This transcript has been edited for clarity.
Hello. I'm Art Caplan. I am in the Department of Medical Ethics at New York University Grossman School of Medicine in New York City.
A friend of mine, a very experienced and respected surgeon, recently shared with me an organ donation request he had received via email. Just read the request. It says, “Hello, I was wondering if you guys needed my left hand for a patient who needs a limb transplant. I saw it.” [organdonor.gov] They were looking for an upper limb donation. ”
This means hands and arms. There's definitely a list that surgeons keep when they're looking for a cadaveric donor for a patient, and for things like arms that aren't emergencies, they create a list and look for matches, sizes, things. You can say that. ethnicity, race, skin color, age, etc.
The inquiry basically said that I had done some research and knew that I would have to donate my entire left hand and a significant portion of my arm. This is fine.
Perhaps strange as it may seem, this question arises as transplants begin to move into new areas of transplantation, sometimes referred to as vascularized composite allografts. I've seen things like this on the news. This includes the face, hands, limbs, eyes, and even the uterus. What should our policy be in this country regarding the acceptance of living volunteers for this new set of organ transplants?
Face and hands are still considered experimental, so you don't need to worry too much about this. There isn't much demand for these surgeries yet, as surgeons and transplant teams are still trying to figure out the cause. immunosuppression And how to do microsurgery, how to try to regrow nerves and see if things work. We are still collecting evidence that way.
The number of trials is small. I would like to add that this kind of procedure is very expensive. A face or hand transplant can cost millions of dollars. Traditional transplants, such as kidneys, livers, and lungs, on the other hand, require living donors.
Indeed, in the case of kidneys, the majority of kidney transplants in the United States today are done not from cadavers, but from people who are actually living donors. We have allowed people, especially children, to donate their lung lobes. There are examples of people donating part of their liver and actually regenerating it as a life source after the donation.
There are great benefits to donating during your lifetime. One is to co-locate the donor and recipient. This is not an emergency surgery. Everything can be planned. The team can rest. You can be sure that no one is getting sick.
When cadaver organs become available, it becomes a kind of crisis surgery. Everyone has to go to the hospital. I hope you're not overly tired or have an infection that makes it too dangerous to proceed with that day. influenzaCOVID-19, or things like surgical teams.
The blood bank is ready. If you think you will need to donate blood, please donate in advance. If the source is a living donor, we are set up to do this in an organized manner. Living donors also have the ability to choose recipients. We allow that, but that's not possible with cadaver donation, where there's a distribution system.
If you want to put your loved one on the waiting list, you can specify who would like to receive it. In a way, it motivates people to donate to earn a living. There is also the reality that living gifts within a family may result in a better biological match. All existing forms of transplantation provide better results than cadaveric donation.
If someone sends in a request and says, “I'd like to donate my arm,” what's the problem? Obviously, ability comes first and foremost. Is this person mentally superior? Is he mentally ill? do they know what they are doing? How can we accept a gift that would render someone dysfunctional and severely incapable of doing much in the world by becoming one-handed?
Even in a world where limb and hand transplants are established and even more common as treatments, I doubt it will be easy for everyone to pass a competency test. Perhaps most likely it will be a family member of someone who wants to donate a limb to a sibling or child. Maybe we can better understand why they choose to help in this way.
If you think about it more carefully, if someone were to become terminally ill and want to donate their arm because they knew they were going to die, we would accept a living donor. If you know you'll get better results when you're alive, you may not want to wait. Why not do it before they die?
Some states also have medical assistance in dying, so people know to plan for their death. Would we allow someone to donate a living hand, limb, or even a womb or eye or anything else?
Again, even at the end of life, before we fight our own illness, we need to improve our functional abilities, such as the ability to sit up, eat, or undergo major surgery. I think we're going to find ourselves in a very difficult situation where there may be people who need it. A disease that threatens your own life. Even if someone is an elderly person and says, “I don't care, I want to do this. I'd rather my child or adult child take this limb,” you still make them worse off. Masu.
I think the combination of capabilities will eliminate most of the surprise calls like the one my surgeon friend had. Within the family, one might consider situations in which something much more distant could be allowed, such as a donation of a limb or hand. Even there, we need to assess capacity, coercion, and what it means to render someone incapacitated and subject to extensive, crippling treatment. Even if it benefits someone else and that benefit is valuable to that person. People who want to donate.
I'm pretty skeptical that society can tolerate the situation with our limbs and eyes.
I'm Art Caplan of the Department of Medical Ethics at New York University Grossman School of Medicine. Thanks for watching.
