CARE AT THE PROMOTION OF LIFE: ORGAN TRANSPLANTATION AND

DONATION
Advance in surgery and introduction of new drugs have led to the steady
growth of organ transplantation and donation. The removal of the organ from one
being and its implantation into another has saved lives or made lives better.
Unfortunately organs are scarce resource. Thus, many who need new organs die
while on the waiting lists. This lack of organs has led to abuses such as robbing,
maiming, or even killing of donors, commercialization of organs by health care
givers, middle men or institutions and coercion exploitation of disadvantaged donors
or needy recipients. It is in the abuse that violation occurs.

Terms to consider:
Organ donation means the giving of tissue/organ/body by a person to another
person or to an institution
Donor the given who may be a cadaver (with an assumptive document by the donor
when still alive or by proxy) or a living person (either by relatives, non-relative)
Vendor is a person who exchange their organ for money
Recipient the receiver of the organ given by the donor or institution; a recipient who
pay the organ is a buyer
Organ transplantation means the transfer or the planting across of organ from
donor/vendor to recipient/buyer
Xenotransplantation is the planting of an organ from animal organ to human
beings.
Allotransplantation it is the transplantation of the organ from one body to another
body of the same species.

Organ donor
Our main concern is to care life that is the life of the donor. The principle
stewardship and nonmaleficence state that man must take care of his body and do
no harm to it. If the donor is the cadaver, harvesting an organ will do no harm. If the
donor is living, taking away a healthy organ is not taking care one’s body: no life is
saved, no health is restored. Removal o organ may even be mutilation. However, a
very proportionate reason and a meritorious act my override the rule of stewardship
and nonmaleficence. The rule of unselfish love, solidarity love of neighbor,
beneficence, and charity these may supercede the rules of stewardship and
nonmaleficence.
In such a case it is praiseworthy, for it takes what it means to belong to a
human society that we are fulfilling our duty to one another (deontological duty) and
to contribute to the goal of medicine (healing). By this it makes the giver a better
person. Still in spite of its meritorious promise there are some requirement before an
organ may be considered moral/bioethically acceptable:

1) the harm and risk must be minimal and proportionate to the benefits to be
derived. Things need to be considered:
a. accurate definition of death must be followed and observed
b. the dying cannot be killed
c. the organ to be removed must not be a necessary condition for life or
for personal procreation, like, brain and gonads
d. an part of the body that can easily be regenerated can be given such
as blood, hair, bone marrow
e. a second kidney or a portion of the liver these are nor necessary for the
personal or procreational identity
2) the donor must be care for before, during and after the donation. This includes
the following consideration:
a. proper screening
b. standard of health care
c. reimbursement of medical expenses
d. disability and livelihood lost (burial expenses of the cadaver)
e. prevention of discrimination in job
f. prevention in community acceptance
3) the intrinsic worth and dignity of the donor must be respected. The following
must observed:
a. free and informed consent must be given
b. information given should include process of matching, the chance of
success of the transplant and permission to refuse
c. financial need and ignorance make te marginalized vulnerable to
exploitation
4) in case of cadaver, consideration must be observed:
a. consent for the donation must be given or obtained specially person
that met an accident
Organ Recipient
Stewardship dictates that in case of serious illness man has the right and the
obligation to take necessary measures to promote life and health. A new organ may
preserve life of the person. To the extent that if it is available one has a right to and
obligation to get it. Some bioethical consideration are required for it to be morally and
bioethally accepted:

1) respect for autonomy must be allow the recipient to choose how to get an organ. It
requires:
a. to give free and informed consent
2) there must be justice in allocation. Justice as equal benefits for everyone in need
would dictate giving nothing to anyone and letting everyone die. It is pointless and
harms all.. the following must be consider:
a. the criterion for judging equality is based on the chance of success
b. the ability to pay the costs of the transplant and the expensive anti-rejection
medication determines success and access
c. given the case that both are capable to spend has success and access, the
first come first serve must be serve.

What the nurse can do, they must contribute on the communal dialogue and public
education must be given, so that the main goal of organ transplantation shift back to
its true nature of:
a. commodities to self love
b. commercialization to charity
c. potential donors must be protected against harm, thus become an advocate of
the donors
d. educating donors that selling organ is not encourage
e. nurse should address the underlying poverty, ignorance and vulnerability of
people that sells their organs; organs ‘should not be for sale’

READING: On Organ Transplantation

Living Donation and Health-Related Harm
By Ryan Sauder and Liza S. Parker

In late December 1998,renada Daniel-Patterson father offered to donate a kidney to

his daughter and ignited a controversy in the bioethics community. Renada had been
born with only one kidney, which began to fail early in her childhood. At age 26,
Renada had to receive dialysis three times in a week. She was unable to attend
school or venture very far from home. This pattern continued until Renada wa 13,
when Mr. Patterson called from prison to offer her his kidney. Renada was surprised
to hear from her father, who was serving 12 years at California State Prison for
burglary and drug convictions. Mr. Patterson was determined to be a compatible
donor, and the family proceeded with the transplant operation. As a result of this
surgery, Renada was able to live the life of a healthy girl for 2 years. Because the
medication to prevent rejection of the transplanted organ made her feel ill and
bloated to skip doses. As a result, her donated kidney began to fail. It was under this
circumstance that David Patterson offered to donate his second kidney to his
daughter in 1998.
This situation present several complicated ethical issues that deserve more thorough
consideration. So, the central question raised by the possibility of a person donating
both of his kidneys concerns the nature and the possible limits of autonomous
decision-making: how much can one person be permitted to sacrifice in order to
assist another? After identifying and briefly discussing other significant issues raised
by this case, we will focus on this primary question.
Personal values and beliefs, including belief about altruism and responsibility, are
obviously involved in people’s decision-making about donating an organ (and also in
seeking or accepting a donated organ). As in all decisions that involve balancing
risks and benefits, empirical information is also relevant. For decisions about organ
donation and transplantation, this empirical information includes data about the
health-related risks of donation; the prospective recipient’s prognosis and quality of
life with, and without, transplantation; the availability and relative burdens of
alternatives to transplantation, including the likelihood that a cadaveric organ will
available in timely manner; the immediacy of the perspective recipient’s need; and
the likelihood of transplantation’s success, which may vary with of the operation, the
quality and source of the transplanted organ, and the recipient’s overall health and
adherence to post-transplantation medical care. Thus, data as seemingly purely
scientific as the likelihood that the recipient has developed or will develop antibodies
that increase the likelihood of organ rejection and pertinent to the decision-making of
perspective living organ donors and organ recipients.
So, too data as obviously socially meditated organ-donor rates among different racial
groups. Prediction of both the likelihood and the importance of a recipient’s adhering
to post-transplantation medical regimes is notoriously difficult; moreover, social
factors frequently play a role in recipients’ adherence.
According to the Health Care Financing Administration report, in 1998 more than
23,000 Americans were being treated for End Stage Renal Disease (ERSD); 1.8 %
of these dialysis patients were below 19 years of age, and 32.3% of the patients
were Black. This statistics demonstrates that African Americans, who compose only
12% of the American population, disproportionately suffer from ERSD. This is due in
part to greater incidence of hypertension and diabetes in the African-American
population. Furthermore, because African-Americans (and members of other
undeserved populations) are more likely to experience a lack of access to
healthcare, frequently cases of diabetes and hypertension are discovered later and
treated less aggressively than in persons with better access to care. This fact
certainly contributes to the greater proportion of Blacks suffering from ERSD.
The length of time that dialysis patients survive varies by age, sex, and race. The
average for a White male between 40 and 44 years old is 6.9 years. The remaining
years of life for a Black male of the same age is 10 years. A White female of the
same age bracket will survive, on average, for 7.1 years; the average for a 40-44-
year old black female is 9.8 years. Aside from numbing of the skin and needle
insertion, hemodialysis itself is not painful; however, dependence on hemodialysis
itself is not painful; however, dependence on hemodialysis affects patients’ quality of
life, as it generally requires frequent travel to a dialysis center and rather stringent
dietary restrictions.
Kidney transplantation-with an organ from either a cadaveric or a living donor-
provides an alternative to dialysis. In 1998, 9,343 persons donated kidneys for
transplant: 5, 327 cadaveric donors and 4,016 living donors. These kidneys were
used in 11, 990 transplant operations. Living kidney donation is a relatively safe
procedure with an estimated mortality rate of 0.03% and a low rate of complications.
There is better chance of organs’ being compatible when the donor and recipient are
of the same race. Because some research demonstrates that antigenic similarity
between donor and recipient improves success rates in transplantation, antigen-
matching is one criterion used to allocate organs. The HLA antigens used to
determine compatibility occur in different proportions among various ethnic groups.
Although a disproportionate number of those awaiting transplantation are African-
American, in 1998 only about 10% of cadaveric donors and 9.5% of living donors
were Black. To the degree that organs are allocated based on antigen-matching,
then, Blacks have a reduced possibility of obtaining good matches and may
therefore wait longer for a kidney (or receive an organ that is less antigenically
compatible).
As of August 1999, there were nearly 43,000 patients waiting for kidney
transplantation. The longest living adult kidney recipient to date was 34 years and 11
months posttransplantation. Similarly, the longest living recipient was 34 years and 7
months. The option of transplantation permits recipients to maintain a normal diet
and schedule and eliminates the need for dialysis. Recipients must, however,
maintain a strict regimen of medications to prevent their bodies from rejecting the
transplanted organ(s).
These data, when applied to Renada’s case in particular, raise some difficult ethical
issues. Here history of noncompliance in taking posttransplantation medications
might suggest to some that Renada does not deserve to be the recipient of second
kidney-a second chance-especially because so many others are awaiting a ‘first
chance’, and because the option of dialysis means that refusal to provide her with a
second transplant organ is not an immediate ‘death sentence’. In the absence of
more specific details regarding the reasons behind and circumstances surrounding
her noncompliance, however, this would be at best a tenuous and premature
argument. The argument is undermined further when one considers that Renada’s
receipt of a second donor kidney would not in any way diminish the pool of donor
kidneys available to other ESRD patients because the donated kidney was offered
by her father, who presumably would not make it available for use by any other
patient (Of course , Renada’s father, who would need dialysis to continue living,
might join the list of those in need of kidney transplantation).
It is noteworthy that Renada’s body had already begun to reject one of her
father’s kidneys. Further testing would be required to determine whether her father is
an eligible donor or whether she is likely to have developed antibodies to his tissues.
Given the increased risks and obvious burden that would be placed on her father
with the loss of hi second kidney, it might be reasonable at least to demand that
there be a greater-minimal chance of successful operation and well-functioning
kidney for Renada.
Some additional ethical concerns stem from Mr. Patterson’s being a prisoner.
If there were any evidence that he was being pressured to donate by those who
have power over him in his institutional setting or who may influence the conditions
for his release, there would be strong reason to question the voluntariness of his
decision. However, most concern about his status as a prisoner has focused not on
his vulnerability to pressure, but on society’s vunerability to increased costs because
of his decision to donate. Because the government generally pays for prisoner’s
healthcare, it has been argued that it is unfair for Mr. Patterson to elect to place an
increased financial burden on taxpayers. Dialysis treatments are quite expensive (up
to $50,000 per patient per year. Source: Josefson D. Prisoner wants to donate his
second kidney. British Medical Journal. 2 January 1999; 318-7), particularly if
patients require off-site transplantation to obtain the treatments. In fact, the majority
of dialysis patients, not merely those who reside in state institutions, receive some
governmental reimbursement for dialysis in accordance with the ESRD benefit of the
Medicare program, and many receive further aid from state medical assistance
programs. However, in this case, either Renada or her father will be on dialysis, so
there would not necessarily be a net increase in expenditure (from some source) on
dialysis. Concern about a prisoner further burdening taxpayers suggests an attitude
toward those convicted of crimes that part of their punishment should include not
being allowed to impose social costs to the same degree as non-prisoners. Only
explicit articulation of this position, social debate and resulting social consensus
about it, and its subsequent implementation could justify basing public policy on this
(now merely implicit) belief.
Some might argue that Mr. Patterson should not be permitted to donate his
kidney and begin dialysis treatment because he might then receive special privileges
in prison because of his death status. A frequent procedure viewed as onerous by
most patients could be perceived as reprieve of sorts for a person accustomed to
monotonous incarceration. Such a claim, however, gives little credence to Mr.
Patterson’s ability to make an informed decision. Because his release date is in
2003, it would it would be remarkably myopic for him to choose to exchange a
healthy kidney and relatively unimpeded lifestyle for a shortened lifetime on dialysis
merely to acquire frequent diversions in his current life situation. To regard Mr.
Patterson’s offer as self-centered is to presume a remarkable lack of foresight. Of
greater concern might be the possibility that Mr. Patterson would hold unrealistic
expectations that his donation might result in additional benefits for him; for example,
a favorable parole board review or reconciliation with his estranged family. Such,
often unrealistic expectations are of concern with all living organ donation; however,
it is difficult to determine whether a prospective donor actually harbors such hopes,
whether they are realistic or not, and whether they impede, or are actually factors in,
autonomous decision-making.
The relevance of medico-scientific and social factors that constitute the
context of the donation-transplantation decision cannot be disputed. Questions of
costs to society arising from individual decisions have some relevance to ethical
analysis of the permissibility of a person donating both of his kidneys and becoming-
dialysis-dependent. It would be unfair, however, to place disproportionate weight on
these costs because they are so temporally proximate and certain in a case like this,
when other’s personal decisions place perhaps more distant burdens on society but
are not subjected to similar scrutiny. Society, for example, condones (and frequently
encourages) persons to pursue high-stress professional occupations or risky
pastimes, despite knowledge of the emotional and financial burdens that such
stressful employment or risky pursuits place on others (e.g., family members or
members of an insurance pool). Similarly, although the health risks and financial
costs associated with smoking are well documented, and smoking is currently
subject to some social ensure, the sale and the use of tobacco products are not
prohibited.
The central question presented by this case is one that would arise if
prospective donor and recipient were both vastly wealth and if there were no more
than the usual level of medical uncertainty regarding the likelihood of the
transplantation’s being successful and benefiting the patient’s that questions
remains: how much can one person can permitted to sacrifice to benefit others.
Three main issues in addressing this question: the concept and the requirement of
autonomous choice, the relationship between self-endangerment and autonomy, and
the interplay between a patient’s sacrificial decision and the medical tenet “do no
harm”.
First, how can we understand the concept of autonomous choice?
Traditionally, bioethics has conceived of autonomy as an individual capacity for right
to self-governance in decision-making regarding her person and her actions. In other
words, an individual should be able to decide and act in a manner that resonates
with her values and belief system. Respect for autonomy has become has become a
cornerstone value of contemporary bioethics that, along with recognition that
individuals are often best situated to protect their own welfare interests, grounds
doctrine of informed consent.
Obtaining informed consent to medical interventions has typical required
components: 1) the decision-maker’s competence 2) disclosure to the decision-
maker of any information particularly relevant to the decision. Especially risks and
benefit that are disclosed and finally, 3) voluntariness of the decision. Evidence of
meeting these three requirement is generally deemed necessary to ensure
autonomous choice in contexts requiring informed consent. In some contexts,
however, although decision-makers assert that decisions are autonomous and
accurately reflect deeply held values and preferences, their decisions appear not to
meet standard informed-consent requirements.
Living organ donation, especially by those emotionally related to the recipient,
is one such occasion. Frequently, a prospective donor, particularly a parent or sibling
of the prospective recipient will experience the decision to donate as automatic. They
frequently report feeing that they had no choice but to donate, and proceed to offer
their organs willingly and without hesitation, sometimes even before hearing of the
risks involved in such a donation. These decisions hardly seem to meet the
traditional requirements of informed consent. Failing to take risks of an intervention
into account when deciding whether to consent to it, and feeling compelled to
consent, are typically hallmarks of a failure of the informed consent process. Yet we
are reluctant to suggest that these prospective donors are not making autonomous
decisions to donate and, consequently, that their decisions (and organs) should not
be accepted.
According to the traditional doctrine of informed consent outlined above, the
decision to offer oneself as living donor prior to full disclosure and consideration of
risks is a red flag of invalid consent. Certainly, disclosure should be made and the
potential donor should be prompted to consider carefully the risks. But to fail to
accept a prospective donor’s decision because it was made too immediately or on
the basis of emotion, not rational and prudential consideration of foreseeable risks
and benefits, would violate the spirit of informed consent in mistaken service of the
supposed letter of the doctrine’s requirements. To discount or declare invalid such a
decision is to largely ignore the context in which the offer was made, relevance of the
relationships of the parties involved, and the importance of those relationships for the
values of decision-maker. After all, informed consent seeks to ensure that patients
make decisions that reflect their values. A parent for example, may offer to donate a
kidney to their child without hesitation or forethought. Although such a decisions
does not reflect the informed consent process traditionally considered necessary for
autonomous decision-making in medical contexts, it may resonate with a clear
history of self-sacrifice that marks many parent-child relationships. Additionally, by
contributing to the well-being of their children, parents may by acting to fulfill their
own chosen life plans. Although such a decision to donate does not meet each
checklist requirement of informed consent, it does not appear irresponsible or
uninformed when viewed in light of the value system previously adopted by the
decision-maker, a value system that informs the relationship between prospective
donor and recipient. Indeed, such a decision may most truly fulfill the autonomy-
oriented goal of informed consent for healthcare decision-making: to allow persons
to act in medical contexts in ways that respect their autonomy by reflecting their
deeply held values.
Intuitively, these decisions make sense, but this altered concept of acceptable
contextual consent warrants further exploration. One specific concern of acceptable
contextual consent warrants further exploration. One specific concern is whether this
understanding of autonomy and this apparent modification of informed consent to
emphasize its spirit by reinterpreting the letter of its requirements would allow
individuals to be too self-sacrificing. For the sake of a conception of autonomy that is
more closely tied to individuals deeply held values than to norms of rational
deliberation, would this interpretation of the requirements of informed consent allow
individuals to sacrifice too radically their own welfare? Or, does allowing individuals
to eschew norms of prudence and rational deliberation, in their pursuit or
preservation of deeply held values and interests, actually serve a deeper sense of
autonomy and a higher sense of well-being?
If Bioethics’ commitment to promoting autonomous decision-making is not
undertaken merely to ensure that decisions accord with values about which there is
broadly held social consensus, if it instead seeks to ensure that individuals’ decisions
reflect their own values, then bioethics’ doctrine of informed consent must be able to
accommodate decisions that are altruistic and even self-sacrificing beyond the point
that most people find acceptable. When the decision-maker makes a convincing
appeal to deeply held, though perhaps idiosyncratic, value system, the decision
should receive the prima facie respect of the bioethical and medical communities.
Nevertheless, there are limits to autonomy, and there may be limits to what society
or bioethical, legal and medical communities may allow a person to consent to, even
pursuit of the most deeply held values.
Traditionally, the scope of person’s autonomy is limited by the rights or
socially protected interests of other. In the case of Mr. Patterson’s decision to donate
his second kidney, however, the question is whether his own health-related interests
should be protected from his autonomous decision to sacrifice them for the sake of
both his values and his daughter’s potential benefit. If we can assume that Mr.
Patterson understands the burden and risks that his donation would entail, should he
be permitted to accept them? In answering this question, we must strive to avoid a
medico-centric perspective that gives primary weight to health-related risks and
benefits. We must give appropriate weight to the psychological and social benefits
that Mr. Patterson may reasonably anticipate from donation of his second kidney. If
his hopes were utterly unrealistic-if, for example, he mistakenly believed that his
prison sentence would be committed or that full reconciliation with his family would
result from his donation, then we would have reason to question Mr. Patterson
further and to question his understanding, appreciation, and weighing of the risks
and benefits that he himself considers material to his decision.
Moreover, because his donation would place some potentially severe
restrictions on his current and future lifestyle (e.g., dialysis, the possibility of a
shortened realities, including the particular health-related risks that prison life,
including sub-optimal healthcare, may pose. He must also understand that others
options are available for Renada (including continued dialysis and the possibility of a
cadaveric kidney donation) and the chances that transplantation with his donated
kidney will improve her quality of life. He should also be prompted to consider that
his donation may impose some psychological and social burdens on Renada; for
example, a sense of obligation or guilt or social bond to he r father that she might not
desire. He might not want to place her in the position of accepting a ‘gift of life’ that
so severely compromises his health. If, however, Mr. Patterson considered all of
these factors and still wished to donate his second kidney, is there any reason not to
permit him to do so?
 If there were superior or comfortable options available to Renada, as with
dialysis there indeed seemed to be, then there is reason not to ask or to allow Mr.
Patterson to sacrifice his health-related interests. If, however, there were no option,
or no option that afforded Renada a similar quality of life in the reasonably
foreseeable future, then the primary ethical barrier to permitting Mr. Patterson’s
donation might be concern about the medical profession’s complicity in the
procedure that so severely compromised one person’s health-related interests for
the benefit of another’s.
Medicine, is supposed to be governed by the norm: “first do no hamr.” Of
course, medical procedures often involve doing some harm for the greater benefit of
the patient. Incisions are made to remove the tumor; side effects of chemotherapy
are imposed and endured with the hope of cure or prevention of recurrence. These
harms are imposed, however, for the direct health-related benefit of the person
harmed. And, quite importantly, only the minimum harm that can reasonably achieve
the desired benefit is imposed. The question Mr. Patterson’s decision raises medical
practitioners can ethically be complicit in imposing harms on one person for the
health-related benefit of another person (e.g., Renada) when the person harmed
(e.g., Mr.patterson) seeks and may reasonably receive social and psychological
benefits and accepts the health-related harm. Our answer is a tentative “yes.”
One additional constraint must be observed: the harm imposed must be the
minimum harm that can be imposed to achieve the desire benefit. In other words, if
Renada could be expected to receive a kidney from a cadaveric donor and in the
meantime remain on dialysis, without considerable disruption of the quality of her life
or risk to her eventual prognosis, then it might be appropriate to refuse to impose the
health-related harm on Mr. Patterson that he is nevertheless willing to accept. To
proceed to impose that health-related harm on Mr. Patterson when the benefit to
Renada may be achieve by other means would be justified, even if Mr. Patterson
were to insist that he wanted to achieve the psychological benefit of being such an
heroic donor or of compensating for past wrongs. The situation would be somewhat
analogous to a case in which a surgical patient asked for a more invasive procedure
than was necessary to remove his tumor because he wanted not only to achieve
health-related benefit but additional psychological benefit that might accrue to him
during a prolonged recovery period. Our analysis of Mr. Patterson’s offer to donate
his second kidney takes seriously potential psychological and social benefits and
weighs them along with health-related risks and potential benefits but does not
consider them to themselves justify a medical practitioner’s imposing health-related
harm. This analysis of the prescription to “do no harm” departs from the traditional
analysis be weighing risks and benefits across two people, but only in cases where
the person to be harmed for the sake of another considers incurring that harm for the
sake of the other to be in accordance with his values and where the harm imposed is
the minimum commensurate with achieving the benefit to the other.
Someone might argue that with the acceptance of Mr. Patterson’s second
kidney for Renada, an additional patient awaiting kidney transplantation might benefit
from the cadaveric kidney that Renada would not use. It would seem that so long as
Mr. Patterson’s incurring the health-related harm of being without kidney is
acceptable to him, there would always be some additional health-related benefit
(albeit to some third person) of Renada’s receiving his kidney that would justify his
donation, even if Renada’s could pursue an alternative that did not impose such
harms on Mr. Patterson. However, this is not the case. So far as we can tell, Mr.
Patterson wants to donate his second kidney for the health-related benefit of Renada
and for the social and psychological benefits he anticipates in virtue of potentially
benefiting her. His is not a desire to donate (to someone) out of general altruism and
for the social and psychological benefits that it might bring. In the determination of
the acceptability of imposing the health-related harms that he accepts, it is the
potential benefits that Mr. Patterson actually anticipates (for himself and Renada)
that may justify imposing harm on him, if he chooses to accept that harm under
conditioned of informed consent.
The considerations that may justify allowing Mr. Patterson to donate his
second kidney and that may justify the complicity of society, medicine, and particular
medical practitioners in his thereby being harmed do not justify accepting his
donation for the benefit of those outside the scope of his concern (e.g., third parties
on the waiting list) or taking that potential benefit into account in balancing harms
and benefits. They also would not justify imposing an obligation to be self-sacrificing
for the benefit of others in general or of particular emotionally related others. If,
however, such sacrifice reflects a person’s deeply held values and is consented to
under conditions of informed consent, the decision to make such sacrifice should be
respected and provides grounds for medical practitioners to violate the apparent
prescription to “do no harm.”

In conclusion, if there had been no comfortable or superior treatment

alternative available to Renada, it might have been permissible to permit her father
to incur the serious health-related harm and future risks to his health that he
expressed willingness to accept. For his decision to donate his second kidney to be
accepted, his decision would have to fulfill the demands of informed consent. As with
many living donation decisions, that informed consent may be best evaluated in light
of the donor’s relationship with the recipient and the value system that informs the
donor’s decision, as well as traditional requirement designed to ensure
understanding of the risks and benefits-health-related, psychological, and social-
involved. Also, to act on donation decision that imposes such severe health-related
harms and future risks, it must be the case that doing so nevertheless imposes the
most minimal harm commensurate with achieving the health-related benefit for the
recipient, and this health-related benefit that may reasonably be anticipated must be
benefit that the prospective donor actually seeks to achieve by his donation.
The permissibility of a prospective donor’s acting in such an apparently self-
sacrificing manner lies in (1) the coincidence of his interests with the benefit to
accrue to the recipient, (2) his belief in this coincidence based on his values, (3) his
informed consent to the myriad risks that he would incur by donating , and (4) his
donation imposing the minimum health-related harm when summed across donor
and recipient, that may still achieve the health-related benefit to the recipient that he
desires. In the case of Renada and her father, the fourth condition did not obtain; the
availability of dialysis and the prospect of recovering a cadaveric organ meant that
the option of receiving Mr. Patterson’s second kidney was the option that imposed
the minimum health-related harm (even assuming that he was eligible donor and that
the chances of success were equivalent to those with a cadaveric organ). In this
case, the reason for refusing, Mr. Patterson’s offer to donate would not reside with
concerns about the autonomy of his decision or with a blanket refusal to accept such
self-sacrifice. Again, such self-sacrifice may be permitted if it is autonomous chosen
and consented to with the desired possible benefit.

Bioethical Issues
1) What harmed will it gives in selling one’s own organ do?
2) Is organ transplantation from human being to animal does not pose a treat to
humanity? How about transforming human being into an animal that can be
used for terrorist activity?