A few pieces came into my inbox over the past couple of weeks around organ donation and transplantation that caught my attention. While we don’t often write about this topic, it is within our concern of medical ethics as it relates to new technologies and developments in medicine. I’ve always been both fascinated and concerned about medical ethics in this domain.  In my nursing days, I worked in university hospitals that did pediatric transplants (heart, kidney, liver, and bone marrow) so I very clearly saw the pros and cons of transplantation medicine as these issues were in front of us daily.

The first story in my inbox was a report about a woman who is the second person to receive a genetically modified pig kidney transplant.  She had suffered from several heart attacks, years of diabetes, and was in kidney failure requiring dialysis just to keep her alive.  Because of her serious health issues, she was deemed not to be a suitable candidate for a human organ transplant.  Receiving a genetically modified pig kidney seemed to be her only chance of survival and she told herself, “You know what? I’m going to do it. I have to do it – for myself and for the rest of my family.” The previous report of such a transplant was in a 62 year old man. He was in end stage kidney failure when he received his genetically modified pig kidney.

Both people had no chance of long-term survival.  These are often the types of patients who are approved to be part of a new clinical trial for a new treatment, whether it be an experimental new drug, medical device, or in this case, being allowed to receive a genetically modified pig kidney.

The ethics of xenotransplantation, the transplanting of tissue or organs between different species, has long been debated. In this new field, the ethical debate usually is framed within three categories.  First, is the concern of animal welfare and the ethical and humane treatment of animals who are often sacrificed for their organs or tissue. Next is the real and serious concern of the dangers of organ and tissue rejection and the long-term need for immunological suppression to keep rejection of the transplant at bay.  Finally, there is the always heated debate around the procurement and allocation of the organs that are available for transplant.  How do we decide who can donate, which includes the debate around living donor donation? And then decide who receives the organ and by what criteria is that decision made?  Over 100,000 people in the United States are on a waiting list to receive a transplant with 17 people dying each day because the supply can’t meet the demand.

Which brings me to another story that caught my eye, where it was reported that there was manipulation of data that made certain patients ineligible for liver transplants at a Houston hospital. Memorial Hermann-Texas Medical Center announced that they had stopped their liver and kidney transplant programs while they conduct an investigation after learning that “a doctor made ‘inappropriate changes’ in a database for people awaiting a liver transplant.” The alleged charges involved changing the acceptance criteria, which of course are serious and warrant an investigation, especially since these sorts of breeches in policy erode confidence in medical ethics. The public is already skeptical of the ethics of organ donation in general and allocation of organs in specific and many lack trust in the system. Stories like what happened in Houston only confirm the public worries.  Will the increase in xenotransplantation alleviate or heighten skepticism and distrust? Whether the field of transplant medicine expands to include xenotransplantation or not, it is clear that we need to think clearly and ethically about transplantation medicine more broadly. Ethics matter and this ethical debate will get murkier as our ability to sustain life increases.  I’d love to hear your thoughts on this.

Author Profile

Jennifer Lahl, CBC Founder
Jennifer Lahl, CBC Founder
Jennifer Lahl, MA, BSN, RN, is founder and president of The Center for Bioethics and Culture Network. Lahl couples her 25 years of experience as a pediatric critical care nurse, a hospital administrator, and a senior-level nursing manager with a deep passion to speak for those who have no voice. Lahl’s writings have appeared in various publications including Cambridge University Press, the San Francisco Chronicle, the Dallas Morning News, and the American Journal of Bioethics. As a field expert, she is routinely interviewed on radio and television including ABC, CBS, PBS, and NPR. She is also called upon to speak alongside lawmakers and members of the scientific community, even being invited to speak to members of the European Parliament in Brussels to address issues of egg trafficking; she has three times addressed the United Nations during the Commission on the Status of Women on egg and womb trafficking.