Organ donation — or why bioethics should interest you | of National Library of Singapore | Our Stories: National Library of Singapore Blog | Jul 2022

Just because you can do something, does that mean you should? Advances in medical technology can raise difficult ethical questions. Librarian Kevin Seet investigates some of the moral questions that arise from biomedical research.

Consider the following scenario: You have a sick child who will die unless he regularly receives matching donations of blood, stem cells or organs. Would you conceive another child to provide a source for these gifts?

Or imagine if you lived in a world where your DNA information about your possible genetic disorders and health risks had to be disclosed to your employer. Would you be willing to undergo routine DNA testing for your job?

What’s this Bioethics is all about.

Whenever there is an intersection between medicine, science, technology and our human body, questions arise about what is right or wrong, and what should or should not be done. Discussions surrounding these ideas form the study of bioethics – the ethical implications and applications of health-related life sciences.

An illustration of an ethical thought experiment: the cart problem, first conceptualized by philosopher Philippa Foot.¹

Bioethics covers a wide range of topics, but let’s focus on something less abstract and more relevant: organ donation.

For some of us, organ donation is just a medical procedure that we hope we never need. However, for those who need it to save their own or someone else’s life, there are many serious issues to consider.

Organ donation – especially for living donors – forces doctors and surgeons to weigh the costs and benefits for everyone involved. A dying patient or a potential donor must also consider the many options and possible effects (operative risks, post-operative care/complications).

All of this is made even more complex if family relationships are involved (are you obligated or responsible to donate your organs to a family member who needs them?)

Local newspapers praise organ donations between family members, made possible by advances in medicine. Cheong, Kash. “The procedure allows the father to bring his son back to life”, November 29, 2014, straits time, 15 (from NewspaperSG)
Poon, Chian Hui., “Siblings Overcome Obstacles to Perform Transplant Operation”, November 18, 2013Straits time, B1 (from NewspaperSG)
“Pierre donates half of his liver”, May 8, 2002, Today, 2. (From NewspaperSG)

On July 16, 1987, the Human Organ Transplantation Act (HOTA) was passed in Singapore to allow the removal of healthy kidneys from people involved in fatal accidents (unless they chose not to). participate in the program). This was to alleviate the shortage of donor kidneys for patients with kidney failure.

HOTA was expanded in July 2004 to include liver, heart, and cornea, as well as organ harvesting from people who died of unrelated medical conditions. The law has also been expanded to govern living donors – people who donate parts of organs (for example, a kidney or a section of a liver) during their lifetime to others in need.

The months leading up to the amendment to the law saw a series of newspaper articles published to debunk organ donation myths. There were also talk shows on national television dealing with questions from the public, encompassing both social and personal anxieties.

The Human Organ Transplantation Act in 1987 and 2004. “The Organ Transplantation Law Will Come Into Force Next Week”, July 7, 1987, Straits time, 1.; “Page 2 Ads Column 1”, March 29, 2004, Today, 2. (From NewspaperSG)

Some people feared that the amended law would mean that every organ in their body would be removed when they died (not true; the law only covers kidneys, hearts, livers and corneas). Others feared that their own medical care would be compromised in order to “expedite” organ harvesting. (Physicians should treat all patients regardless of their suitability for organ procurement).

Another concern was that brain-dead patients could still regain consciousness and therefore did not have to have their organs removed. (Brain death, however, is complete and irreversible. It should not be confused with being in a coma.)

Things get complicated when bioengineering comes into play. In October 2021, a kidney from a genetically modified pig was successfully transplanted into a brain-dead patient (with family consent), where it functioned normally in place of a human kidney without kidney rejection. organ for the 54 hours of the study. ²

Was your first reaction more “Ew! Is it even okay to do that?” or was it more “It saves lives more easily”? These are indeed bioethical questions.

The kidney transplant procedure is the result of decades of scientific and medical research experiments, including the use of the genetic engineering tool CRISPR (short for Clustered Regularly Interspaced Short Palindromic Repeats), the development of transplant procedures of organs beginning with animal-to-animal transplants, and the evaluation of each procedure by medical and ethical boards around the world. Each step required careful consideration and debate as to whether it was legally and ethically acceptable to proceed, for all subjects living or dead, human or animal.

Illustration inspired by Phillipa Foot’s Trolley Problem

Many bioethical scenarios can be played out as a cart problem thought experiment. This is a fictional scenario where one person has the option of saving five people at risk of being hit by a cart, by hijacking the cart to kill just one person.³ Imagine any scenario and think: what should be the right decision to make? If you or your loved one were in the same scenario, would you have made the same decision?

It may just be a thought experiment at the moment, but you never know if you or your loved one might need one of these life-saving medical procedures in the future.

Want to know more about bioethics in organ transplantation? Here are some books from our collection to help you get started:

(From left to right)

  • Brandy Schillace, Mr. Humble and Dr. Butcher: An Ape-Headed, Pope’s Neuroscientist, and the Quest to Transplant the Soul (New York: Simon & Schuster, 2021) (Call No. 617.48092 SCH- [HEA]);
  • Hallam Stevens, Biotechnology and Society: An Introduction (Chicago: University of Chicago Press, 2016) (Call No. 660.6 STE);
  • Dick Teresi, The Living Dead: Organ Harvesting, Ice Water Testing, Corpse with a Beating Heart How medicine blurs the line between life and death (Knopf Doubleday, 2012)

You can also consult:

Amy Webb The Genesis Machine: Our Quest to Rewrite Life in the Age of Synthetic Biology (New York: PublicAffairs, 2022) (Call-in 572.86 WEB)

Donna Dickenson Body Shopping: The Economy Fueled by Flesh and Blood (Oxford: Oneworld, 2008) (Call No. 174.957 DIC)

Bioethics is a theme that books, movies, and TV shows also explore. by Jodi Picoult My Sister’s Keeper deals with organ donation while science fiction works such as Kazuo Ishiguro Never let Me Go and the 2005 film The Island deals with organ harvesting. The 1997 sci-fi thriller GATTACA takes place in a future dominated by eugenics while TV shows like Accommodation features a main character who constantly does ethically questionable things to save his patients.

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