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Nakazawa E, Yamamoto K, Akabayashi A, Shaw MH, Demme RA, Akabayashi A. Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses. JOURNAL OF MEDICAL ETHICS 2020; 46:144-150. [PMID: 31537615 PMCID: PMC7035681 DOI: 10.1136/medethics-2019-105507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 06/10/2023]
Abstract
In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of 'designated donation' and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B's consent. Second, if B offers to give back the organ to A, then B's act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B's right to bodily integrity. But B's refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.
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Affiliation(s)
- Eisuke Nakazawa
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Keiichiro Yamamoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Aru Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Margie H Shaw
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, New York, USA
| | - Richard A Demme
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, New York, USA
| | - Akira Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
- Division of Medical Ethics, New York University School of Medicine, New York, New York, USA
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Nakazawa E, Maeda S, Yamamoto K, Akabayashi A, Uetake Y, Shaw MH, Demme RA, Akabayashi A. Reuse of cardiac organs in transplantation: an ethical analysis. BMC Med Ethics 2018; 19:77. [PMID: 30119629 PMCID: PMC6098651 DOI: 10.1186/s12910-018-0316-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background This paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.” Methods Medical, legal, and ethical analysis, with a main focus on ethical analysis. Results From the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse. Conclusion We conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.
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Affiliation(s)
- Eisuke Nakazawa
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shoichi Maeda
- Course for Health Care Management, Graduate School of Health Management/Department of Health Policy and Management, School of Medicine, Keio University, Kanagawa, Fujisawa, 252-0883, Japan
| | - Keiichiro Yamamoto
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Aru Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yuzaburo Uetake
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Margie H Shaw
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, NY, USA
| | - Richard A Demme
- Division of Medical Humanities and Bioethics, University of Rochester Medical Center, Rochester, NY, USA
| | - Akira Akabayashi
- Department of Biomedical Ethics, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Division of Medical Ethics, New York University School of Medicine, New York, NY, USA.
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Cho HR, Park SJ, Kim GY, Park HJ, Lee JS, Choi HJ. Successful Reuse of a Kidney Allograft from a Brain-Dead Donor into a Second Recipient: A Case Report. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.2.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hong Rae Cho
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Jun Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Ho Jong Park
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jong Soo Lee
- Department of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Jeong Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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