Recently I have addressed many an issue on the whole question of ethics and the law needed in organ transplants!
And I thank those of you practitioners from the US, UK, Spain, Germany, Australia, India, Korea and Japan who have contacted me on the same and for your kind feedbacks and assistance in this issue.
I have also pursued vigorously an argument that there should never be the commercialization of organ transplants and Malaysia must never be a state where organ transplants are conducted purely for commercial purposes and for the financial and personal gratification of individuals, professionals or even certain foundations in and out of the country!
I am aware that there are many groupings out there not interested to take a punitive stand against rogue physicians, hospitals or foundations but I must differ and state here categorically that it is important that both organ transplants and practitioners are monitored to uphold the highest ethical principles and not be a stooge for the wild and abusive commercialization of organ transplants!
In some geographical locations organ transplants are a commercialized trade listed in the stock exchange!
This to me is vulgar!
Having discussed this matter with many friends in and out of the country, individuals who are a classic example of ethics and dedication I am today outlying guidance so that those involved in the practice of medicine, directly, indirectly or through NGOâ€™s, organizations, medical foundations bear in mind these principles and ethical conduct in conducting organ transplants!
Let us call these the MAGNIFICENT 8 GUIDELINES!
(1)Â Â Â Â Â Â Â Â First, that in all professional relationships between a physician and a patient, the physician’s primary concern must be the health of the patient. It is certainly not rocket science that the physician owes the patient primary allegiance.Â This concern and allegiance must be preserved in all medical procedures, including those which involve the transplantation of an organ from one person to another where both donor and recipient are patients.Â Care must, therefore, be taken to protect the rights and interest of both the donor and the recipient, and no physician may assume a responsibility in organ transplantation unless the rights of both donor and recipient are equally protected.Â A prospective organ transplant offers no justification for a relaxation of the usual standard of medical care for the potential donor.
(2)Â Â Â Â Â Â Â Â When a vital, single organ is to be transplanted, the death of the donor shall have been determined by at least one physician other than the recipient’s physician.Â Death shall be determined by the clinical judgment of the physician, who should rely on currently accepted and available scientific tests and principles involved!
(3)Â Â Â Â Â Â Â Â As a Consumer Advocate I have always maintained that there should be full unadulterated disclosure, discussion of the proposed procedure with the donor and the recipient or their responsible relatives or representatives and that this is mandatory.Â The physician should ensure that consent to the procedure is fully informed and voluntary, in accordance with the guidelines on informed consent.Â I must mention here that the said physician’s interest in advancing scientific knowledge must always be secondary to his or her concern for the patient. In fact I do appeal for the involvement of a third party to be part and parcel of this deliberations,Â a silent but involved individual â€“ a patient advocate bearing witness that this entire is transparent, accountable and above board.
(4)Â Â Â Â Â Â Â Â Transplant procedures of body organs should be undertaken (a) only by physicians who possess special medical knowledge and technical competence developed through special training, study, and laboratory experience and practice, and (b) in medical institutions with facilities adequate to protect the health and well-being of the parties to the procedure. I would go further and state that these operations and procedures should only be allowed in specific classification of hospitals and other medical centers approved for the scheme and under strict enforcement procedures.
(5)Â Â Â Â Â Â Â Â The decision on who the recipients of organs for transplantation should be determined by the physicians and consultants rather than by politicians and third parties in view allocation of limited medical resources and the greater need.
(6)Â Â Â Â Â Â Â Â It would be silly for policymakers and others involved in this matter not to consider organs as a national, rather than a local or regional, resource.Â As such I call for geographical priorities in the allocation of organs. They should be prohibited except when transportation of organs would threaten their suitability for transplantation.
(7)Â Â Â Â Â Â Â Â And there should be clarity and order and patients should not be placed on the waiting lists of multiple local transplant centers, but rather on a single waiting list for each type of organ and the final decision to be made by the surgeon in context!
(8) Â Â Â Â Finally, it is very important that life donors should only be first degree relatives, direct relatives or with blood linkage! And I say this purely to discourage abuse and to monitor the motivation behind unrelated donors schemes! I am highly suspicious of these donor schemes and ask pertinent questions because there is a ‘suspicious element’ behind them and we do not need to create a scheme where the ‘rich use the poor’ as was the case recently in an island state with rich beneficiaries and where the donors were poor Indonesians! If this is not addressed then we can have even in Malaysia the following namely organ trading,Â commercialization and kidnapping! This will be Malaysia’s healthcare system’s worst nightmare, which we must avoid!
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