Volume 70 Number 3 May 2003	back to contents

F. J. O’Neill Chair in Clinical Bioethics and Chairman, Department of Bioethics, Joint Appointment, Transplant Center, Cleveland Clinic Foundation, Cleveland, OH and
Professor of Clinical Medicine, Department of Medicine, Ohio State University, Columbus, OH.

Address correspondence to George J. Agich, Ph.D., F. J. O’Neill Chair in Clinical Bioethics and Chairman, Department of Bioethics, Joint Appointment, Transplant Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.

Presented at the Issues in Medical Ethics 1999 Conference at the Mount Sinai School of Medicine, New York, NY on December 10, 1999, and updated as of January 2002.

ABSTRACT

The concept of vital organ transplantation is critically analyzed by considering how traditional transplantation modifies the commitment to saving lives. Problems such as those associated with immunosuppression might seem to provide a compelling reason to oppose extension of transplantation to non-lifesaving situations. A closer examination, however, shows that immunosuppression does not present an intractable objection. For some organ transplants, such as the uterus, use of immunosuppression could be limited to the childbearing years. Complexities associated with assessment of quality of life are discussed using the example of hand transplantation. Assessment of success and functionality in a hand transplant is more complicated than it might appear at first. These complications suggest that monitoring and assessment should be a part of any extension of organ transplantation. Informed consent provides a limited, but important, component in justifying extended transplantation. Such justification, however, does not rest on patient autonomy, but on the reasonable prospect of benefit. Transplant programs considering an extension of traditional transplantation should develop formal protocols that include assessment of costs, benefits, quality of life, and the adequacy of informed consent.

KEY WORDS

Ethics, organ transplantation.

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