As a doctor, practicing medicine for almost four decades, every day I come across the dilemma of someone willing to donate their tissue or organ to someone who needs it.
As a medical professional, there is no medical dilemma in this issue. It is clear that any willing donation of an organ by a competent adult to someone who is in need of this is acceptable as long as the procedure is medically acceptable and the risk of donation is nil or minimal.
The procedures with no risk during donation include blood donation, sperm donation, breast milk donation, and bone marrow donation. Certainly organ donation such as kidney, liver and pancreas have some risks (the kidney being the least risky), but are still medically acceptable.
An interesting debate now going on is surrogacy where in a lady rents her womb to carry someone else’s baby for nine months with certainly some risks associated with pregnancy along with the anesthetic and surgical risks of a cesarean section which may be needed in some pregnancies.
The real dilemma here is not about medical issues but about donating or renting an organ for non-altruistic reasons or in other words, commercial reasons.
A lot of debates, media space and television time have been devoted into the ethics and moral issues of organ donation and many so called organ donation scams.
Because of this, the Human Organ Transplant Act (HOTA) was promulgated by the government to control organ transplantation procedures. Interestingly, this may be the only procedure in medicine where an approval is needed by concerned authorities before it is performed even when the medical need is obvious.
Interestingly, surrogacy, which is renting one’s womb for 9 months and many a times to foreigners for commercial reasons, has not received the same kind of critical review by the press, regulatory authority, ethicists and the general public. It’s only in the last few days that the government has contemplated banning surrogacy for foreigners and regulate non-altruistic surrogacy.
Even though there is a lot of similarity between commercial organ donation and commercial surrogacy: One is to produce life and the other to gift a life, there has been very little negative publicity in the media and among the general public on surrogacy as compared to living unrelated organ donation.
Be as it may the fundamental issues that we as a society need to debate in a medically justified procedure are issues such as who should have the right to decide whether donation should be only on altruistic, moral and ethical grounds, especially when people have donated blood and sperm for commercial reasons and surrogacy, has been going on for decades.
There is no doubt that we should avoid exploitation and coercion of the weaker sections of the society and follow the law of the land in these issues. We also need to revisit the individual’s right to donate or rent an organ or tissue, whether it is for altruistic or a commercial reason in a medically acceptable procedure where the risk to the donor is nil or minimal.
But clearly there needs to be a healthy debate involving the regulators, media, ethicists, jurists, health care professionals, civic society members and patient representatives before outright condemnation and banning of non-altruistic donation.
I would certainly appreciate your views and feedback on this very sensitive and important issue which could be a life and death situation for the hundreds and thousands of patients in need of these procedures.
Dr. H Sudarshan Ballal
Chairman – MHEPL, Chairman – Medical Advisory Board
Manipal Hospitals, 98, HAL Airport Road, Bangalore-560017
Disclaimer: The views expressed in this article are of the writer and not of the hospital.