The illusion of long life, the protection of individual values, mistrust, fear and alienation are other examples of attitudes towards death, organ donation and transplantation (12). The three ethical principles taken individually can lead to policies that conflict with each other. Therefore, the principles must be balanced in order to achieve a fair result. The benefit should lead to maximizing the net benefit to the community, thus integrating the ethical principles of charity (doing good) and non-evil (doing no harm). To maximize benefits, factors such as patient survival, transplant survival, quality of life, alternative treatments, and age may be considered [55]. Social aspects such as social value, social status, occupation, race, etc. should not be taken into account in policy formulation. Behaviors that may exclude patients from the list may not be permanent. The ethical question for transplant centers is whether patients can recover from what they consider unacceptable and what criteria patients must demonstrate to show that they are now an acceptable candidate. A question for the UNOS Ethics Committee is whether the non-compliance behavior is serious, consistent and documented in current or past treatment [54]. The issue of financial incentives for living or deceased donors is unlikely to be resolved anytime soon.
It could be that two ethical principles seem to be colliding. On the one hand, the incentives could be bad for the reasons given by opponents. The other ethical principle of valuing human life and trying to preserve it by offering more donors financial incentives is also a good argument. The law called the Human Organ Transplantation Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Overall, the law accepted brain death as a form of death and criminalized the sale of organs. With the acceptance of brain death, it became possible not only to perform kidney transplants, but also to start other solid organ transplants such as liver, heart, lungs and pancreas. Despite the THO legislation, organ trafficking and kidney scandals are regularly reported in the Indian media. In most cases, enforcement was deficient and, in most cases, its provisions were abused. Along with the living and non-living donation program, the deceased donation program has slowly evolved in some states. In about one-third of all liver transplants, organs come from the deceased donor program, as do all heart and pancreas transplants. In these states, some hospitals, as well as dedicated NGOs, have maintained the momentum of the deceased donor program.
The MOHAN Foundation (an NGO based in Tamil Nadu and Andhra Pradesh) has facilitated 400 of the 1,300 organ transplants that have died in the country over the past 14 years. To address the organ shortage, developed countries are rethinking the ethics of programs that have nothing to do with it, and there seems to be a step forward to make it an acceptable legal alternative. The supply of deceased donors in these countries has reached its peak and there has been no further increase in recent years. India currently has a death donation rate of 0.05 to 0.08 per million people. We need to find a solution on how to use the potentially large pool of trauma-related brain deaths for organ donation. This year, the Tamil Nadu state government issued seven special orders. These prescriptions should streamline the activity of deceased donors and help increase their numbers. Recently, on 30 July 2008, the Government introduced further changes as an official gazette to stop organ trafficking.
The ethics of organ donation trade and transplant tourism have been widely criticized by international bodies. The legal and ethical principles we universally follow in organ donation and transplantation are also important for the future, as they can be used to resolve our conflicts related to emerging sciences such as cloning, tissue engineering and stem cells. If the proposed transplant takes place between a married couple, the licensed doctor, i.e. the head of the transplant centre, must assess the fact and duration of the marriage (marriage certificate, marriage and family photos, birth certificate of the children with contact details of the parents). If the proposed donor or recipient, or both, are not Indian nationals, whether close relatives or others, the AC will review all such requests. A senior official at the embassy of the country of origin must confirm the relationship between the donor and the recipient. If the proposed donor and the recipient are not close relatives, the Authorization Committee shall assess that there is no commercial business between the recipient and the donor, and shall assess in particular the following: In Romania, a multi-ethnic and multicultural country, religion plays an important role and influences the decisions people make in certain areas of life. The last census in 2011 showed that only 0.2% of the country`s total population identified as non-religious or atheist, with the majority (86.5%) being Orthodox. Of the Romanian population, 56 % live in urban areas and 46 % in rural areas (6).
A religion`s official stance toward organ donation and transplantation plays an important role in persuading the community to accept organ donation for transplantation. Most religions support and promote organ donation and transplantation, Pope John Paul II had repeatedly advocated organ donation and organ transplantation as a “service to life.” Understanding the ethical, cultural, social and religious values of a multi-ethnic population is important and can change the final organ donation decision without violating these values. Some of the problems are the lack of avarnes in terms of organ procurement, religious acceptance, brain death and misunderstandings that need to be corrected (7). Examples of misunderstandings include the belief that the donor`s body would be mutilated and abused, or that even if a person wanted to donate an organ, other organs would also be removed (8). This is completely false, because organs are surgically removed in a routine operation and only those intended for donation are removed from the body, which does not disfigure the body or change its appearance. Cooperation with religious leaders on organ donation between religious communities and discussions to ensure active engagement in organ donation should be considered at the national and local levels. There are various complex risks arising from organ transplantation that are not seen in most surgical procedures. A risk assessment includes standardized and customized factors. There are several broad categories of risk [1, 2, 34, 35]: A mandatory choice would require each adult to decide and record whether to be an organ donor upon death. No country currently has a mandatory choice policy. This would eliminate the need for consent. This would relieve the family of a potentially painful decision and avoid family disagreements.
Since the individual made a decision about their body prior to death, many of the objections to presumed consent would be removed. Mandatory choice has been criticized for being insensitive to families and forcing individuals to deal with their own death. The American Medical Association Council on Ethical and Judicial Affairs believes that a prescribed choice is not mandatory, since individuals are free to say no [48].