Akademik Veri Yönetim Sistemi
26th Congress of the European Society on Philosophy of Medicine and Healthcare, Nazerat, İsrail, 21 - 24 Ağustos 2012
26th Congress of the European Society on
Philosophy of Medicine and Healthcare, Worst Case Bioethics
Israel-Nazareth, 21-24 August 2012
“Ethics of Organ
Transplantation revisited in view of recent face and composite tissue
transplantations in Turkey”
Yesim Isil Ulman*, Alihan Gurkan**,
Nurdan Tozun***
Organ transplantation is a
life-extending and life-saving medical procedure that improves the quality of
life. By means of this high medical technology, a whole or partial organ or
cells from a deceased or living person can be transplanted into another
individual to replace the recipient’s non-functioning organ with the donor’s
functioning organ. During the last decades, the science of organ
transplantation has developed a great deal by the improvement of transplant
outcomes, by the increase of transplantable organs such as kidney, heart,
liver, lungs, pancreas that have been replaced successfully in many medical
centres over the world (1). Recent remarkable cases of composite tissue allotransplantation
for the purpose of reconstructing major portions or all of a number of severe
defects, such as the hand and facial deformity have been glimmer of hope for
many people lately (2). However, the gap between the demand for organs and the procurement
of transplant material still remains wide despite the advances in organ
transplantation technology, and organ donation is the key element of this issue
which is highly based on ethical and psychosocial factors as well as medical
and scientific ones.
Composite tissue allotransplantation is the transplantation
of composite tissue for the purpose of reconstructing major portions or all of
a number of severe defects, such as the hand and facial deformity (3). Pioneering
cases of this revolutionary technique were carried out in France (2005), China (2006)
and USA (2007-2009). Clinicians and researchers from Turkey have taken part in
the medical teams realizing experimental studies especially in United States just
from the beginning (4). This fact provided them with competence and eminence to
carry out the procedure in Turkey. The three successive allotransplantations in
the foremost medical centres in Turkey at the beginning of 2012 aroused wide attention of the medical and academic
circles by the high technology used in these pioneering transplantations. The
medical and surgical teams of these highly technological and risky practices
are hailed by the public at first by their eminence and zest. However they triggered
a broad public debate in Turkey due to the post-operative loss of one of the
patients, the sensational news at media breaching confidentiality of the patients
and their families, the infringement of the legislation per se, consequential cancellation of the transplantation licence
in one hospital.
The aim of this presentation is to deal with composite
tissue and facial transplantation regarding the recent revolutionary examples
in Turkey by dragging attention to the ethical challenges of the procedure
focusing on the issues of informed consent, confidentiality, balancing benefit
and harm, responsibility of the media and the promotion of organ donation without
missing to remunerate these major achievements from Turkey in the science of
transplantation.
Key Words: Organ transplantation, composite tissue transplantations, ethics.
References:
(1) Wright L, Ross K, Daar AS. “Organ
Transplantation” in Cambridge Textbook of
Bioethics, ed. Singer & Viens, 2009:145-152.
(2) Gordon CR et al. The world’s
experience with facial transplantation what have we learned thus far? Ann Plast Surg 2009;63: 572–578.
(3) Rohrich RJ, Longaker MT, Cunningham B.
On the Ethics of Composite Tissue Allotransplantation (Facial Transplantation,
Plastic and Reconstructive Surgery, May 2006:2071-2073.
(4) Betul G. et al. A New Composite Facial
and ScalpTransplantation Model in Rats, Plastic and Reconstructive Surgery,
2003;112( 5): 1302-1311.
* Assoc. Prof. Acibadem University School of Medicine, Dept. of Medical
History and Ethics /yesimul@yahoo.com
** Profesor, Acibadem University School of Medicine, Dept. of General
Surgery / alihan.gurkan@acibadem.edu.tr
*** Profesor, Acibadem University School of Medicine, Dept. of Internal
Diseases / nurdantozun@hotmail.com