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Student Education

Biomedical ethics: Organ transplantation

BMJ 2003; 327 doi: (Published 01 July 2003) Cite this as: BMJ 2003;327:0307232
  1. Pierre Mallia, family doctor and lecturer in family medicine and biomedical ethics1
  1. 1Faculty of Medicine and Surgery, University of Malta

In the third part of our series, Pierre Mallia looks at the controversial world of organ transplantation

Classifying organs

  • Regenerative organs such as blood and bone marrow

  • Non-regenerative organs such as kidneys, liver, heart, corneas

It is generally considered that donation of organs is an altruistic human endeavour. Organs can be classified into regenerative, such as blood and bone marrow, and non-regenerative, such as kidneys, heart, liver, and corneas.

A scarce resource

Organs are a scarce resource, especially non-regenerative ones. People on waiting lists are assessed according to medical necessity at the time an organ is available. Most non-regenerative organs come from cadavers of people who have expressed a wish to donate after they die. The kidney is the only non-regenerative organ that can be donated during a person's lifetime since it is possible to live with one kidney.

Different countries use various methods to obtain organs. In an opting-in system, accepted by most, you opt to donate your organs after death. Opting-out systems are rarer: your organs can be taken when you die unless you express a wish against this during your lifetime. Some American states have tested a “mandated choice,” whereby you must state your wish on applying for driving licence. This has generated some doubt about whether people should be forced to make such a choice. Donor cards are also common, but unless they are made binding the medical team will probably still seek the consent of the family in some countries.

Often, when someone dies in an accident and the relatives arrive at the hospital, the medical team advise them on the possibility of donating the organs of the deceased. This is often met positively by the relatives as it engenders the sensation that the death was not in vain and could save other people's lives. It is wise that the …

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