Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Debate: Medical Ethics Series 1

Open Access Gateway

Ethical Issues in Organ Transplantation

Abouna G.M.

Author affiliations

Department of Surgery, Drexel University Medical College1, Philadelphia, Pa., USA

Corresponding Author

Prof. George M. Abouna

734 Woodcrest Road

Radnor, PA 19087 (USA)

Tel. +1 610 688 6871, Fax +1 610 964 8571

E-Mail abouna@bellatlantic.net

Related Articles for ""

Med Princ Pract 2003;12:54–69

Do you have an account?

Login Information

Contact Information

I have read the Karger Terms and Conditions and agree.


Clinical organ transplantation has been recognized as one of the most gripping medical advances of the century as it provides a way of giving the gift of life to patients with terminal failure of vital organs, which requires the participation of other fellow human beings and of society by donating organs from deceased or living individuals. The increasing incidence of vital organ failure and the inadequate supply of organs, especially from cadavers, has created a wide gap between organ supply and organ demand, which has resulted in very long waiting times to receive an organ as well as an increasing number of deaths while waiting. These events have raised many ethical, moral and societal issues regarding supply, the methods of organ allocation, the use of living donors as volunteers including minors. It has also led to the practice of organ sale by entrepreneurs for financial gains in some parts the world through exploitation of the poor, for the benefit of the wealthy. The current advances in immunology and tissue engineering and the use of animal organs, xenotransplantation, while offering very promising solutions to many of these problems, also raise additional ethical and medical issues which must be considered by the medical profession as well as society. This review deals with the ethical and moral issues generated by the current advances in organ transplantation, the problem of organ supply versus organ demand and the appropriate allocation of available organs. It deals with the risks and benefits of organ donation from living donors, the appropriate and acceptable methods to increase organ donation from the deceased through the adoption of the principle of ‘presumed consent’, the right methods of providing acceptable appreciation and compensation for the family of the deceased as well as volunteer and altruistic donors, and the duties and responsibilities of the medical profession and society to help fellow humans. The review also deals with the appropriate and ethically acceptable ways of utilizing the recent advances of stem cell transplantation from adult versus fetal donors, tissue engineering and the use of organs from animals or xenotransplantation. Data provided in support of the concept that clinical organ and tissue transplantation can be more beneficial and life saving if everyone involved in the process, including physicians and medical institutions, respect and consider the best interests of the patients, as well as honor the ethical, moral and religious values of society and are not tempted to seek personal fame or financial rewards.

© 2003 S. Karger AG, Basel


  1. Cecka JM, Trasaraki PI: Clinical Transplantation 2000. Los Angeles, UCLA Tissue Typing Lab, 2000.
  2. Cooper L, Neumann ME: Renal data statistics. Part II. The bigger picture. Nephrol News Issues 2001;15:73–77.
  3. Abouna GM: The humanitarian aspects of organ transplantation. Transpl Int 2001;14:117–123.
  4. Merrill JP, Murray JE, Harrison JH, Guild WR: Successful homotransplantation of human kidneys between identical twins. Am J Surg 1958;148:343.
  5. United Network for Organ Sharing (UNOS): Annual Report, 1999.
  6. United Network for Organ Sharing (UNOS): ‘Update’, special edition, Winter 2002.
  7. Keown P: Improving the quality of life: The new target for transplantation. Transplantation 2001;7:S67–S74.
  8. Eggers PW: Effect of transplantation on the Medicare End Stage Renal Disease Program. N Engl J Med 1998;38:223–229.
    External Resources
  9. Hunsicker LG: Survival advantage for renal transplantation. N Engl J Med 1999;341:1762–1763.
  10. Caplan AL, Coehlo OH: The Ethics of Organ Transplantation: The Current Debate. New York, Prometheus Books, 1998, pp 9–12.
  11. Jarvis R: Join the club: A modest proposal to increase availability of donor organs. J Med Ethics 1995;21:199–204.
  12. Abouna GM: Recent Pronouncements by Two Major Religions on Organ Transplantation: Current Status of Clinical Organ Transplantation. The Hague, Nijhoff, 1984, pp XI–XII.
  13. Cohen B, D’Amaro J: Some contemporary ethical consideration related to organ transplantation. Transpl Int 1995;8:238–243.
  14. United Network for Organ Sharing (UNOS): Policy of Organ Distribution. June 2001.
  15. Cerilli J: Ethical guidelines for organ procurement. Transplantation 1988,46:171–172.
  16. Evans RW: Organ transplantation and the inevitable debate as to what constitutes basic health care benefit. Clin Transpl 1993:359–391.
  17. Weinstock JL, Vice President, Gift of Life Donor Program, Philadelphia, 2002 (personal communication).
  18. Abouna GM: Marginal donors: A viable solution for organ shortage. Transplant Proc 1997;29:2759–2765.
  19. Turcotte JT, Benjamin M, Caplan AL: Patient selection criteria in organ transplantation: The critical questions. Transplant Proc 1989;21:3377–3445.
  20. Ethical considerations in the allocation of organs and other scarce medical resources among patients. Am Med Assoc Rep 49. Arch Intern Med 1995;155:29–40.
  21. Matas AJ, Delmonico FL: Transplant kidneys sooner: Discard fewer kidneys. Am J Transplant 2001;1:301–304.
  22. Gow PJ, Pillat D, Multimer D: Solid organ transplantation in patients with HIV infection. Transplantation 2001;72:177–181.
  23. The Definition of Irreversible Coma: Report of ad hoc Committee of Harvard Medical School of Definition of Brain Death. JAMA 1968;205:337.
  24. Norton DL: Clinical application of brain death protocol. J Neurosci Nurs 1992;24:354–358.
  25. Medearis DN Jr, Hommes LB: On the use of anencephalic infants as organ donors. N Engl J Med 1989;321:391–393.
  26. Abouna GM: Kidney transplantation from live donors: Benefits, possible risks and dilemmas. J Kuwait Med Assoc 1998;30:89–92.
  27. Abouna GM, Panjwani D, Kumar MS, White AG, Al-Abdulla IH, Silva OS, Samham M: The living unrelated donor: A viable alternative for renal transplantation. Transplant Proc 1988;20:802–804.
  28. Spitall A: Evolution of attitudes at US transplant centers toward kidney donation by friends and altruistic strangers. Transplantation 2000;69:1728–1731.
  29. Landolt MA, Henderson SJ, Barrable WM, Greenwood SD, McDonald MF, Soos JG, Landsberg DN: Living anonymous kidney donation: What does the public think? Transplantation 2001;71:1690–1696.
  30. Consensus Statement on the Live Organ Donors. JAMA 2000:284:2919–2926.
  31. Safety of cells, tissues and organs for transplantation: General requirements. Can Standard Assoc Bull Nov 2001;8–64.
  32. Marlago M, Broelsh CE: Living related liver transplantation. Transplant Proc 1994;26:3620–3624.
  33. Cronin D, Mills JM, Siegler M: Transplantation of liver graft from living donors into adults: Too much too soon. N Engl J Med 2001;344:1633–1637.
  34. Broering DC, Mueller L, Ganschow R, Kim JS, Achilles EG, Schafer H, Gundlach M, Fischer L, Sternech M, Hillert C, Helmke C, Izbicki JR, Burdelski M, Rogiers X: Is there still a need for living related liver transplantation in children? Ann Surg 2001;23:713–721.
    External Resources
  35. Adams MB, Nicole M, Martyh M: Living donor liver transplantation. Curr Opin Organ Transplant 2001;6:363–366.
    External Resources
  36. Singer PA, Siegler M, Whitington PF, Lantos JD, Emond JC, Thistlewaite JR, Broelsch CE: Ethics of liver transplantation with living donors. N Engl J Med 1989;321:620–622.
  37. Strong RW: Death after the living related liver transplantation. Liver Transpl 2000;6:250.
  38. Abouna GM: Emergency adult living donor liver transplantation: Is it justifiable? Transplantation 2001;71:1498–1500.
  39. Peters TG: Life or death: The issue of payment in cadaveric organ donation. JAMA 1991;265:1302–1305.
  40. Reedy KC: Should paid organ donation be banned in India: To buy or let die. Natl Med J India 1993;6:137–139.
  41. Miller DB: Ethics of paid organ donation and the use of executed prisoners as donors. Kidney Int 1999;55:733–737.
  42. Abouna GM: Moral, ethical and medical values sacrificed by commercialization in human organs; in Abouna GM, Kumar AG (eds): Organ Transplantation. Norwell, Kluwer, 1991, pp 543–545.
  43. Sheil R: Policy statement from the ethics committee from the Transplantation Society. Transplant Soc Bull 1995;3:3.
  44. Radcliffe-Richards J, Daar AS, Guttmann RD, Hoffenberg R, Kennedy I, Lock M, Sells RA, Tilney N: The case for allowing kidney sales. Lancet 1998;351:1950–1952.
  45. Cameron JS, Hoffenberg R: Ethics of organ transplantation reconsidered: Paid organ donation and the use of executed prisoners as donors. Kidney Int 1999;55:724–732.
  46. Thomas C: Living donor receive leave benefits. Transplant Chronicle 2000;7:4.
  47. Amerling R: A market for living organs revisited. Transplant News Issues 2001;2:S16–S17.
  48. Coutts MS: Fetal Tissue Research. Scope Note 21, Kennedy Institute of Ethics, March 1993.
  49. Niklason LA, Langer RL: Prospects for organ and tissue replacement. JAMA 2001;285:573–576.
  50. Gale RP: Cord blood cell transplantation: A real sleeper. N Engl J Med 1995;332:392–394.
  51. Fine A: Human fetal research: Practice, prospects and policy. Cell Transplant 1994;3:113–145.
  52. Zamir G: Gene therapy and graft mortification. Curr Opin Organ Transplant 2001;6:343.
    External Resources
  53. Fandrich F: Pre-implantation stage stem cells induce allogeneic graft acceptance with host conditioning. Nat Med 2002;8:171.
  54. Eradini S: Stem cells for all seasons? Experimental and clinical issues. JR Soc Med 2002;95:5–8.
  55. Machalinski D, Kijowski J, Marlitz W, Markiewski M, Paczkowski M, Kopkowski A, Majka M, Ostrowski M, Ratajczak MZ: Heparinized cadaveric organ as a potential source of hematopoietic cells for transplantation and gene therapy. Transplantation 2001;71:1003–1007.
  56. Bartholomew A, Sher D, Sosler S, Stock W, Lazda V, Koshy M, Devine S, van Besien K: Stem cell transplantation eliminates allo-antibody in a highly sensitized patient. Transplantation 2001;72:1653–1655.
  57. Grant D, Mendicino M, Levy G: Xenotransplantation: Just around the corner? Surgery 2001;129:243–247.
  58. Bukler L, Cooper DK: Xenotransplant: State of the art. Front Biosci 1999;4:416.
  59. Abouna GM: The use of ex-vivo xenogeneic whole liver perfusion as a bridge to liver regeneration or liver transplantation. Graft 2001;4:120–125.
  60. Abouna GM, Fisher LM, Still WJ, Hume DM: Acute hepatic coma successfully treated by extracorporeal baboon liver perfusions. BMJ 1972;1:23–25.
  61. Abouna GM: Long-term hepatic support by multi-species liver perfusion. Lancet 1970;ii:391.
  62. Levy M, et al: Liver transplant after extracorporeal hepatic support with transgenic porcine liver. Transplantation 2000;69:272.
  63. Starzl T, et al: Renal transplantation from baboon to man: Experience with six cases. Transplantation 1964;2:752.
  64. Starzl T, et al: Baboon to human transplantation. Lancet 1993;341:65.
  65. Heneine W, Tibell A, Switzer WM, Sandstrom P, et al: No evidence of infection with porcine endogenous retrovirus in recipients of porcine islet-cell xenografts. Lancet 1998;352:695–699.
  66. Patience C, Patton GS, Takeuchi Y, Weiss RA, McClure MO, Rydberg L, Breimer ME: No evidence of pig DNA or retroviral infections in patients with short-term extracorporeal connection to pig kidneys. Lancet 1998;352:699–701.
  67. Martin N, et al: Porcine endogenous retrovirus (PERV) was not transmitted from transplant porcine endothelial to baboon in-vivo. Transpl Int 1998;11:247.
  68. Platt JL: Genetic engineering for xenotransplantation. Transplant Proc 1999;3:1488.
    External Resources
  69. Institute of Medicine (IOM): Xenotransplantation, Science, Ethics and Public Policy. Washington, National Academy Press, 1996.
  70. Bishop LJ: Animal Research and Education: Ethical Issues. Scope Note 46, Kennedy Institute of Bioethics, 2001, p 3–6.
  71. United Network for Organ Sharing (UNOS): Update, Jan 2000, p 17.

Article / Publication Details

First-Page Preview
Abstract of Debate: Medical Ethics Series 1

Received: March 27, 2002
Accepted: August 07, 2002
Published online: January 30, 2003
Issue release date: January – March

Number of Print Pages: 16
Number of Figures: 1
Number of Tables: 2

ISSN: 1011-7571 (Print)
eISSN: 1423-0151 (Online)

For additional information: https://www.karger.com/MPP

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.