Organ Transplantation andReproductive Technology

        1.Organ Transplantation

• Judaeo Christian teaching says that organ transplantation is a gift of life to someone and is a benefit but not all religious traditions would agree with this concept.
• There are limitations and issues based on consent, sources of organs , buying and selling of organs on Black Market and private contracts with the poor in other countries.
• Some would say that people have a right to a transplant, others would disagree. How do you react to these questions?

       2.The Use of Reproductive Technology

The Science of Infertility has developed beyond belief in the last 25 years. The use of Genetic knowledge in the creation and manipulation of human life is big business.                                          

Designer babies that are created with certain characteristics and physical traits are now a possibility due to the advancement of science. People with the ability to pay may now use this branch of science to produce their children.

• How do you react to this new branch of genetic knowledge to produce children?
• Is there any real difference between this science today and what Hitler's Leibensporn experiment tried to accomplish to produce a master race?
• Do people have a right to have children?
• What does Judeo-Christian Tradition teach?

Phi 1010     Language of Organ Transplants

The First Organ Transplant   Transplantation is the use of a healthy body part from a donor to be used in helping another person to live. The first transplants involved Blood Transfusions and Kidney Transplants. Chemical Rejection on the part of the recipient is always a constant issue.

Types of Transplants

Homoplastic/ Allograph –Human Being to Human Being Transplants    

There are two terms above that are used to describe this form of transplant. A body part from one human being to another human being

There are two sources for human to human transplants  

*Living person to living person

*Cadaver (dead person) to a living person

Heteroplastic/ Xenograph- Animal to Human Transplants     In this  form of transplant. A body part from an animal to a human being (Ex: certain large vessels and veins and other parts that can be used from specifically raised animals)

Judeo-Christian Tradition views transplantation as a Charitable Gift/ Sharing Life with another person who needs help to live

Some Religious Traditions reject or restrict certypes of  transplantation on the basis it is a desecration of a human body/

Through Blood is lifeforce created by God not to be shared with other bodies, according to some interpretations of the Bible or other religious literature. Ex: Shinto, Christian Science,Jehovah's Witnesses, Orthodox Judaism

The Question of the Right to a Transplant   The Transplant Debate: Do human beings have a right to a transplant regardless of their ability to pay?

The Principle of Totality  I may not give up more bodily parts than I need to live. May not sacrifice my life even with good intention.

Judeo-Christian Tradition / Respect for the Dead  The bodies of the dead should be respectfully buried according to religious custom when the use of the body is over. This would include those who have donated their bodies for medical school training of doctors.

Proper Burial after Donation is a sign of respect since the body contained the LIFEFORCE and THE SPIRIT OF GOD(SOUL) of the person during their life.The boby is holy and should be respected after death.

Issues in Transplantation: Age, Cost, Sources of Organs Used in Transplantation (legal and illegal)sources

The National Organ Bank System (United States)   In this country, organ transplantation is highly regulated. If a person is determined to need a transplant they are put on a national list with other patients. When organs become available the first criteria to be considered is the Chemical Match of the patient and donor. Other considerations are age, general health, and chronic conditions of recipient. The first issue in transplantation on the part of the recipient is always the CHEMICAL MATCH with the donor's body. If the match is too remote,there can be total rejection. You also have the issue of the ability of the donor and recipient to withstand the rigor of the surgery. Whether the recipient has other serious medical conditions that could hinder the outcome for a successful transplantation.

Organ Selling vs Organ Donation Issue ( Pro and Con) There are some who would argue that people everywhere should be able to sell their organs for money. Donation is no longer realistic, there are more patients who need organs than there are people to donate. Paying money might be a motivation to supply more organs. There is a Black Market of Organ Selling in some countries. The rich who are able to pay can often procure organs from the poor in other countries. They have the ability to bypass the National Organ Bank System in America. Some countries have even built new facilities to allow such trade to occur. Many times the health of the poor donor is compromised  because of the lack of care for them post surgery. (Watch video on this situation)

Note: If a patient has a relative or a friend who is willing to donate an organ to them and there is a chemical match the National Organ Bank System is avoided

Topic: Organ Transplantation READINGS: Medical Ethics by O'Boyle  pg 249 Organ Transplantation / Chapter 13 in Shannon Text (Third edition) Chapter 15 in (Fourth edition)  To Locate Catechism reading you may click on the site below #2288-2301, pp.551-553 .Beginning with Respect for the Dignity of Persons through Respect for the Dead. http://www.vatican.va/archive/ENG0015/__P80.HTM 4 Videos: ( 2 on Youtube and two on links below) The Gift of Life/The Mayo Clinichttp://abcnews.go.com/Nightline/video/inside-mayo-clinic-organ-transplant-unit-gift-life- 19593011 The Organ Tradehttps://www.youtube.com/watch?v=wSTBpkaDzAg  

GENETICS The genetic revolution is changing the very nature of medicine. Advances in genetics have opened the possibility for the selection of embryos based on their genetic makeup through preimplantation genetic diagnosis (PGD) and prenatal genetic testing (PGT), as well as the altering of genes through gene therapy for the treatment of disease and the still future potential for possible human enhancement. Genetic medicine is changing how we view behavior and personal responsibility, the gift of children, and the identity and nature of human beings. Issues from this growing area of inquiry include among others adverse diagnosis and genetic counseling, privacy considerations, gene patenting, biobanking, personalized or precision medicine, genetic discrimination, and gene therapy.

REPRODUCTION TECHNOLOGY Reproductive ethics is concerned with the ethics surrounding human reproduction and beginning-of-life issues such as contraception, assisted reproductive technologies (e.g., in vitro fertilization, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ISCI), etc.), surrogacy, and preimplantation genetic diagnosis. Ethical issues specific to this field include among other concerns the introduction of technology into the reproductive process, distinctions between reproduction and procreation, the potential for abortifacient effects through the use of certain contraceptives, embryo & oocyte cryopreservation, embryo adoption & donation, uterus transplants, mitochondrial replacement/donation interventions; synthetic gametes, the exploitation and commodification of women for reproductive services (i.e., egg donation and surrogacy), and sex selection of embryos or fetuses

An Ethical Perspective on Reproductive Technologies

Daniel S. McConchieReproductive Ethics

The inability to have a child is a true burden. Would-be parents often ask both God and themselves why their innate desire to have children continues to be unfulfilled. This kind of self examination reflects how deeply emotional and traumatic infertility can be. Sometimes a couple may even keep the situation secretive to avoid embarrassing themselves in front of family and/or friends.

Sadly, this response only serves to heighten the pain that many couples experiencing infertility feel. 15 % of couples in the United States cannot have children after one year of sexual relations. As a result, clinics specializing in aiding the reproductive process have sprung up all over the country. Couples spend many thousands of dollars to increase their chances of having a child.

There are several reproductive technologies which are currently in use, including fertility drugs, artificial insemination, in vitro fertilization (IVF), use of a surrogate mother, gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and intracytoplasmic sperm injection (ICSI). Although these technologies are all different from each other, they all raise certain ethical issues which should concern anyone considering them. The issues as developed here should be nuanced by the fuller explanations in the book Sexuality and Reproductive Technology.

Care of Multiple Embryos

A crucial issue in reproductive technologies is the safety of the embryos whether they are inside of a mother's body or in a laboratory. Because human life begins at conception, all embryos should be treated with the utmost care. For example:

1. A couple using IVF should decide ahead of time how many embryos to implant and attempt to create only that number of embryos. If more than the ideal number of embyros are created, the extras may be implanted with the others or frozen (to be implanted later)–whichever option poses less risk to the lives of the mother and embryos. No embryos should ever be discarded.
2. Only a limited number of embryos should be implanted following in vitro fertilization. Such an approach will decrease the chance that too many embryos will implant, thereby risking the lives of all the embryos and/or the mother.
3. A couple considering fertility drugs should research the options carefully. Some drugs may cause multiple eggs to mature rather than merely putting the body back into a normal, healthy, fertile state. Potentially harmful multiple pregnancies can result. One drug, clomiphene citrate, does not carry the risk of multiple pregnancies that some of the other fertility drugs now available do. Also, the multiple pregnancy risk can be minimized with the use of ultrasound to monitor the maturing egg(s). With monitoring, multiple pregnancies can be avoided.
4. Selective reduction (abortion of some implanted, developing embryos so the others have a better chance to survive) is not an ethical option. However, selective reduction should not be necessary if an appropriate number of embryos are implanted in the first place.
5. A couple should only consider implantation procedures whose percentage of success is equal to or greater than that of unassisted natural implantation. Otherwise, embryos are being placed at greater risk than is normally the case in human reproduction.

Use of Donor Eggs/Sperm

It is not advisable to use donor eggs and/or sperm in any reproductive technologies for a variety of reasons:

1. Who are the parents? Are they the ones whose genetic material (sperm and egg) combine to form the child or the people who raise the child? This question might be a simple one for the parents caring for the child, but how simple is that question from the viewpoint of the child? Sometimes, legal battles even result between the sets of parents involved in one child's life.
2. Should children know that one or both of his or her (rearing) parents did not provide the egg or sperm which brought them into being? Should children have access to the donor(s) (genetic parents)? Should genetic parents have visitation rights?
3. A distinctive imbalance may be introduced into a marriage where donor eggs or sperm are used in place of one parents eggs or sperm. There is the possibility of resentment from the partner whose eggs or sperm were not used. ("You take care of her! She's your child.") Accusations of unfaithfulness can result because, in a real, genetic sense, one of the spouses has had a child with another person. Emotional attachment to the "mystery person" can also develop in the spouse who genetically had the child with the donor.
4. These and other difficulties flow from violating the "one flesh" model of marriage in Scripture, in which children are literally to be the result of the two married parents (and their eggs and sperm) becoming "one flesh".

Surrogate Motherhood

The most common form of surrogacy involves inseminating the surrogate with the husband's sperm–generally because the wife cannot carry a child through pregnancy. Such an arrangement should be avoided because a donor egg is involved, as explained above. Even when a donor egg is not involved–e.g., when the husband's sperm and wife's egg are joined in vitro–the bonding problems discussed below generally make such an agreement unwise. Particularly problematic are commercial arrangements in which surrogates receive payment for producing a child beyond expenses they incur. Like the selling of organs, such arrangements wrongly commercialize the body. In fact, financial contracts essentially entail the purchasing of the baby and imply an unacceptable form of ownership of human beings. Less problematic are altruistic surrogacies such as rescue surrogacies where a woman acts to save an embryo that would otherwise be destroyed.

Bonding

Whenever donor eggs/sperm or a surrogate are used, the question of bonding can affect all parties involved. Bonds can develop between child and genetic parent(s), between surrogate mother and child, and between the genetic parents. The risk that inappropriate bonds will be created through the reproductive process is very real and can cause many problems. On many occasions, surrogate mothers have sued the genetic parents for custody after the baby was born or for the right to abort a malformed fetus even though the genetic parents wanted the child to live.

Financial Implications

Undergoing reproductive treatments is very costly. In vitro fertilization costs between $10,000 and $20,000. Surrogacy can cost between $20,000 and $40,000. And these treatments do not guarantee that a child will result. In fact, clinics average only 20-40% live birth success rates. However, these success rates are most likely this high due to the implantation of multiple embryos and selective abortion which is very problematic ethically. Following ethical guidelines that protect human life from conception would probably make the percentage much lower.

Prudence

One serious consideration should be the prudence of seeking to have a child with reproductive technologies when the costs and/or risks are so great. There are two primary concerns:

1. The money could go towards meeting another great need. It can be difficult to imagine anything more important than the creation of life. However, we also have a responsibility to be concerned about those people already in the world today. There are people in many parts of the world without adequate medical care. For example, it costs just pennies per person to inoculate them against many of the world's greatest killers.
2. Adopting a child is often an option for people to consider. It's true that it is difficult to adopt in some countries, but international adoption is gaining popularity because of the number of orphaned children and speed with which the adoption process can often be completed. There are many children in the world in need of a home. In Cambodia, many children have been orphaned through years of war. In China where the government allows parents to have only one child, many female babies are left with orphanages by parents who want a boy. In Bulgaria, a reported average of 90% of the many children in orphanages will become criminals unless they are adopted. Those who are able should investigate the possibility of international adoption before ruling it out.

Many people experience a very natural urge to be parents. Some are seeking to satisfy this urge using reproductive technologies without fully understanding all their implications. Before using technological methods of reproduction, it is wise to study in-depth the available options, understand the ethical issues involved, and above all, seek the will of God before moving ahead.

STEM CELLS  Stem cell research has been touted as a highly promising avenue for the treatment of disease and injury. Embryonic stem cells (ESC) have the ability to differentiate into the more than 200 different cell types in the human body. While these controversial cells have been promoted as more promising for the treatment of disease, this research involves the destruction of embryos, and thus makes it unethical from CBHD's perspective. Furthermore, despite all of the early claims of potential ESC research has faced significant technical hurdles. Adult stem cells are found in several human tissues (e.g., bone marrow and umbilical cord blood), and in contrast to embryonic stem cells do not raise the same kind of moral concerns and have provided a number of successful treatments and therapies. Recent advances in this field also include the discovery and development of induced pluripotent stem cells (iPS or iPSCs) and direct cell reprogramming, both of which hold significant promise for the understanding and treatment of disease and avoid the ethical concerns of embryonic stem cell research raised by the destruction of human embryos. Other ethical considerations regarding stem cell research include the potential use of human pluripotent stem cells in animals as well as the potential creation of human gametes or embryos from stem cells. Stem cell research falls under the broader category of biotechnology.   

No matter how a human being comes into existence, he or she is always a person to be loved. We should always try, however, to act in ways which respect human dignity from the very first moment of a human being’s existence. Some forms of reproductive technology (RT) fail to show adequate respect for the value of human life and the meaning of procreation.

The Church teaches that ethically acceptable forms of reproductive technology respect:

1. The dignity of newly conceived human life. The human being is to be respected and cared for as a person from the first moment of his or her existence. Forms of RT which involve a willingness to expend or harm human life by discarding, freezing or subjecting embryos to excessive risk are morally unacceptable.

2. The dignity of human life in its transmission (procreation.) Human life should only be generated in and through acts of sexual intercourse between a husband and wife.

The human person must be accepted in his parents’ act of union and love; the generation of a child must therefore be the fruit of that mutual self giving which is realized in the conjugal act wherein the spouses cooperate as servants and not as masters in the work of the Creator who is Love. (Donum Vitae II,B, 4, 7)

Because of the inestimable value of the human person, technology should never dominate over our origin. The conception of a child should be the result of a marital act of self-giving love. Every human being must be accepted as a gift and blessing and not as a product of direct human control and the third party intervention of doctors and technicians.

The Church is particularly concerned about forms of RT which use donor sperm or eggs. This is held to be contrary to the unity of marriage, to the dignity of the spouses, to the vocation of parents, and to the child’s right to be conceived and brought into the world in marriage and from marriage. (Donum Vitae II, A. 2.)

Forms of RT which replace or substitute for the role of the marital act (e.g. artificial insemination and in vitro fertilization), even if the sperm and egg have come from a husband and wife, fail to show proper respect for the dignity of procreation and human life. However forms of RT which assist or help an act of intercourse to achieve its purpose may be morally permissible (e.g. treatment of underlying causes of infertility; low tubal ovum transfer; and possibly GIFT).

Appreciative of the suffering caused by infertility, the Church commends medical research and practices that, while safe-guarding the dignity of human life and procreation, work to prevent and treat fertility problems. The Church also reminds childless couples that their married life still remains a gift to the Church and provides them with many opportunities to serve human life. 

Catechism of the Catholic Church III. THE LOVE OF HUSBAND AND WIFE2360 Sexuality is ordered to the conjugal love of man and woman. In marriage the physical intimacy of the spouses becomes a sign and pledge of spiritual communion. Marriage bonds between baptized persons are sanctified by the sacrament. 2361 "Sexuality, by means of which man and woman give themselves to one another through the acts which are proper and exclusive to spouses, is not simply something biological, but concerns the innermost being of the human person as such. It is realized in a truly human way only if it is an integral part of the love by which a man and woman commit themselves totally to one another until death." 143 2362 "The acts in marriage by which the intimate and chaste union of the spouses takes place are noble and honorable; the truly human performance of these acts fosters the self-giving they signify and enriches the spouses in joy and gratitude." 145 Sexuality is a source of joy and pleasure: The Creator himself . . . established that in the [generative] function, spouses should experience pleasure and enjoyment of body and spirit. Therefore, the spouses do nothing evil in seeking this pleasure and enjoyment. They accept what the Creator has intended for them. At the same time, spouses should know how to keep themselves within the limits of just moderation. 1462363 The spouses' union achieves the twofold end of marriage: the good of the spouses themselves and the transmission of life. These two meanings or values of marriage cannot be separated without altering the couple's spiritual life and compromising the goods of marriage and the future of the family. The conjugal love of man and woman thus stands under the twofold obligation of fidelity and fecundity. Conjugal fidelity2364 The married couple forms "the intimate partnership of life and love established by the Creator and governed by his laws; it is rooted in the conjugal covenant, that is, in their irrevocable personal consent." 147 Both give themselves definitively and totally to one another. They are no longer two; from now on they form one flesh. The covenant they freely contracted imposes on the spouses the obligation to preserve it as unique and indissoluble. 148 "What therefore God has joined together, let not man put asunder." 149 2365 Fidelity expresses constancy in keeping one's given word. God is faithful. The Sacrament of Matrimony enables man and woman to enter into Christ's fidelity for his Church. Through conjugal love, they bear witness to this mystery before the world. 2367 Called to give life, spouses share in the creative power and fatherhood of God. 154 "Married couples should regard it as their proper mission to transmit human life and to educate their children; they should realize that they are thereby cooperating with the love of God the Creator and are, in a certain sense, its interpreters. They will fulfill this duty with a sense of human and Christian responsibility." 155 2368 A particular aspect of this responsibility concerns the regulation of procreation. For just reasons, spouses may wish to space the births of their children. It is their duty to make certain that their desire is not motivated by selfishness but is in conformity with the generosity appropriate to responsible parenthood. Moreover, they should conform their behavior to the objective criteria of morality: 2369 "By safeguarding both these essential aspects, the unitive and the procreative, the conjugal act preserves in its fullness the sense of true mutual love and its orientation toward man's exalted vocation to parenthood." 157 The gift of a child 2375 Research aimed at reducing human sterility is to be encouraged, on condition that it is placed "at the service of the human person, of his inalienable rights, and his true and integral good according to the design and will of God." 166 2376 Techniques that entail the dissociation of husband and wife, by the intrusion of a person other than the couple (donation of sperm or ovum, surrogate uterus), are gravely immoral. These techniques (heterologous artificial insemination and fertilization) infringe the child's right to be born of a father and mother known to him and bound to each other by marriage. They betray the spouses' "right to become a father and a mother only through each other." 167 2377 Techniques involving only the married couple (homologous artificial insemination and fertilization) are perhaps less reprehensible, yet remain morally unacceptable. They dissociate the sexual act from the procreative act. The act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that "entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children." 168 "Under the moral aspect procreation is deprived of its proper perfection when it is not willed as the fruit of the conjugal act, that is to say, of the specific act of the spouses' union …. Only respect for the link between the meanings of the conjugal act and respect for the unity of the human being make possible procreation in conformity with the dignity of the person." 169 2378 A child is not something owed to one, but is a gift. The "supreme gift of marriage" is a human person. A child may not be considered a piece of property, an idea to which an alleged "right to a child" would lead. In this area, only the child possesses genuine rights: the right "to be the fruit of the specific act of the conjugal love of his parents," and "the right to be respected as a person from the moment of his conception." 170