Anatomists are regarded as custodians of cadaveric material donated to science. Almost every facet of medical science has experienced explosive advances. This has impacted directly on anatomists and their role. Increasingly, anatomists are raising concerns with regard to the treatment of human tissue (Jones,2002, Clin. Anat. 15:436-440). The Korperwelten (Bodyworlds) of Gunther von Hagens et al. (1987, Anat. Embryol. 175:411-421) has evoked considerable debate about the treatment of human cadavers. Thus far clinical anatomists have had little role to play in policy formulation, legislation, and ethical imperatives as applied to cadaveric donation for organ transplantation. Anatomists play an even more negligible role in the raging ethical controversy around live related/unrelated organ transplantation. Due to the critical international shortage of cadaveric donors, boundaries are being pushed to meet the needs of potential recipients (Ohler,2001, Prog. Transplant. 11:160-161). Constant reappraisal of these ethical and moral issues is therefore appropriate. Issues that relate to cultural and economic imperialism and pronouncements of international transplant societies may also require re-evaluation. The legislature governing the donation of human tissue in various countries is usually governed by a Human Tissue Act or its equivalent. In general, such acts are congruent with the Human Tissue Act (South Africa: Government Gazette 9, November 2001; No. 22824) that states "It is an offense to charge a fee in relation to the donation of human organs." In many countries, however, various lay press report that "the sale of body parts is now coming of age." Terms such as "rewarded gifting" and "donors" being transformed into "vendors" are opening a Pandora's Box (Nelson et al.,1993, "Financial incentives for organ donation: a report on the UNOS ethics committee payment subcommittee"). Cameron and Hoffenberg (1999, Kidney Int. 55:724-732) feel strongly that arguments in favour of the sale of organs are sufficiently cogent to warrant further discussion. Equally disturbing is the use of executed prisoners as organ donors. In the developing world there are additional socio-economic, indigenous and cultural, religious, and ethical issues to consider. In addition, strategies that are ethically sound and morally acceptable to expand the pool of living donors must keep pace with recent advances in medicine. A paradigm shift is required for anatomists to contribute to the international ethical debate, not only as custodians of the dead but also as protectors of the living. Their voices should be heard in transplantation and other forums, and contribute to the ethical debate as well as relevant evolving legislature.
In 2005, 3974 Canadians were on waiting lists for organ transplants and 275 patients died while waiting. Canada's organ shortage has led to calls for changes to Canada's organ donation system and its legal framework. Herein we examine an issue in which law reform could both increase the number of available organs and better align practice with respect for autonomy, a core value underpinning the Canadian legal system: the issue of family overrides of a valid donor consent to postmortem donation. That is, we examine what should happen when an individual consented to postmortem donation but the family would like to override that consent. First, we examine the requirements for valid donor consent. Second, we consider the legal status of family overrides of valid donor consent in relation to postmortem donation. Third, we describe the available data with regard to the practice of permitting families to override valid donor consent and discuss the possible reasons for this practice. Finally, we describe and defend the desired results with respect to law reform and describe the actions needed to realize these results.
The number of organs available for transplantation in Canada is insufficient to meet the demand, so many patients die waiting for surgery. Improving the supply of donor organs by enacting legislation is controversial. Three approaches to legislation have been suggested: required request, mandated choice, and presumed consent. Required-request legislation demands that physicians ask all families of potential donors for permission to retrieve organs. Mandated choice requires all adults to register whether they wish to be organ donors. Presumed consent allows the removal of organs without permission if no choice was registered. These laws are aimed at coercion of physicians, patients and families retrospectively, but their relative success and ethics are questionable. Facilitating the organ donation process may be a better solution.
The advent of the human genome sequence has focused research on understanding underlying genetic links to complex diseases such as cancer, asthma and heart disease. In the past few years, individual countries, such as Iceland, Estonia, Singapore and the United Kingdom, have created national databases of their citizens' DNA for comparative research. Most recently, an international consortium including Nigeria, Japan, China and the United States launched a $100 million project called the International HapMap to map the human genome according to haplotypes, blocks of DNA that contain genetic variation. Such population genetic databases present challenging ethical, social and legal issues, yet regulation of genetic information has developed sporadically, from region to region, without a consistent international standard. Without a clear understanding of the consequences of genetic research in terms of individual and community-wide discrimination and stigmatization, genetic databases raise concerns about the protection of genetic information. This Note provides a survey of the evolving landscape of population genetic databases as a legislative and public policy tool for national and international regulators. It compares different approaches to regulating the collection and use of population genetic databases in order to understand what areas of consensus are formulating a foundation for an international standard. As the first population genetics project that will span multiple countries for the collection of DNA, the International HapMap has the potential to become an influential standard for the protection of population genetic information. This Note highlights issues among the national databases and the HapMap project that raise ethical, social and legal concerns for the future and recommends further protections for both individual donors and community interests.
Organ transplant is often the only viable treatment for patients with end-stage organ failure. Until now, Icelandic legislation has required informed consent for organ donors, but a new parliamentary bill has been put forth to change the laws to presumed consent. The goal of this study was to investigate the attitude of the Icelandic population towards legislative changes to presumed consent.
Descriptive cross-sectional study using a questionnaire. The study population included all Icelanders, 18 years and older. The sample involved 1400 persons randomly selected from a Capacent Gallup mailing-list. The response rate was 63% or 880 answers.
The majority of Icelanders are in favour of the proposed legislative change (more than 80%). Women were more likely to support presumed consent than men, 85% versus 76% respectively. Younger participants were more likely to be positive towards the new law, but no significant difference was found in attitude by family income, demographics or education. Persons who knew someone close to them that had received a transplanted organ were 50% more likely to be in complete agreement with the proposed legislation. Only 5% of participants were currently registered organ donors - 29 women and 15 men.
Icelanders are very positive towards changing the law to include presumed consent in organ donation. Women and younger people tended to be more in favour and similarly those who know someone that has received donated organs. A majority of responders are willing to donate their organs, but very few are registered as donors.