14 - Ethical Problems with Organ Transplantation

Summary

From the start, organ transplantation was associated with questions and problems that went beyond the immediate scientific and medical domain. As a scientific and surgical practice it involved the values, norms, and cultural ideas of doctors, patients, and society. How closely scientific subjects were interrelated with subjects outside the scientific field shows in the fact that, implicitly or explicitly, doctors and scientists concerned themselves with ethical issues even in their professional articles. Some of the problems still connected to organ transplantation today were already being brought up in medical-scientific literature between the 1880s and 1930s, though not usually in relation to the concept of “ethics.” These materials concern above all the sources of transplants, the problem of testing the new therapeutic methods on humans, the informed consent of both donor and recipient, and the question—more or less theoretical at the time—of the ethical admissibility of engendering children from transplanted reproductive glands.

Organs from Animals

A considerable amount of the tissue used for transplantation came from animals. Some potential donor animals, such as monkeys, were exceedingly hard to come by. In 1910, for example, Unger only acquired a macaque as a “kidney donor” thanks to the help of the Berlin Zoo. But finding animals for transplants was by no means the only issue. Animal experiments were controversial to begin with, and the influence of the antivivisectionist movement should not be underestimated. Upon pressure from animal rights advocates, the Rockefeller Institute employed a special caretaker to look after the animals used for Carrel’s transplant experiments. The use of animal organs for xenotransplants on human patients provided another target for criticism. Before the era of transplant surgery, Brown-Séquard’s organotherapy had outraged the proponents of the English animal rights movement because the organ extract came from animals. In the twentieth century, British antivivisectionists wanted to prevent Voronoff from presenting his transplantation of monkey testicles when he visited Great Britain.

On the other side of the animal controversy, quite a few medical scientists thought that acquiring organs from animals was the ideal solution for their “supply problem.”