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Discussion on Organ Transplantation

Gupta: There were some very important issues in organ transplantation and selling in this session. It raises important ethical and social issues.

Sohn: I am from Korea and the first paper is by Prof. de Castro. Are there any questions for?

Daniels: I am from New Zealand. Thanks Leonardo for an interesting and provocative paper. I look forward to seeing more in a later edition of this paper. But the point I wanted to raise is that I am intrigued by the fact that you raised the issue of the language that we use. And you highlighted commodification and commercialization. Do you think that these are negative terms, which give a particular orientation to the whole way we think about this topic? I wonder if you also thought about the fact that when we use the word "donor" we are doing quite the opposite. That for example, in my society, a donor is somebody who donated, who provided something as an altruistic gift. So if we don't look at language, if we both look at the negative and the positive, I would suggest that we really go too far to call people who receive money donors.

de Castro: I am quite well aware of that objection. However, I think that an organ donor and I insist on using the word "donor" even for someone who receives money, ought to be recognized as a donor because it is much more than the material organ that the donor gives away. I insist that it is not a commodity when the kidney is given away. The donor does not only give a material organ, he gives part of himself, not in a literal sense but in a figurative sense. Because in doing so, he undertakes risks, he gives a part of not just his body but part of his life. That is something not adequately compensated by money; it cannot diminish the value of his contribution. It doesn't mean that if he receives money, he is no longer a donor. I would just like to point out that even donors to universities, donors who give contributions to universities, receive something in return; and yet we still call them donors. Rarely does a donor just give something away without expecting anything in return.

Sohn: Thank you. We'll move to the next topic. Are there any questions for Dr. Bagheri?

Leavitt: I have two comments. My first question is that given there have been a number of journals and review articles about continuous brain functions after patients were declared brain dead. I think that the more serious question would be whether brain death is really death. My second comment, excuse me for saying something, which might be a little bit radical. However coming to an Asian bioethics meeting, I was looking forward to hearing more Asian ideas and culture. Sometimes I get the feeling, not just in your talk but also in many other talks, that the purpose of Asian bioethics is to try to make Asian medicine more Western. How much autonomy is there? How much organ donation should someone agree to? I heard some remarks from a Japanese physician in Tsukuba a couple of years ago that linked the background of Shinto to the reluctance to donate hearts; the belief that when the blood is flowing the person is still alive; and the belief that when organs are taken from a supposedly brain dead person there is a violence to the person that has an effect to the soul. I don't know what is true or false. I don't want to judge this. But the advantage of hearing more is maybe we should respect more the Asian culture. Because maybe there are deep truths there that we haven't investigated deeply. That's my comment.

Bagheri: My presentation is talking about the conflict between Japanese culture and the law. I think Japanese law has an over-emphasized the a Japanese approach to the authority of the family. When a person, an individual is competent, but when this patient becomes incompetent as in when he is in a brain-dead state, the family can not make a substitute judgment. They cannot be authoritative decision-makers. It seems to me that this is not based on Japanese culture. We are talking about Asian culture. But it seems to me the law has exaggerated this culture maybe because of the 30 year debate on brain death. And it pushed policy maker to choose very restrictive regulations for organ transplants.

Hamano: I don't agree with his interpretation on organ transplants. I don't agree with his views about the authority of the family being a particularly Japanese or Asian value. But because the doctors tend to compromise one issue is that families are often damaged by the behaviour of doctors.

Bagheri: Japanese culture has affected Japanese law. And of course, Japanese law will affect Japanese culture. But that law on organ transplantation was not ratified to ban organ transplants but to promote them. However the very restrictive regulation is not going to promote organ transplantation.

Sohn: Korea also passed the Organ Donation Act in 1999. And we have similar difficulties as in Japan, of decrease in transplants after the law. It may be revised next year, like in Japan.

Gupta: The next paper is by Dr. Kwon from Korea. Are there any questions for Dr. Kwon?

Leavitt: I would just like to make a brief question about something you said. I wrote one sentence down and I think I agree with you, "The organs should be procured from a living donor, like in brain death." Does this mean that you think that a brain dead person is not dead?

Kwon: In this place I wanted to look at the differences between different organs, like cornea, bone marrow, tissues from organ, cord blood. Sometimes it is not easy to appreciate the tissues and cells and organs.

Awaya: My name is Tsuyoshi Awaya from Okayama University, Japan. Do you know of a company called CryoLife in the United States. They sell tendon, bone marrow, heart valves etc, everything. I did research in the United States and wrote a book about this in 1999 wherein I elucidated this issue. We should share this type of information. There is a Chinese version of the book and an English one will soon be made available.

Kwon: It is like a supermarket in organs.

Awaya: Yes, and it involves many countries.

Gupta: Thank you, and the next paper is by Lei Ruiping. Are there any questions?

Doering: I would like to congratulate you on this brilliant analysis that you gave. I would like to ask you some more specific information, which might help us to put this into context in the social debate. In Germany and other European countries, we have a very emotional argument in this context that people don't want to receive organs from corpses because they fear becoming like this. People were afraid to become like pigs. In that sense there is more than a biological argument in that. What is the social situation?

Lei: The social services are also different in each country. As for China, this question is not in a Confucian framework. Some ideas place nature in balance with human beings, related to Taoism. As we know Chinese people think humans are in balance with nature and dignity of human beings is tied to that. Emotionally, most Chinese people will accept this kind of treatment. There is some value also in suffering. We can obtain something valuable from nature when our life is threatened.

Macer: You said the multi-national companies and media are promoting xenotransplants in China? Which has been the most influential? And which has the media been open?

Lei: I think Chinese media is interested because xenotranplantation is a totally new field in China. Three or four universities are carrying out studies. The media is interested because it's just the beginning. The public, including the media, and reporters are not well informed. The scientists just focus on the technical questions like how to overcome rejection and how to get immunosuppressive medication.

Dua: What are the success rate of organ transplantation in China, and the global percentage?

Lei: We are just starting in China. We are not yet in the clinical trial stage. They are using animal models for organ transplantation in universities. It is still a preliminary stage so we cannot say any percentage yet.

Dua: For general information, there was a pig heart organ transplant operation in India. And the patient died after a few hours. People therefore are afraid of it.

Sohn: I think it's time to close our session.

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