Organ Transplantation: A Paradigm of Medical Progress

Organ Transplantation: A Paradigm of Medical Progress Returning from Rome to Chicago recently in seat 23A of a Boeing 747 operated by British Airways I felt a magical sense of relief from the complexities of daily living. This world full of human beings seemed temporarily at peace from the vantage point of six miles up. It occurred to me that each one of us should, on occasion, pull back from the everyday intensity of moral decision-making and simply document certain human processes as they occur. A clear pattern of behavior would likely emerge. Given the wisdom of time and overview, we would all make fewer judgmental errors and moral definition would be better served. Such posture would be particularly suited to the evolution of biomedical technology of the past thirty years. Open heart surgery, organ transplantation, and development of biomechanical devices each illustrate the wisdom of exercising caution when drawing moral conclusions in the short haul. Many of my colleagues and I wonder if development of these technologies would even be possible in today's milieu of legal and ethical constraints. Yet each is contributing greatly to the welfare of mankind. I should like to develop discussion of one particular technology, organ transplantation, simultaneously along three avenues. These include: transplantation as a technique and as a therapy - as an every-day reality. I want to discuss how it got here, why it is here to stay, and why there will be more of it in the future. Secondly, I want to consider transplantation as a science. Why much of the original work seemed doomed to fail; why science is forced to catch up with transplantation and how science has helped transplantation become a permanent fixture in modern therapy of end-stage organ diseases. Finally, I want to talk about transplantation as a social phenomenon. I want to consider the definition of death; distribution of resources; and imposed limitations on progress in this most visible of therapeutic realities. In addition, I would like to lace this discussion with enough examples to personalize transplantation for me as a physician and for you as philosophers. And I would like to share with you a few phrases such as "bioethical perspective" or another way of saying bioethical wisdom, and "predictive bioethics," which is another, if somewhat dangerous, way of approaching the question: What if? You may also want to contemplate "reactive bioethics" and all that term implies. Please don't think that I in any way believe biomedical ethics is adversarial to medical and surgical progress. In fact. I strongly support philosophical interest in the direction biomedical scientists and practitioners are taking technology today. I believe professionals in biomedical ethics are and will continue to make an enormous impact on our understanding of how technology relates to the human condition. Bioethical perspective (or wisdom) may bring us full around from the sterile, so-called scientific method to the Hippocratic holism that reminds us all that we are, finally, human beings. I simply want to offer a few thoughts to see if you might relate to them in some way as being helpful in our joint assessment of organ transplantation as an example of medical progress. When I arrived in the hotel in Chicago, there was a message requesting that I call Marsha Dunn, a wire service reporter. She was at another hotel in the same city covering an important meeting of transplantation specialists, and was just finishing a story on the dilemmas of anencephalic babies as organ donors that highlighted an infant friend of mine named Paul Holc. Paul is notable in the world of transplantation for being the youngest person ever to receive a solid organ transplant. More importantly and sadly, he remains the only person in history to be living with the transplanted heart of an anencephalic infant. There are many good, practical people on this planet who felt that transplanting Paul's heart was a wonderful and compassionate thing to do, both for Paul and his family and for the family of the donor. …