Lenin De Janon Quevedo - Argentina -Wednesday 30 - Oral Presentations Misc. A
- 1. “ ALTRUISTIC SOLIDARITY” IS A DONOR’S VALUE THAT DOES NOT IMPOSE RECIPROCAL REQUIREMENTS ON RECIPIENT IN PROCUREMENT AND ALLOCATION OF ORGANS FOR TRANSPLANT Author: LENIN DE JANON QUEVEDO, MD.
- 2. INTRODUCTION & OBJECTIVES The problem of organ availability is dramatically practical. Organ offers are not enough for actual needs. Altruism has been the basis in cadaveric donation, but some scholars believe it is wrong to keep it as mandatory. A model based on solidarity, understood as reciprocal duties and obligations (RDO) is suggested to increase donations and contribute to justice in allocations. The objectives of this study are: To compare altruism and solidarity between the classical (Aristotelian) theory and analysis offered by Principialism (PRC). To consider potential scope of RDO approach for allocation purposes.
- 3. MATERIALS & METHODS Library and internet searches using the keywords: altruism, solidarity, organ donation, organ allocation, organ transplantation, medical ethics, ethics of principles, aristotelism and thomism. Review and analysis of specific medical literature over the past 15 years. Deeply review and analysis of international declarations on ethics of organ transplantation: International Code of Medical Ethics (CME) of World Medical Association (57 th General Assembly, 2006), Statement on Human Organ Donation and Transplantation (SHODT) of World Medical Association (57 th General Assembly, 2006) and World Health Organization Guiding Principles on Human Cell, Tissue and Organ Transplantation (WHO-GP) (1991, revised 2009). Selection of 42 bibliographical sources in web, digital or paper copies.
- 4. MATERIALS & METHODS Moral Aristotelian tradition consultation: Nicomachean Ethics and Metaphysics . These sources were: Examined directly or through the opinions of specialized scholars. Supplemented with the Thomistic vision from Aquinas's Summa . Model of solidarity conceived as RDO: Gubernatis and Kliemt (GK) approach for organ allocation. Its “solidarity rule”, in case of unavoidable priorities due to organ scarcity, admits: Advantage to access to organs, granted by declared willingness to donate of potential recipients. Disadvantage of those patients placed in waiting list who have been unwilling to donate. Approach: analyzed by decision making method of bioethical principles. Main source of ethics of principles: 6 th edition of Beauchamp and Childress's Principles of Biomedical Ethics.
- 5. RESULTS ALTRUISM (other higher) To procure the good for some other. The movement toward something superior, which exceeds limits. Alter: al— modified Latin ad— to, toward, and —ter from Indo-Aryan —tara , that denotes superiority (Sanskrit). Self-fulfillment, self-esteem or satisfaction for justice and social reputation are involved, independently of philosophical or religious argumentations. Analogous to altruistic behavior has been detected in animal species, only between genetically correlated individuals. Understood as conditioned by the logic of a return (strong reciprocity) implies: rewards for collaboration or punishments for omissions of cooperation norms. In classical Aristotelian thinking, altruism is perceived as the human tendency to possess a moral (no linked with others) good, needed for self-perfection and for keeping person’s integrity. SOLIDARITY (totality) To sustain the integrity of the whole. Term derived from Indo-Aryan sāwel̥— whole, ὅλος (holos, Greek), солнце (sun, Rus.), solid (Lat.).
- 6. RESULTS GK APPROACH ANALYZED BY METHOD OF PRINCIPLES PRC: common morality is guided by balanced and specified rules. GK approach: solidarity as RDO. The “reciprocity” plays roll of moral norm because involves rules of obligation. Everybody is benefited and harm is prevented. The rule “to avoid damage” has to be specified to engage in situation of organ scarcity: one organ available for two potential allocations. Balancing will decide based upon the weight of recipient's behavior. PRC justifies advantage, founded on the attitude toward organ donation, granted to potential recipient by RDO-based model of GK. Medical reasons become less important. Life of “unwilling to donate recipient” might not be defended. Other assumption of solidarity: would be moral ideal, i.e., traits of individual character, supererogatory and non-normative, could be fulfilled or not. GK approach could select recipients on “lifestyle” or “behaviors”, and would not observe allocation’s criteria of SHODT of WMA.
- 7. RESULTS CLASSICAL ARISTOTELIAN ANALYSIS (Altruism & Solidarity) Organ donation is: Not an end in itself. Part of sequential actions of donors, aimed to pursuit the highest good (life defense) . Moral good: proposes no material reward, gratifies self (donor) interest. “ The other higher”, i.e., altruistic. A way of donors to seek for self-fulfillment and happiness. Altruism: Moral virtue, a habit (repeated practice of good actions) capable to be learned by exercise, shared in common sphere. Guides the donors to approach to the principle of life defense. Allows donors to interact with recipients through the virtue of “benevolence”. Altruistic donation preserves community as a whole: holds solidarity. Is weighted in 6 th principle of WHO-GP. Altruism and solidarity have common root: tendency to personal improvement.
- 8. RESULTS CLASSICAL ARISTOTELIAN ANALYSIS (Altruism & Solidarity) Altruistic solidarity: Entails non-reciprocal, donor-centered act. Leads individuals to donate . Improves organ supply without retribution beyond personal satisfaction. Contributes clearness for organ procurement. Is related to actions encouraged by community: can be normative. Can be applied by mean of learning of virtues. Altruistic benevolence in organ shortage: Understands that scarce resource should be granted to the neediest recipient. Encloses needs according to life's risk assigned through medical criteria. Believes that hierarchy founded on medical grounds will be always possible. Ensures justice and equity in organ access, as suggested in 9 th principle of WHO-GP Allows physicians to be compassionate to recipients, as referred to in CME of WMA.
- 9. CONCLUSIONS Altruism and solidarity share common origin and common goals. Altruistic solidarity is donor’s expression allowing improvement of human being. Altruistic solidarity preserves the recipients. RDO conception ignores altruism as necessary part of solidarity.
- 10. CONCLUSIONS Solidarity thought of as RDO emphasizes on recipients' behavior adding to him/her more burdens, ponders beneficial relationship or interchange of goods, and is closer to mutualism. RDO approach would not be consistent with principles of procurement and notion of justice in access to organs, according to international documents. Understanding solidarity just like RDO offers a biased view of the principles of transplantation medicine and basic human rights.