1	Some Sociological Aspects of Organ Donation and Transplantation Dr Robert O’Neill University of Western Sydney
2	Reconsider the relationship we have with each other the relationship we have with strangers the relationship we have with our family the relationship we have with society the way we perceive our own bodies the way we think about death
3	Death Cardiac death Brain death Arguably, we live in a ‘death-denying’ society
4	Perceptions of the body FUNCTIONALIST/ CARTESIAN (Body and Soul seen as separate) HOLISTIC VIEW (Body and Soul seen as integrated)
5	Some reasons why people are reluctant to donate organs forced to confront own mortality fear of being prematurely pronounced dead anxiety about disfigurement of the body fear of bodily mutilation fear of inflicting pain upon the dead belief in the sentient corpse worry at entering the afterlife without vital organs fear of retribution from beyond the grave a mistrust of the medical profession
6	Relationship to society Why would you donate your organs to society? in effect, donating your organs to a complete stranger?
7	Relationship to society You may feel it is the right thing to do But why is it ‘the right thing’? - because you feel part of society? - because you want to contribute to society? - because you want to give something back to society? - because you want to give the ‘Gift of Life’?
8	Relationship to society Altruism / Good of Society versus Individualism / Pursuit of Self Interest The ‘conscience collective’
9	The Gift Relationship the obligation to give gifts the obligation to receive gifts the obligation to reciprocate the gift with one of equal or greater value
10
11	USING LIVING DONORS
12	LIVING KIDNEY DONATION (as a % of total kidney donations) USA - 51% of kidney donations EUROPE - 20% of kidney donations AUSTRALIA- 20% of kidney donations CANADA- 59% of kidney donations
13	Using living donors – advantages (1) eliminates placement on national waiting list tx surgery can be scheduled at a mutually-agreed-upon time reduced risk of pre-operative mortality avoidance of complications associated with organ preservation UNOS: Critical Data
14	Using living donors – advantages (2) recipient can begin immunosuppressive therapy prior to transplantation transplantation from living donors more successful due to better tissue match fewer rejection episodes living donor and recipient may experience psychological benefit UNOS: Critical Data
15	Using living donors - risks donor mortality (0.03% - 0.06%) donor morbidity -pain / discomfort associated with operation iatrogenic consequences - possible damage to remaining portion of donor’s organ infection / bleeding negative psychological consequences for donor UNOS: Critical Data
16	PARADOX ENTHUSIASM FOR LIVING RELATED DONATION BUT NOT FOR LIVING UNRELATED DONATION
17	LIVING DONATION - BEST DONORS identical twin brother or sister (then, in order of preference) parents any other relatives (half-brothers, half-sisters, children, grandparents, nieces, nephews, cousins, aunts or uncles) living unrelated donors
18	SURGERY AS CRIMINAL ASSAULT AND BATTERY Actions for assault, battery and false imprisonment are categories of tort law known as trespass upon the person and they each involve a direct and unlawful interference with the person by another without consent (Macfarlane 1995:52) CONSENT ELIMINATES ASSAULT
19	"However" However, one cannot consent to do harm to themself Mayhem is the crime of intentionally and maliciously maiming or disfiguring a person...under modern law, it is possible to contend that surgically removing an organ from a person constitutes mayhem. ..consent by donor may not be an adequate defence (Michigan Law Review 811 pp853-4 cited in Kennedy & Grubb 1989:977)
20	DEFENCE OF BENEFIT no therapeutic benefit to living donor can argue psychological benefit to living donor (e.g. loss of relative, loss of support)
21	PARADOX LACK OF ANONYMITY BETWEEN RECIPIENT AND DONOR IN LIVING RELATED DONATION WHILST ANONYMITY STRICTLY ENFORCED IN CADAVERIC DONATION
22	"lack of anonymity influences and..." lack of anonymity influences and effects: family dynamics the decision to donate the motivation to donate living donor / recipient relations
23	LIVING DONORS DECISION TO DONATE- Impulsive ‘My sister needed a kidney…I had no trouble deciding. It was just a known fact in my mind; a given, a no-brainer’. I was with Howard…when he found out he needed a kidney.It was then that I decided to see if I was a candidate’ ‘I gave it no thought, I just did it’
24	lack of anonymity influences and effects: family dynamics the decision to donate the motivation to donate living donor / recipient relations
25	DISCONCERTING FACTORS ARISING FROM LIVING RELATED DONATION gender imbalance use of elderly / grandparent donors can doctors realistically refuse an offer of living donation? potential conflict of interest for doctors
26	PARADOX ALTRUISTIC MOTIVATION OF LIVING UNRELATED DONORS QUESTIONED MOTIVATION OF LIVING RELATED DONORS ACCEPTED UNCRITICALLY
27	PARADOX LIVING DONATION DESTROYS ANY CLAIM OF EQUITY IN ORGAN ALLOCATION
28	"living donation" living donation creates a two-tier allocation system advantages those recipients who can ‘bring their own donor’ Recipients of living related donation effectively ‘jump the queue’