Medical Ethics and Xenotransplantation

When deciding between Jimmy and Sarah, Jimmy requires the kidney in order to fulfill his life goals, whereas Sarah needs it to ensure she can continue to care for her children. Choosing one or the other requires an ethical judgment based on medical facts and patient’s rights. Jimmy will receive the kidney, as his age and ability to maintain a healthy lifestyle are taken into account, his likelihood of organ transplant success makes him a better choice.

Jimmy demonstrates a higher need for personal autonomy than Sarah and is therefore more deserving of the kidney. In terms of beneficence, it is best for Jimmy to receive the kidney over Sarah given that Jimmy’s life goals require a stronger commitment to the use of the organ than Sarah’s (Kerstein, 2009). The harm involved in giving the kidney to Jimmy is that another person loses out on a kidney donation, given that Sarah’s husband will only donate if a match is found for her. With regards to justice, the decision to give the kidney to Jimmy could be construed as unfair, given that there will one loss kidney donation overall, but it is important to note that, inversely, it is more utilitarian to prefer giving a valuable organ to someone about to start their life, rather than a woman who is already committed to her own life and is approaching the latter part of her life. There are two primary variables that result in the decision of the kidney going to Jimmy; first, the age of the patients; second, the likelihood of organ transplant success.

The matter of who should receive the kidney is largely a function of who will receive the greatest use of the organ. The age of the patients comes with a broad variety of consequences and ethical judgments that must be made. First, it is assumed that both patients will live full, long lives. Based on the age of the patients, Jimmy will receive substantially more years of use from the donation than Sarah (Clinical Digest, 2013). Thus, Jimmy is more deserving of the organ.

As a factor in the donation, the age of the patient becomes relevant when a substantive change in the utility of the organ arises. It would be far less of a dilemma if the matter in question was a choice between a decrepit, extremely aged woman and her young adult counterpart. When age discrepancy becomes too large to justify limited resources for the sake of someone soon to pass, it instead becomes clear that age is a factor when there is a substantive utility change that can be observed. In this case, kidney transplants in older patients are less common. As the age of the patient increases, the age group of 50-54 and 55-59 marks the point where dialysis is the preferred method of treatment for kidney disease.

As Sarah is quite near this established boundary and, moreover, is well past the prime of her life, it stands to reason that the age of the patients can, in fact, be used to justify the donation of the organ to young Jimmy. Within two extremes of age and likelihood of operational success, the patient with substantially better chances of survival and success is ethically more appealing. Sarah runs the risk of rejecting the organ and wasting precious medical resources, as well as potentially harming her own health through a failed graft.

In this case, xenotransplantation is a viable alternative for the problem at hand. Though a strong case can be made to justify giving Jimmy the single kidney, every argument that could be presented in favor of the young man has serious downsides. There are significant and perhaps unanswerable questions regarding who should truly receive the kidney. Given that there are massive downsides to either patient, xenotransplantation becomes a logical and preferable alternative. Hawthorne (2011) argues that the xenotransplantation offers the ability for doctors to have an unlimited source of cells, tissues, and organs for patients (390). With no medical risks, the financial cost of xenotransplantation is a limiting factor. Xenotransplantation is not a medical reality, so the costs cannot be estimated. Ethically, there is concern from some sources that harvesting animals to use as farms for organs and cells is negative. However, I argue that there is no discernible moral difference in using non-sentient animals for organ harvesting when compared to harvesting them for meat. The end result is the same, and the practical benefit of xenotransplantation cannot be denied based on a physician's ethics. Animals rights are not as important as human rights.

It is argued in this paper that the age of the patients combined with the likelihood of their operation’s success are the most defining and important factors of deciding the case. Secondly, when a patient joined the waiting list is significant. If a patient has been on the list longer, they have a strong claim to organ available. The underlying assumption is one of utility. Organs should be donated to people who demonstrate the capacity to use the organ for a long time, who have the highest chances of grafting success, and who have been waiting the longest. The age factor and likelihood of operational success are the important objective measurements. The general public would find this method too utilitarian and would focus more on the emotional aspect of denying elderly patients organ donations simply because of their age. Such objections, however, are not utilitarian and are ultimately not realistic.

Organ donation is a difficult area to understand ethically, but it is argued here that Jimmy demonstrates a choice that will have better rewards for the gift of the kidney. In contrast to Sarah, Jimmy is far younger and more likely to accept the donation, meaning that the overall health benefit to the young man is substantially higher than that of Sarah.

References

Clinical Digest. Success of kidney transplants is affected by donor age and length of cold storage.(2013). Nursing Standard, 27(30), 17.

Hawthorne, W. J., Simond, D. M., Stokes, R., Patel, A. T., Walters, S., Burgess, J., & O'Connell, P. J. (2011). Pre-clinical model of composite fetal pig pancreas fragment/renalxenotransplantation to treat renal failure and diabetes. Xenotransplantation, 18(6), 390-399.

Kerstein, S. J. (2009). Autonomy, Moral Constraints, and Markets in Kidneys. Journal OfMedicine & Philosophy, 34(6), 573-585.

Mendonça, L. L., Martínez-Alarcón, L. L., Ríos, A. A., Ramis, G. G., Quereda, J. J., Abellaneda,J. M., & ... Parrilla, P. P. (2013). Are Veterinary Students in Favour ofXenotransplantation? Comparative Opinion Study in a Brazilian and a SpanishUniversity. Transplantation Proceedings, 45(3), 1046-1049.

Ross, L. F., Parker, W. W., Veatch, R. M., Gentry, S. E., & Thistlethwaite, J. R. (2012). EqualOpportunity Supplemented by Fair Innings: Equity and Efficiency in AllocatingDeceased Donor Kidneys. American Journal of Transplantation, 12(8), 2115-2124.

Stadlbauer, V. V., Stiegler, P. P., Müller, S. S., Schweiger, M. M., Sereingg, M. M.,Tscheliessnigg, K. H., & Freidl, W. W. (2011). Attitude toward xenotransplantation of patientsprior and after human organ transplantation. Clinical Transplantation,25(3), 495-503.