Organ transplantation has been one of the phenomenal success stories of the latter part of the 20th century. 50 years ago, there are no other options other than death when a vital organ fails. During the past three decades, with the advent of clinical organ transplantation, came the hope of a second chance of life for many patients. Clinical organ transplantation has been considered as one of the most gripping medical advances as it offers the gift of life to patients with terminal failure of vital organs.

A Closer Look at Organ Transplantation Process

Organ transplantation is a complex process of surgical transfer of a donated organ to a patient with end-stage organ failure. Despite the risks, it provides a chance for desperately ill people to live and for some people, an organ transplant is the last hope. The surgical operation of a healthy organ from one person and its transplantation into another person whose organ has failed or was injured is often lifesaving and gives the recipient an outstanding new lease on life. History says that the first successful organ transplant was performed in 1954 in which the kidney was transplanted between identical twin brothers. Organ donation is a voluntary process where an individual agrees to donate his/her organ to be removed with legal consent while the donor is alive or after death. In few cases, donation might be for the purpose of research or for the transplantation purpose. The most common transplantations include pancreas, kidney, liver, intestine, bone marrow, skin, cornea and heart. Organ transplantations are very critical and the success depends on factors like matching the blood type, size of the organ, the severity of the patient's condition and the geographical distance between the donor and the recipient.

Although the current advances in immunology and tissue engineering and the use of animal organs result in very promising solutions to many of these problems, it also raises additional ethical and medical issues that must be considered by medical professionals as well as society. Initially, living organ donation was restricted to blood relatives because it was believed that there would be less likelihood or rejection but advances in immunosuppression have reduced the incidence of acute rejection. Current advancements in stem cell biology and tissue engineering show benefits in the treatment of common diseases, including diabetes, Parkinson’s disease, systemic lupus erythematosus etc. The organs that are removed from recently deceased people are called cadaveric organs. However, there is a continuing concern regarding the consent laws and regulations of governments and other authorities to increase access to cadaveric organs by accepting the ‘presumed consent’ law. Some ethicists argue that it is improper to assume consent simply because there is no recorded objection.

Ethical Boundaries

The primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs. The unavailability of donor organs is one of the reasons of ethical concerns regarding organ transplantation. It can be overcome by increasing the number of donor organs. With the state of the discrepancy between organ donors and people waiting for an organ transplant, researchers have begun to consider non-traditional donations which include:

I. Animal Organ Transplantation/Xenotransplantation

Xenotransplantation is a procedure that involves the transplantation or implantation of cells, tissues or organs from a non-human animal source to a human recipient. Significant improvements in our understanding of the immunologic barriers between larger animals and humans offer the hope of the clinical application of animal-to-human transplants. More sophisticated genetic engineering of animals, as well as more complex modulation of the animal-to-human antibody and cellular recognition, will probably need to occur for the field to move forward.

II. Fetal Transplantation

The prospect of therapeutically effective fetal tissue transplants has raised new questions to the researchers as it has the potential to treat disorders such as diabetes and Parkinson’s disease. The utilization of human fetal tissue for transplantations is based upon a large body of research data derived from experimental animal models. At this time, not too many fetal transplants have been performed, but the various applications are promising avenues of clinical investigation for specific disorders.

III. Stem Cell Transplantation

Bone marrow transplant involves the administration of healthy hematopoietic stem cells in patients with depleted bone marrow. A bone marrow transplant can be effective in treating diseases and it also improves the quality of life.

IV. Artificial Organ Transplantation

An artificial organ is a human-made complex organ device or tissue, implanted into a human to replace a natural organ to restore a specific function so that the patient may return to a normal life. Artificial hearts are being transplanted and artificial kidney transplantation is under development. The dependence on human donors restricts the overall supply of donor organs. Artificial organs may be a way to eliminate the waiting list of recipients in the future.

Organ transplantation is a tale of remarkable achievement and an ongoing challenge. In conclusion, we can say that the current organ shortage is estimated to keep outpacing organ demand for years to come. Xenotransplantation remains an experimental approach. As long as the shortage of organs continues, there will be ethical challenges to confront. Although many obstacles are still there, the era of transplantation is considered one of the miracles of modern medicine and surgery.