lunes, 23 de abril de 2018

New preservation technologies: an ethical solution to the organ shortage?

New preservation technologies: an ethical solution to the organ shortage?


New preservation technologies: an ethical solution to the organ shortage?
Many Western nations face dire shortages of vital organs for transplant. Some doctors have proposed controversial changes to increase the number of organs available.

One such proposal – defended by American bioethicists Franklin Miller and Robert Truog – is that we abandon the dead donor rule for vital organ procurement. If transplant surgeons are able to harvest organs before death, then they will have an increased likelihood of procuring viable, non-damaged organs. Many organs are “lost” as a result of doctors having to wait too long before being allowed to procure them.

Yet perhaps we won’t need to opt for such an ethically contentious solution to the organ shortage. A research team led by biomedical engineers from the University of Oxford have discovered a way of preserving harvested livers that is far more effective than current cold-storage techniques. This new technique may eventually allow us to double the number of liver organ transplants available, some experts say.

Here’s an excerpt from a Nature article on their ground-breaking findings:

The metra device works by supplying the liver with oxygenated blood, anti-clotting drugs and assorted nutrients, all while keeping the organ at a steady 37°C. Because immune cells are removed from the device’s blood supply to avoid inflammation, “the liver is allowed to recover in a very benign environment”, says Peter Friend, a transplant surgeon at the University of Oxford, UK, and co-founder of the device’s manufacturer, OrganOx.  The trial involved 220 patients across Western Europe whose livers had failed because of hepatitis, cirrhosis, cancer or other causes. Each participant was randomly allocated a donor liver that was either hooked up to the metra machine, or stored on ice — which slows down cellular metabolism to mitigate damage, but makes the organ prone to injury when blood supply returns to the tissue.

  Recipients of livers kept on the device showed a 50% average decrease in levels of an enzyme associated with organ damage, compared with recipients of livers preserved on ice. The rate of early allograft dysfunction — a serious and potentially deadly complication of transplantation — occurred in only 10% of machine-stored liver recipients, versus 30% of those allocated ice-stored ones. (The one-year trial was too short and small to detect any difference in long-term patient survival.)

“Personhood” is a concept that is of great relevance to a range of bioethics debates. These include embryo research, abortion, the withdrawal and withholding of treatment, and euthanasia. Ironically, conservative bioethicists argue for a liberal definition of personhood, while liberal bioethicists tend to defend a more restrictive account of who classifies as a person. The former suggest that personhood pertains to a radical capacity for conscious activity, and all human beings, regardless of whether they have actualised this capacity or not, are persons.

The latter argue that the unborn and the radically incapacitated do not have a capacity for conscious self-awareness, and do not count as persons.

Yet the way in which we define personhood has a relevance that goes beyond debates about human beings. It also has significant bearing on debates about animal rights.

Some bioethicists argue that certain non-human animals, such as chimpanzees, should be recognised as “persons”. NYU animal studies professor Jeff Sebo, for example, says that chimps have many of the traits – self-recognition, use of language, friendships and the pursuit of goals – that we take to be constitutive of personhood. As such, we should include them in our definition of personhood. Sebo has championed a protracted legal campaign in New York State to have two chimpanzees, Kiko and Tommy, recognised as persons.

Here’s what Sebo had to say in a recent New York Times op-ed:

Sometimes when we are overwhelmed by the complexity of an issue, it can help to start by stating a simple truth and going from there. In this case, the simple truth is that Kiko and Tommy are not mere things. Whatever else we say about the nature and limits of moral and legal personhood, we should be willing to say at least that. The only alternative is to continue to accept an arbitrary and exclusionary view about what it takes to merit moral and legal recognition. Kiko and Tommy deserve better than that, and so do the rest of us.
I wonder if these two different debates – the limits of human personhood and the scope of animal personhood – have implications for each other. Perhaps those who defend the rights of the unborn and severely incapacitated humans must also acknowledge the need to afford greater legal recognition to intelligent non-human animals. And perhaps those who advocate for a definition of personhood that includes intelligent animals should also include those at the margins of human life.

Deputy Editor

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