Is it always better to give? Ethical challenges in tissue donation
It is common for people to be invited to register as an organ and tissue donor at the same time, often in the context of getting or renewing a driver’s license. To agree to both might appear to be a similar, easy decision. However, Christians should discern with care before agreeing to be a tissue donor, or in donating their bodies for research, as there are unique ethical issues involved in each.
Organ donation – of kidneys, livers, hearts, and lungs – is generally well regulated, ethically delineated, and understood by the public in the U.S. The 1984 National Organ Transplant Act makes it illegal to buy or sell human organs, establishes a framework for fair distribution, and even states that “human body parts should not be viewed as commodities.” The Catechism states that “Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity.”
Tissue and body donation after death, however, differ in two key respects, with the result that ethical abuses are more likely. Tissues, human bodies, and body parts can be bought and sold at a profit, by for-profit companies and such transactions, and the treatment of these bodies and tissues are much less closely regulated when they are regulated at all.
Donations of human tissue, such as corneas, skin, tendons, and bones help many patients in need. Over 40,000 cornea transplants each year help people to see (I myself received a cornea transplant). Many burn victims benefit from donated skin, and those suffering from spine or joint injuries are helped by donations of bone and tendons. However, because human tissue can be sold for a profit, some donated tissue goes to cosmetic companies for research and products. And human skin is in such high demand for plastic surgery that sometimes it is hard for hospitals to get the skin they need to treat burn patients.
The revenues that can be generated by tissue sales are significant. In 2012, experts estimated that tissue from a single body could generate from $80,000 to $200,000 in revenue. With such amounts of money at stake, it is no surprise that financial incentives can overwhelm considerations of respect for the human body and even respect for the informed consent process. People do not realize when they agree to be an organ and tissue donor after death that their bodies can become subject to for-profit businesses and commercial enterprises.
The issues encountered in whole-body donation are similar in key respects to those of human tissue. Human cadavers have long been used to teach medical students about human anatomy and now are used to teach basic skills like intubation and to test new surgical techniques. But today human cadavers are being used for a wider range of purposes such as forensic research (by being left in forests to determine how long it takes for victims of foul play to decompose) and car crash testing (the dummies in commercials do not always provide precise-enough data). While the information gained from research can be helpful, it is essential that researchers treat the human cadavers with which they have been entrusted with dignity (including respectful disposition or burial) and that people are able to give informed consent. In a recent case, a man learned that his mother’s body was used by the military in explosives testing despite his having refused this option during the consent process. Unfortunately, given the financial incentives and lack of regulation, it appears that some companies fall far short of meeting these standards.
When deciding whether to be tissue donors, Christians should carefully investigate the institutions that will receive their bodies or tissues, the uses or goals which their donation will serve, and how their remains will be treated with dignity.
JOHN F. BREHANY, PH.D., STL, is director of institutional relations at the National Catholic Bioethics Center, and past executive director of the Catholic Medical Association.