Ethics Committee Update

02 01

significant ethical dilemmas met with uncompromised principles

The Ethics Committee of TTS continues to tackle several ethical issues impacting global transplantation. Many of the ethical dilemmas relate to strategies for expanding both deceased and living donor transplants without compromising ethical principles, including:

  1. Global kidney exchange;

  2. Legal age limit for live donation;

  3. Advanced donation programs;

  4. Living donor transplant for metabolic disease;

  5. Living donors in multivisceral organ transplant;

  6. Guidelines for the psychosocial evaluation of living donor; and

  7. Euthanasia and subsequent organ donation.

The latter is already occurring in countries where there is ethical and legal acceptance for euthanasia, and the TTS Ethics Committee will be addressing the complex ethical issues in this challenging area.

Xenotransplantation and stem cell therapies are strategies for dealing with the global organ shortage. There have been major advances in both fields, and clinical translation is imminent. CRISPR technology has made “humanized” pigs a reality, increasing the feasibility of xenotransplantation. There are transplant teams poised to start clinical trials next year, using donors from pigs for both kidney and pancreatic islet transplantation. Similarly, advances in stem cell technology (both embryonic and induced pluripotent stem cells) have resulted in beta cells clusters that are considered safe and effective in reversing diabetes in non-human primates. These stem cell derived beta cell clusters are also “on the cusp” of clinical trials to reverse diabetes in people with Type 1 diabetes. The ethical hurdles for both xenotransplantation and stem cell therapies are significant, and these topics will be of paramount importance in the agenda of the TTS Ethics Committee.

The ethical issues confronting social media are equally significant – and Google has become an important first line of information. The potential for commercial transactions around organ donation are apparent and are just one of many ethical concerns that the TTS Ethics Committee will need to address with the multiple social media platforms that have become part of our lives.

Finally, an important mission of the TTS is to advise and assist transplant professionals in the development of transplant programs in resource-limited countries. Assistance in the development of an infrastructure with regulations and a transparent reporting system will minimize the risks of practices linked to transplant tourism, unethical organ sources or other irregularities. The ethical issues in assisting transplant programs in these countries will continue to be an important area for the TTS Ethics Committee.