The Linacre Quarterly Volume 31 | Number 2 Article 5 May 1964 Moral and Ethical Reflections on Human Organ Transplantation Joseph E. Murray Follow this and additional works at: http://epublications.marquette.edu/lnq Recommended Citation Murray, Joseph E. (1964) "Moral and Ethical Reflections on Human Organ Transplantation," The Linacre Quarterly: Vol. 31 : No. 2 , Article 5. Available at: http://epublications.marquette.edu/lnq/vol31/iss2/5 (between identical twins) would gift has been solicited and invariably have as great a chance of success as granted. But if thes~ difficulties seem Moral and Ethical Reflections renal autografts (re-implanting a kid­ great, consider-as we had to consider ney in the . same individual) . Conse­ -the situation of identical twins, one On Human Organ Transplantatior * quently, the first kidney transplanta­ with fatal kidney disease, who were tion to be undertaken involved identi­ legal minors. Could one twin, as a cal twins. The prospective donor and minor, make free legal di sposition of JOSE PH E. M URRAY, M .D .** the recipient twin were fully inform­ a kidney for transplantation? Do the ed about the ·investi gational nature of parents, as legal guardians, have au­ Implicit in the definition of medi­ entirely feasi ble. But good rest its the procedure and about the uncer­ thority to make such disposition? cine as "applied biology" is the con­ in animal experimentation, desira )le tainty of success. The reci pient gave What of the psychic trauma to the cept that it is applied for the benefit though they are, do not guarar ee his full and informed consent. Fur­ healthy twin if he is legally prevent­ of man-and not just tor generic similar results clinically, nor do p, ,or thermore, since he was dying of ure­ ed from saving his brother's life by "man" but also, and perhaps espec­ results necessarily exclude clinical ~ 1c­ mia because of destroyed kidneys, donating a kidney? These legal hur­ ially, for the specific individual man cess. Man remains, inevitably, he there was no question that the reason dles-and others-have been tempo­ who happens to be sick. Similarly ultimate experimental model. T 1is for proposing transplantation was a rarily surmounted with the help of implicit in this context, however, is has proven to be the case with '.lt­ "proportionately grave" one. Fortu­ kindly-disposed jurists, but the final the notion that "biology" is not a tempts to modify by irradiation he nately the operation, carefully plan­ opinions remain to be written. static mass of knowledge applied by recipients of renal homografts. In ned and executed as a team effort rote but rather a constantly evolvi ng, dogs, for example, there has b, en was an: unqualified success for th~ THE UNRELATED DONOR expanding, and changing fund of in­ only one successful kidney homog1a ft recipient, who survived to lead an ac­ As we state in a yet unpublished formation that requires discrimina­ using this technic, but it has enjo ed tive and productive life for eight article4 : 2 3 tion in its use. Experimentation, greater success in humans (betw 'en years • In the case of the recipient Justification even for the use of a cadav­ therefore, is an integral part of medi­ non-identical twins on two occasi ,ns twin, therefore, a favorable clinical eric kidney or a " free" kidney is not cine. And here, of course, one can and with maternal and inter-sibl ng result ~as achieved within the rigor­ automatic just because the p rospective re­ 1 cipient is otherwise doomed to die .. .. see the dim outline of a moral prob­ transplants on at least three other, ) . ous eth1Cal framework prescribed for All the mo re difficult to justify is the lem that the conscientious physician, It was the decision to underh ke any human experimentation. In the use of living volunteer donors. Although Christian or not, may be obliged to kidney transplantation in man, m de case of the donor twin, however, uni­ chemical suppressive agents may be ef­ face. over 10 years ago, that posed fo r us que medico-moral problems arose. fecti ve temporarily, many questions re­ the first significant moral problem main unanswered. " The potential THE DONOR TWIN dehumanizing abuses of a market in hu­ HUMAN EXPERIMENTATION IN related to human experimentation. man fl esh" is a phrase used by Lederberg -GENERAL AND IN RELATION TO Although the procedure had been at­ There is little doubt that the indi­ (in M11,n and His Future). Although ad­ HUMAN TRANSPLANTATION tempted in the past, there had been vi~ual who has been surgically de­ mitting that his attitude may be con­ prived _of o!"1e of his two kidneys is strued as an "alarming or ungraci ous re­ It is a generally accepted principle no clinically successful precedent. The action to the gift of life," he warns that any innovation, medical or surgi­ surgical technic of transplantation at a. pote1;1tial physiologic disadvant­ against misguided medical progress in the cal, must have an adequate experi­ was well-established, however, :rn d age m facmg the rigors of life. Does name of humanity. Physicians removing mental basis before being applied to there was ample clinical and exp ri­ the possible benefit to the recipient intact organs from healthy donors with­ mental evidence to indicate that, im­ outweigh this hazard to the donor, out a conscientious concern for the prob­ man. However, it is seldom possible lem of better procurement may be lik­ to state precisely how much experi­ munologically at least, renal isogra fts ~ince a su.ccessful kidney transplant ened to the old lumber barons felling mental background can be considered m appropnate cases is life-saving, it trees indiscriminately .... To our knowl ­ "adequate." It · should, of course, be l Murray, J . E., Merrill, J. P., D ammin, would seem that it does. And it has edge n o healthy living donor has yet been G . J ., D ealy, J . B., Jr., Alexandre, G . W., been on this premise that the donor's an operative fatality, yet fatal operative sufficiently extensive to suggest that and H arrison, J . H.: Kidney transplan· complications are a lways possible. As translation from the laboratory to the tation in modified recipients. Ann. Surg. 2 physicians motivated and ed ucated to clinic or operating room will be 156:337-355 Sept. 1962. ~ urray, J . E. , Merrill, J. P., and H ar- make sick people well we make a bas ic ~1s~n, J: H.: ~enal homotransplantati on in identical twins. Surgical Forum 6:432 *Part of a symposium on "Human Transplantation: Medical and M oral A spects," 1955. 4Murray, J. E., Merrill, J. P., D ammin, sponso red by the Guild of St. Luke of Boston and held at Boston College on Janu· 3 G . J ., H arrison, J. H ., H ager, E. B., and ary 29, 1964; Rev. J ohn J. Lynch, S.J., Professor of Moral Theology, W eston Col· MJerrill, J. P., Murray, J . E., H arrison, Wilson, R. E.: Current evaluation of lege, also participated. · H ., and Guild, W. R.: Successful human kidney transplantation. (Pro­ homotransplantation of human kidney ceedings of Sixth H omotransplantation **Assistant Clinical Professor of Surgery, H arvard Medical School; Senior Associate between identical twins. J.A .M.A. 160: Conference) Ann. New York Acad. Sci. in Plastic Surgery, Peter Bent Brigham H ospital; member, Guild of St. Luke of 277-282. Jan. 28, 19 56. (in press 1964). Boston. MAY, 1964 55 54 LINACRE QUARTERLY qualitative shift in our aims when we proponents of the favorable opinio ,. risk the health of a well person, no mat­ In several issues of Theological Stu,'. THE YET TO BE ter how pure our motives. To relieve our­ ies Father Lynch8 has brought tl e selves of this responsibility we must JOSEPH B. DOYLE, M.D. * strive fo r better organ procurement so matter up to date. that the day wil l come when even the Great men of science, see yourselves as we, identical twins will not require a living THE PRESS, THE .PATIENT, AND PUBLIC RELATIONS The unconceived-the yet to be. donor. Have you forgotten that as we The dramatic aspects of hum n MORAL THEOLOGY AND KIDNEY You, too, were once unknown except to Him from time's first dawn? TRANSPLANTATION transplantation create additional pre )­ lems, as we suggest in a pendi: g As emphasized by Father Lynch5 article4 : Two living cells apart, an egg afloat in Nature's nutrient stream, the only really unique difficulty in Your other half-the sperm-that one alone the matter of kidney transplantation "Spare parts surgery" is a popular tor ic in the public press. We cannot esca ,e From half a billion drawn together by merest chance? inter vivos concerns the donor. As the public relations aspects no mat er Or what design? . humans we merely exercise steward­ how we try. It is our obligation to , 0 - ship, not mastery, over our bodies, operate with a responsible press to p O· and hence do not have absolute free­ duce an informed public, yet we m st What great Designer planned that fluid tryst? dom concerning . their disposition. In protect the patient's right to priva y. Who stocked its stream for those six days Most patients requiring kidney tra s­ one of the earliest articles dealing When fused at last, you floated in plants are known in their local comm, · The lonely darkness of beginning life ? specifically with inter vivas renal ity and information first leaks out fr m transplants, Father Connell6 has indi­ this source. The medical center ca6 1g cated that such donations are licit if for such a patient must guard against p ·e­ Your vaunted brain-12 billion cells began as one.