Question

In a certain clinic, there are five patients in urgent needs of organ transplants. All five patients are middle age people, who are significant contributors to the society (we can assume that they are a well-known physicist, an important military officer, neuroscientist, a great politician, and a social reformer.) One day a new patient comes to this clinic, a middle age janitor, with very advanced brain cancer.

The janitor does not have a chances to recover from his brain cancer. He does not have any family, and he is a volunteer organ donor. His organs would save lives of the five other people. But the janitor wishes to live as long as he can. The doctor (who is the owner of this clinic) estimates that the janitor will live for another six months. Unfortunately, none of the five other men is able to wait for the organ transplant that long. If this situation is left to its natural order, all six people will be dead in six months.

By the virtue of his profession, the doctor is committed to saving human lives (and not to terminating human lives). By his rational judgement, the doctor thinks he should try to do what will bring the best possible outcome; it seems the right thing to do is to save as many (significant) people as possible.

What should the doctor do?

Should he let all the six people die out of their natural causes? Or,

Should he arrange an urgent surgery for the janitor, and conduct it in the way the janitor dies during the medical procedure (the doctor would be the only one who knows what really happened)? This way he can use the janitor’s organs to save the other five men.

Answer 1

Organ Donation

Any person who is legally competent can choose organ donation. Here any body part or entire body may be donated.It is an anatomical gift made by the person before death.

Some people have donor cards, while others mark it on the driving license if the countrys law permits.

The agencies usually handle organ donation includes ; Organ bank, Organ Sharing Network, Organ Sharing Alliances etc

Legal Aspects Organ Transplantation

There will be penalty for illegal removal & receiving of organs

Making payement for organ is also legally not permitted

Organs Usually Transplated Includes : Lungs, Heart, Kidney, Liver, Pancreas, Heart Valve, Bone marrow, Skin, Cornea, Tendon, Middle Ear

Sources Of Organ Donation

1. Diseased ( Cadaveric )

Most organs are collected from the diseased donors after the death of the person. It is possible only if the died person registered for donation or with the first relatives consent. In the given senario Mr. Janitor is not having a family to give consent for donation after death but he is already a volunteer organ donar, so the organs can be taken after the death without any legal issues.

Death is of two types

a ) Brain Death ; It Is an irreversible end of brain functions. It usually happen after a head injury or Tumor

b ) Cardiac / Natural Death ; In cardiac death the heart stops beating, which leads to no supply of blod to the vital organs which makes them not usable for transplantation. However if the person is in ventilator & it is sure that the person cannot survive the family can make the decision of transplatation & removal of life saving devices.

2. Living Donors

Here The person making the donation is alive. Majority of the living donor will be family members, but others are also permitted by the law. Living donation is under some precondition. Eg a living person is allowed to donate only one kidney & the remaining one is enough for fulfilling the function in the donor

A solution for the scenario is,

Some organs can be transplated in parts or segments instead of transplanting an entire organ eg, liver, intestine, kidney & lung segments. This technique allows the living donors to donate part of an organ while maintaining the functional organ themselves. If Mr.Janitor is ready to be a living donor & among the five members if anyone is in need of the organs coming under living donation category, the doctor can save atleast few members with saving the life of Mr. Janitor, who want to live as long as he can, which will be the practical solution in this scenario.

If the doctor removed the organ after risking the life of Mr.Janitor, it is a punishable offence coming under illegal removal of organ.

The doctor has to follow all the legal & ethical aspects while treating a patient. The ultimate role of the doctor is to save the life of the patient, not to risk their life for personal gain.He cant do a false sugery just to make the life of Mr. Janitor at risk, having the intension in mind to save the life of the other five patients.

Other thing to consider is patient rights. All patients has the right to get treatment without considering their cast, creed, family background & socio-economic status. He also focus on the Employee responsibilities. As an employee the instituition provides some rules & regulations to be followed by the employees for the betterment of the clients & for incresing the popularity & to become competetive in the health care industry. So the death of the patient during surgery will be noted as a bad mark for the instituition.