People throughout the world are trying to resolve the primordial question whether organ transplantation breaks ethical norms or brings hope to disillusioned patients. Throughout the history, physicians have continuously become hostages to ethical dilemmas triggered by the progress of technologies and medical knowledge. Although a number of discoveries and improvements have been made, the theme of organ transplantation remains controversial till the present days. However, one does not think about the issue of organ transplantation until the serious disorder comes to their family and transplantation is the only solution. In this respect, some people perceive organ transplantation as a life-saving procedure, while the others view it as a violation of human rights. Thus, the theme of organ transplantation evokes numerous debates and disputes among physicians as well as ordinary people. Although organ transplantation causes an ethical drama, it is vital for many people and their families because it can save one’s life. Therefore, it is critical to investigate the background of organ transplantation in Canada, its principles, ethical foundations, and the issue of living organ transplantation. Moreover, it is of crucial importance to analyze the challenges the organ transplantation system faces.
In 1999, the two Canadian health care organizations emphasized the importance of a stable and growing interval between the demand for transplants and their actual supply in Canada (Norris, 2011, p. 1). There institutions were House of Commons Standing Committee on Health and the National Coordinating Committee for Organ and Tissue Donation, Distribution, and Transplantation. While replying to this claim, the government stated that it took into consideration all the provided recommendations in order to find a proper solution to the problem of organ transplantation in Canada (Norris, 2011, p. 1). Nevertheless, the assistance of all levels of government was required to improve the situation. In their reports, the two above-mentioned organizations offered to develop a national strategy and form a committee of experts to monitor the particular strategy. As a result, in 2001, the Canadian Council for Donation and Transplantation (CCDT) was established. In 2004, the particular organization became a non-profit institution. Hereby, it focused on the provision of consultations and recommendations on the health issues that might require transplantation. In 2007, functions of CCDT were transmitted to Canadian Blood Services that took control over organ transplantation system (Norris, 2011, p. 2). Although the government of Canada took different measures in order to improve the situation, the current organ transplantation system could hardly meet the needs of Canadians.
Principles and Ethical Foundations
In 1984, the Canada Health Act was assigned that legislated on the variety of principles for health care in the country. The principles presented in the act were reaffirmed in the reports of 2002, 2004, and 2003 accordingly by First Ministers of the state (Canada’s Organ and Tissue Donation and Transplantation Communities & Canadian Blood Services, 2011, p. 52). In fact, these principles include versatility, accessibility, and comprehensiveness. Moreover, the availability of the necessary health services as well as the adoption of reforms based on the needs of patients are of great importance. At the same time, it is necessary to provide all Canadians with access to the health care services together with the qualitative collaboration among all levels of governments in order to satisfy the evolving health care needs. While the organ and tissue donation and transplantation system (OTDT) is an essential part of Canada’s health care system, it follows the same principles and foundations. In fact, these principles lie in the strategies of the OTDT system in order to improve and develop the current situation in the particular area (Canada’s Organ and Tissue Donation and Transplantation Communities & Canadian Blood Services, 2011, p. 52).
The participants of the OTDT communities have concluded that there exist more ethical principles, which should be added to the above-mentioned ones. Indeed, these principles are unique to OTDT and perfectly demonstrate the targets of the organization. In fact, these principles include management, liability, solidarity, honesty, credibility, safety, and sufficiency of supply (Canada’s Organ and Tissue Donation and Transplantation Communities & Canadian Blood Services, 2011, p. 52). Thus, the OTDT system controls the donated organs and tissues to be taken from the donors who authentically wish to save one’s life. These donated organs are considered gifts to society as a whole; thus, they cannot be a property of any organization. Moreover, a liability of the organization is of critical importance because both donors and participants in the OTDT system need to know in what ways their donations are used to insure that all the actions are productive. Sufficiency of safe and secure supply is also required in order to meet the expectations of the population. Additionally, solidarity and fairness of the OTDT system are of great importance to improve the access of Canadians to the necessary care. Thus, while the problem of organ trafficking and transplant tourism is a topical issue, it is vital to comply with the above-mentioned ethical principles and foundations.
Living Organ Transplantation
In most cases, organ donations happen after the death of a donor. However, some organs may be transplanted while the donor is alive. Regarding the growing need for transplants, the rates of living donation have rapidly increased (Kim et al., 2014, p. 5). The particular way of organ transplantation is observed as an alternative to the already formed procedure of donation. Although living donation frequently takes place among family members, there are some cases when it may happen between strangers. Nevertheless, it remains a controversial theme due to many factors. One of such factors is ethical issues that remain unresolved, specifically the consent of a donor. It should be noted that there exist different cases of living donation that, in turn, raise the variety of ethical dilemmas. For example, the living donation can be made by a relative or friend of a patient, the anonymous donor who is unknown to the organ recipient, or the donor who has seen an advertising allocated by a person in need of a transplant. Thus, all of the above-mentioned cases raise unique ethical issues regarding the area of consent.
To consider that consent of the donor valid, it has to be voluntary, informed, and made by a person who has capacity to do it. Thus, it is critical to insure that the donor is appropriately informed about the procedure and consequences it may cause. In fact, it is a basic component while obtaining consent of an individual who is going to donate their organ. According to Reibl and Hughes (1980), physicians have to provide the individual with “material information”, specifically the information that a human will need and want to know in order to make an informed choice (as cited in Caulfield, 2006, p. 2). Moreover, the potential donor should be aware of the possible risk, including death, surgical morbidity, certain changes in their health, as well as an impact on family life, employability, and financial position of a person. According to Tokarski (2002), “as many as 25% of live donors experience either depression or financial hardship after donating an organ” (as cited in Caulfield, 2006, p. 3). At the same time, the donor is evaluated by physicians in order to investigate the possible physical and psychological response to the donation process. Thus, if a potential living donor is diagnosed with a certain disease, they should undergo treatment before the transplantation. Therefore, a person who wants to donate their organ for transplantation has to be provided with proper information to avoid unexpected consequences.
Challenges the OTDT System Faces
According to data provided by the Canadian Institute for Health Information (CIHI), in 2009, 3,796 patients waited for organ transplants (as cited in Canada’s Organ and Tissue Donation and Transplantation Communities & Canadian Blood Services, 2011, p. 60). In 2008, 249 people on the wait lists had not succeeded to receive the transplant because they died before their turn came. Nowadays, the growing demand for organs has greatly increased. Unfortunately, the OTDT system can hardly cope with a current demand, and what is more important, it shows the tendency to be unable to satisfy the patients’ needs in the future. In this respect, the four major challenges can arise, namely poor potential for organ donation, ineffective organ allocation, lack of fairness in the OTDT system, and fragile evaluation and accountability mechanisms. In fact, the donation rate in Canada is extremely low that can be explained by different factors such as inability of family members to donate, untimely provision of the needed transplant, and sometimes lack of professionalism and knowledge. Moreover, the sizes of waitlists are so big that some patients may not even live to see their turn. Therefore, certain changes and improvements have to be made in order to provide Canadians with proper health care.
Although organ transplantation remains a debatable theme, it provides patients with a chance to live. In comparison to previous years, many improvements have been made, but there still exist difficulties and challenges the OTDT system faces. As a result, patients waiting for their organ transplants risk remaining without them. Moreover, the donor’s consent is an important component of the procedure. At the same time, the issue of organ transplantation raises a number of ethical dilemmas. In this respect, some people consider the particular procedure a violation of human rights, while the others view it as a salvation. Nowadays, there are a lot of changes to be done to improve the OTDT system as well as influence people’s attitudes toward organ transplantation, emphasizing its value and use. Nevertheless, these ethical dilemmas can be hardly resolved until the entire system is upgraded.