither be written off in advance nor accepted at face value.(Para.9)Detailed study of the textpMeaning:that is to say that the claims associated with the policies
47、cant be discarded/disregarded or accepted without further investigation,because they have never been tested.p write off:to accept the loss or failure ofp Example:We will just have to write off the arrangement if we cant find the money for it.Detailed study of the textp accept/take something at face
48、value:to accept a situation or accept what someone says,without thinking there may be a hidden meaning.p Example:You shouldnt always take his remarks at face value,you know,he is quite eccentric.Detailed study of the textWe must,as we judge these different policies,think about the meaning of organ t
49、ransplantation in its fullness.(Para.10)Detailed study of the textpMeaning:When we comment on different policies,we should think about the meaning of organ transplantation in all aspects.pfullness:completenesspExample:In the fullness of her joy,she could hardly speak.Thinking about public policy in
50、this area means balancing these different realities and facing soberly the moral costs and benefits of different policies.(Para.10)Detailed study of the textpMeaning:When thinking about the policies for an organ procurement system,we must take various realities into account and fully understand the
