Organ Donation — Or Why Bioethics Should Matter to You

Just because you can do something, does it mean you should? Advancements in medical technology can raise difficult ethical questions. Librarian Kevin Seet studies some of the moral issues that arise from biomedical research.

Consider the following scenario: You have a sick child who will die unless he or she consistently receives compatible donations of blood, stem cells or organs. Would you conceive another child to provide a source for these donations?

Or imagine if you lived in a world where your DNA information about your possible genetic disorders and health risks had to be disclosed to your employer. Would you consent to routine DNA testing for your job?

This is what Bioethics is all about.

Whenever there is an intersection between medicine, science, technology and our human bodies, questions arise about what is right or wrong, and what should or should not be done. The discussions surrounding these ideas form the study of Bioethics – the ethical implications and applications of health-related life sciences.

An illustration of an ethical thought-experiment: The Trolley problem, first conceptualised by philosopher Philippa Foot.¹

Bioethics covers a wide range of topics, but let’s focus on something less abstract and more relatable: organ donation.

For some of us, organ donation is just a medical procedure we hope we will never need. However, for those who need it to save their own or someone else’s life, there are many serious questions to consider.

Organ donation – particularly for living donors – forces doctors and surgeons to weigh the costs and benefits for everyone involved. A dying patient or a potential donor must also consider the many options and possible effects (operation risks, post-op care/complications).

All these are made even more complex if familial relationships are involved (are you obligated to donate your organs to a family member who needs it?)

Local newspapers laud organ donations between family members, made possible through medical advances. Cheong, Kash. “Procedure lets father give son new lease of life,” 29 November 2014, Straits Times, 15 (From NewspaperSG)
Poon, Chian Hui., “Siblings overcome the odds to carry out transplant op,” 18 November 2013, Straits Times, B1 (From NewspaperSG)
Pierre donates half his liver,” 8 May 2002, Today, 2. (From NewspaperSG)

On 16 July 1987, the Human Organ Transplant Act (HOTA) was passed in Singapore to allow the removal of healthy kidneys from those involved in fatal accidents (unless they had opted out of the scheme). This was to alleviate the shortage of donor kidneys for patients with kidney failure.

HOTA was extended in July 2004 to include the liver, heart and cornea, as well as organ harvesting from those who had died from unrelated medical conditions. The Act was also expanded to govern living donors – people donating organ parts (e.g. a kidney or a liver section) while alive to others who need it.

The months leading up to the Amendment to the Act saw a series of newspaper articles published to debunk myths on organ donations. There were also talk shows on national television addressing public queries, encompassing both social and personal anxieties.

The Human Organ Transplant Act in 1987 and 2004. Organ transplant Act to take effect next week,” 7 July 1987, Straits Times, 1.; “Page 2 Advertisements Column 1,” 29 March 2004, Today, 2. (From NewspaperSG)

Some people were worried that the amended Act meant all the organs in their bodies would be harvested upon death (not true; the act only covers the kidneys, heart, liver and corneas). Others were concerned that their own medical care might be compromised in order to “speed up” organ harvesting. (Doctors have to treat all patients without considering their suitability for organ harvesting).

Another concern was that brain-dead patients could still regain consciousness, and thus should not have their organs harvested. (Brain-death, however, is complete and irreversible. This is not to be confused with being in a coma.)

Things get more complicated when bio-engineering comes into the picture. In October 2021, a kidney from a genetically modified pig was successfully transplanted into a brain-dead patient (with the family’s consent), where it functioned normally in place of a human kidney with no organ rejection during the 54 hours that the study lasted.²

Was your initial reaction more “Ew! Is this even alright to do?” or was it more “This makes it easier to save lives”? These are bioethical questions indeed.

The kidney transplant procedure was the result of decades of scientific and medical research experiments, including the use of the genetic engineering tool CRISPR (short for Clustered Regularly Interspaced Short Palindromic Repeats), the development of organ transplantation procedures beginning with animal-animal transplants, and the evaluation of every procedure by medical and ethical boards all over the world. Each step required intense scrutiny and debate over whether it was legally and ethically acceptable to proceed, for all subjects living or dead, human or animal.

Illustration inspired by Phillipa Foot’s Trolley Problem

Many bioethical scenarios can be played out in the form of a trolley-problem thought experiment. This is a fictional scenario in which a person has the choice to save five people in danger of being hit by a trolley, by diverting the trolley to kill just one person.³ Imagine any scenario and consider: What should be the right decision to make? If you or your loved one were in the same scenario, would you have made the same decision?

It may well be just a thought experiment for now, but you never know if you or your loved one might need one of these life-saving medical procedures in the future.

Keen to find out more about bioethics in organ transplantation? Here are some books in our collection to get you started:

(From left to right)

You can also check out:

· Amy Webb, The Genesis Machine: Our quest to rewrite life in the age of synthetic biology (New York: PublicAffairs, 2022) (Call no. 572.86 WEB)

· Donna Dickenson, Body Shopping: The economy fuelled by flesh and blood (Oxford: Oneworld, 2008) (Call no. 174.957 DIC)

Bioethics is a theme that books, movies and TV shows explore as well. Jodi Picoult’s My Sister’s Keeper deals with organ donation while sci-fi works such as Kazuo Ishiguro’s Never Let Me Go and the 2005 movie The Island deals with organ harvesting. The 1997 sci-fi thriller Gattaca takes place in a future dominated by eugenics while TV shows like House features a lead character who constantly does ethically questionable things to save his patients.

The National Library has a new Bioethics Resource Corner at Level 7 with specially curated physical and digital collections that might interest you. This corner is a collaboration between NLB and the Bioethics Advisory Committee, supported by the Ministry of Health.

Kevin Seet is a librarian overseeing the Business, Science and Technology Collections at the Lee Kong Chian Reference Library. His responsibilities include managing this collection, developing content and providing reference and research services.

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[1] Duignan, Brian. “Trolley Problem”. Encyclopedia Britannica, July 21, 2022. https://www.britannica.com/topic/trolley-problem

[2] Nancy Lapid, “U.S. Surgeons successfully test pig kidney transplant in human patient,” Reuters, published 21 October 2021, https://www.reuters.com/business/healthcare-pharmaceuticals/us-surgeons-successfully-test-pig-kidney-transplant-human-patient-2021-10-19/.

[3] “What is the ’Trolley Problem’?” Merriam-Webster. Accessed July 25, 2022. https://www.merriam-webster.com/words-at-play/trolley-problem-moral-philosophy-ethics

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