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Dr Abdul Aziz al Kabba, Member of the Faculty of Medicine, King Fahd Medical City , Riyadh Saudi Arabia .
Introduction
Justice is action in accordance with the requirements of laws and rules. Whether these rules are grounded in human consensus or societal norms, they are supposed to ensure that all members of society receive fair treatment. Justice is a central issue in human rights[1]. Issues of justice arise in several different spheres and play a significant role in causing, perpetuating, and addressing conflicts arising out of a feeling of being treated unjustly. Issues of justice arise regarding fair allocation of organs for transplantation and are accompanied by a lot of ethical discussiona [2] [3] [4].
There are many theories of justice; the most influential being based on the principles of utilitarian, communtarianism, feminism, libertarianism, socialism, and cosmopolitanism. Justice is a central issue in the discussion of the ethics of distribution of benefits and burdens as well as associated side effects, good or bad. So in its narrower sense, justice is fairness. The principles of justice and fairness can be thought of as rules of "fair play" in issues of social justice. There is no single principle that can address all problems of justice. Several principles of justice arguably merit acceptance, some formal and others informal.
Discussion
Shortage of organs for transplantation is a major impetus for the development of laws and regulations that affect and govern organ transplantation, directly or indirectly. Many countries possess the technical capacity and health care infrastructure to undertake transplantations, but they experience a serious shortage in the supply of suitable organs. Among developments to overcome this problem have been: legislation aiming at increasing rates of recovery of transplantable organs, recovery from individuals at different stages in the process of health, and an expanded concept of legitimate donations of non-vital organs from living persons. A further development, related to the problem of scarcity, is equitable allocation of organs that become available from cadaveric sources.
Recently my good teacher died because he had severe renal failure leaving behind many children. He was a good teacher to me and he supported me to be a successful person. He had tried to seek treatment for his end renal failure disease but his only solution was to buy a kidney for transplantation. He collected money to buy the kidney from his life's savings and also asked for help from the health system. Many people were ready to sell him the kidney. One of these was a poor man who had a big family and many children to feed. He lived in a poor old house and needed the money to improve the livelihood of his family and to educate his children. He agreed to the sale but the health system refused because the policy was only free kidney donations. The patient was faced with a long waiting list for a free kidney and died before a kidney could be found for him. The poor man and his family continued suffering from the effects of poverty. Is this system fair? Does it need change?
There is increasing pressure to allow sale of organs to meet demand but this has raised the most controversy from ethical, legal, and philosophical points of view[5]. Many countries prohibit selling human organs for transplantation[6]. This seems unjustified to me. There are many wealthy renal failure patients needing kidney transplantation. They can afford buying a kidney but are prohibited by the laws and have to be on very expensive renal dialysis for long periods of time while waiting for a free kidney. The cost of renal dialysis over a long time is very expensive compared to transplantation and contributes to high hospital and healthcare budgets. On the other hand there are many poor people in many countries suffering from the effects of poverty and a low socio-economic status. They have big families needing adequate housing and funds to educate their children. If given the offer, they will readily agree to sell their kidneys for their and their families' benefit.
Allowing legal sale of organs will undercut illegal human organ trading and illegal renal transplant surgeries in some countries like India , Pakistan , Indonesia , Philippines
There are many factors affecting the issue of kidney sale that must be considered: donors, recipients, financial payments, conflict of interest, and safety, value of life, justice, and informed consent. I think in my opinion, there is lack of justice in this situation and we need to re-discuss this topic again and again for more international regulations[7] and for justice to both donors and recipients. Recipients want access to kidneys and donors exist who can sell their kidneys because of dire need for money because of poverty[8]. Since sale of kidneys is taking place anyway illegally, it will be better to legalize to be able to regulate it to protect the poor from exploitation[9].
Conclusion
From these examples and many other examples, we notice that justice is very important for everybody and everywhere and especially in the health field. It is true that there are differences in the cultures, countries, laws, policies, procedures, but that will not differentiate in the principle of real justice. We should update our health system policies and procedures to support the justice at all levels especially in the health care felid and organ transplant to help people and community.
[2] Braun WE.. Allocation of cadaver kidneys: new pressures, new solutions. Am J Kidney Dis. 1994 Sep;24(3):526-30.
[3] Smart B. Fault and the allocation of spare organs. 5. J Med Ethics. 1994 Mar;20(1):26-30.
[4] Rhodes R. (Mount Sinai School of Medicine, New York , NY 10029
[5] Schweda M, Schicktanz S. The "spare parts person"? Conceptions of the human body and their implications for public attitudes towards organ donation and organ sale. 2. Philos Ethics Humanit Med. 2009 Feb 18;4:4.
[6] Friedman EA, Friedman AL. Reassessing marketing of kidneys from the 2008 perspective. 3. Blood Purif. 2009;27(1):53-7
[7] Surman OS, Saidi R, Burke TF. Regulating the sale of human organs: a discussion in context with the global market. .Curr Opin Organ Transplant. 2008 Apr;13(2):196-201.
[8] Naqvi SA, Ali B, Mazhar F, Zafar MN, Rizvi SA. (Sindh Institute of Urology and Transplantation, Civil Hospital , Karachi Pakistan
[9] Bakdash T, Scheper-Hughes N. (Bioethics at Damascus University , Damascus
world's poor? PLoS Med. 2006 Oct;3(10):e349