Monday, January 1, 2007

The Future of Organ Transplantation

Two recent breakthroughs in human cell research suggest that a revolution in transplantation may be on the horizon.

In August of 2005, a study funded by the UK Government, and led by researchers from Kingston University’s School of Life Sciences, disclosed that the research team had grown an artificial liver from umbilical cord stem cells. Hailed as the first step in creating a fully artificial liver for transplantation, researcher Dr. Colin McGuckin said, “the transplant of a section of liver grown from cord blood could be possible within the next 10 to 15 years.”

More recently, (April 2006), news reporting agencies documented a breakthrough in the growth of transplantable human bladders from tissue taken from recipients’ own defective bladders. The bladder cells were cultured in a nutrient bath in a laboratory, and after two months, the bladders were fully grown. Not only were the transplants successful, but the recipients were free of side effects, including tissue rejection. The Wake Forest University team of scientists are currently working on ways to grow 20 different tissues and organs.

This is surely welcomed news. For not only will these advances potentially relieve the problems of organ rejection and the immense shortage of suitable donors, but also the ethical problems surrounding the use of brain dead donors.

Those familiar with the history of brain death and organ transplantation know they share a common, and perhaps, dubious past. In 1968, when a Harvard ad hoc committee first suggested neurological tests for the condition known today as brain death, they failed to say why (biologically or philosophically) brain death should be equated with human death. Instead the committee justified brain death on pragmatic grounds, one of which was to remove the ethical problems surrounding organ donation. But if brain dead patients are not really dead, then the removal of their organs for transplantation is the direct cause of their deaths.

Despite latter attempts to construct a conceptual basis for brain death, many bioethicists continue to recognize that brain death fails to correspond to any coherent biological or philosophical conception of death. In fact, over the last 20 years or so, advances in critical care medicine continue to challenge the conceptual assumptions put forth by brain death proponents. But instead of abandoning brain death, some bioethicists are suggesting that certain neurologically diminished patients (such as PVS patients) are not really being harmed if their organs are removed for life-giving transplants, given their severe, neurologically impaired state. Such utilitarian thinking, however, would only further the problems surrounding organ donation. Instead, prudence suggests that we ought to focus our energies on more promising technologies that remove the problems of organ rejection and donor shortage, while at the same time allay much of the ethical controversy surrounding current practice.