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LEGAL AND ETHICAL ASPECTS OF ORGAN TRANSPLANTOLOGY IN GEORGIA

Автор Доклада: 
Kekenadze G., Kekenadze D.
Награда: 
LEGAL AND ETHICAL ASPECTS OF ORGAN TRANSPLANTOLOGY IN GEORGIA

LEGAL AND ETHICAL ASPECTS OF ORGAN TRANSPLANTOLOGY IN GEORGIA

Giorgi Kekenadze, student
I. Javakhishvili Tbilisi State University
David Kekenadze, research scholar
Shota rustaveli Batumi State University

In the article is reviewed Legal and ethical aspects of organ transplantology in Georgia.
Topic is actual, because nowadays in Georgia more than 100 people live with transplanted organs. However, much more need organ transplantation.
According to the International Health Organization there is a longstanding practice of kidney, liver, heart and pancreatic transplantation in the world. But In Georgia from the parenchymal organs (heart, liver, kidney, pancreatic) only Kidney is transplanted.
In this work I have discussed all legal and Ethical aspects of organ transplantation in Georgia. These issues in Georgia are regulated by ‘Human organ transplantation’ law. Currently in Georgia doesn’t exist effectively functioning donor bank, donors and potential donors' list. From my point of view it's important to create an efficient body, with its own technical equipment. The Web site, which allow any citizen of Georgia, be registered as potential donor. Provide his/her personal data and in case of need he/she will be contacted. Also, if we consider that in Georgia in 2011 has entered the electronic ID cards, managing of this process will be more simplified. It is also important to protect the privacy of donors.
To sum up, It is necessary to regulate legislature about organ transplantation in Georgia. We must implement above mentioned innovations in it. 21st century has given to us various technological possibilities and we must use it in order to let citizens of Georgia live long and healthy lives.
Key words: Organ Transplantation, Legal, Ethical, Aspects, Donor, Body donation, Georgia.


“According to the Additional Protocol to the Convention on Human Rights and Biomedicine, on Transplantation of Organs and Tissues of Human Origin, (Strasbourg, 24.I.2002) the term "transplantation" covers the complete process of removal of an organ or tissue from one person and implantation of that organ or tissue into another person, including all procedures for preparation, preservation and storage. (1)
The ethical and legal issues related to organ and tissue procurement and transplantation are often discussed in light of such principles as autonomy, benevolence, non-maleficence, free and informed consent, respecting the dignity, integrity and equality of human beings, fairness, and the common good. The Judeo-Christian perspective affirms the great dignity of each human person created in the image of God (cf. Gen 1:26-31). The various aspects, parts and functions of a human person participate in this dignity. We are also social beings who have a responsibility as co-creators and stewards of God's creation. "In the donation and transplantation of human organs, respect is to be given to the rights of the donor, the recipient and the common good of society."(CHAC, 44)
Topic is actual, because nowadays in Georgia more than 100 people live with transplanted organs. However, much more need organ transplantation.
According to the World Health Organization there is a longstanding practice of kidney, liver, heart and pancreatic transplantation in the world. But In Georgia from the parenchymal organs (heart, liver, kidney, pancreatic) only Kidney is transplanted. (21.)

Organ transplantation in Georgia

According to the data of the Transplantologists Association In 1999 on the basis of the Caucasus Transplantologists I Conference resolution was founded «Caucasus Transplant Coordinators Group”, the aim of it is organs transplantation promotion in regions and regional co-operation. (16) In many countries organ transplantation issue is regulated by state Legislation and International Acts. Every state is trying to create a legislative framework in the field of organ transplantation, which would make transplantation safer and attract more donors. In the absolute majority of countries the organ trade is prohibited by law. Also in accordance with the Georgian law article 52 “about transplantation of human organs and tissues” prohibits the Organ trade(2)

In accordance with Georgian Criminal Code 135 prima article first part trafficking of organs is punishable by imprisonment for a term of six to nine years. And if it took place permanently punishment is 8 to 12 years imprisonment; when the group is to organize the sale of organs, the punishment shall be reinforced in a 11 - to 15 years imprisonment. (3)
It should be noted that Iran is the only country where by the law citizens can sell their organs for transplantation to other ones. Given the fact that between Georgia and Iran is not so much the distance, we can say that in Georgia there is a high risk of illegal trade of human organs. From developing countries take place illegal flow of human organs, which then fall on the black market. Some countries contradict relevant limitation and prohibition to organ trafficking. For example, Moldova has banned the adoption of children abroad; fearing that trafficking of organs would take place. Also, I think that we need to tighten the control in Georgia.
From the Ethical or legal point of view when transplanting the organ it is very important to take into consideration donors and at the time of death donor’s family or relatives will. Georgian law “regarding Humans Organ Transplantation” Article 4 establishes, that capable person has the right voluntarily declare consent or refusal while alive or after death to remove his/her organs. “And Article 5 clarifies that a person's decision acquires legal effect, when it is drawn up in written form and is confirmed by signature of the Head of the appropriate Medical Establishment.(2) Bulgarian legislator due to the lack of the transplanting organ, in 2006 adopted law on organ transplantation, in accordance with it all citizens of Bulgaria – dead by car accident or other accident - will automatically become a donor, if he/she hadn’t written denial in advance, or his/her relatives after a short period of time had not refused to donate the deceased. (22)Subsequently, it is clear that the Georgian legislation gives importance to the execution of a person's will, in his/her lifetime.
Law of Georgia on “ Human Organ Transplantation'' Article 8 defines the case, when it is possible to transplant organs from the body when there is no consent given in the lifetime in written form confirming the approval or rejection. The removal of the organ should not be contrary to the belief and should be given in article 9 of the specified persons (spouse, child, parent, grandchild, and, brother, etc...) approval. (Preference is given to the consent of the close relatives). Article 18 of the same law defines the category of persons who may be a living donor. They are: genetic relatives of the recipient, the recipient's spouse, if from the marriage registration has passed no less than 1 year, the recipient's wife child, mother, father, grandchild, grandmother, grandfather, brother; (2)
In accordance with the changes made in the Law on October 1, 2006 by which is possible to take organ that has self renewal ability from the donor and transplant to another person, it is acceptably even if the donor is not a genetic relative or spouse;(2) Consequently, such an approach can be considered balanced with other countries' experience. For instance, In Russia Law about ‘Transplantation of human organs and tissues’ states that the donor may be a genetic relative of the recipient. Contrary to Russian legislature In Norway donor may be any person who is not less then 18 years old and who has given a written agreement. (6;22)
Although, there is possible to transplant half of the liver of a living donor, because it has the regeneration ability but besides of is there is not performed such kind operation in Georgia. To Transplant kidney, the donor and the recipient (the person to whom is made transplantation of the organ) must gave the immunologic responding. Compatibility basic parameters are - blood group matching, leucocytosis antigen and in accordance with cross-reaction. But besides the compatibility, everybody can’t be living donor. By Applicable law, to the recipient can be transplanted genetic relative, spouse or spouse relative organ. (2;5)
The Georgian law, the Human Organ Transplantation'', article 12 establishes that the person is meant dead after brain death or cardiac arrest and irreversible cessation of circulatory is established”. For the corpse donation only brain death diseased can be used. In 2000, the Ministry of Health according to international standards, developed criteria for determining brain death.(4;11)
According to the Presidential Decree issued in 2001 of brain death is defined as "any structure of the brain (including brainstem) irreversible cessation of function."These both definitions the American Bar Association, American Medical Association, is identical, according to which "death stated" as a circulatory and respiratory functions, all brain structures (including stem) function Irreversible termination; The Presidential Decree "Human brain death criteria" (4) to determine that brain death diagnosis by two independent commission of doctors, which consists of the doctor also include expertise in at least 5 years work experience with a critical care physician and neuropathologist, but cannot be completed with the specialist related to organ tissue and transplanting. In Paraclinical examination may be involved the relevant field experts. In addition, studies should be conducted twice 12-hour interval (for adults) and three times 48-hour interval (in children). The diagnosis of brain death must be done due to typical clinical signs of this phenomenon (unconscious, no existence of reflexes, lack of spontaneous breathing) and paraclinical examination by (isoelectric line electric-encephalogram or Blood circulation Termination transcranial Ultra - sound dopplerography).
Although on the legislative level is set out the criteria for brain death and the process, such a diagnosis aren’t actually made in Georgia. Transplantologists Association of Georgia in 2007, according to data for 18 months was inspected 12 patients with suspected brain death. The diagnosis of brain death was given in 2 cases. The problem is that both doctors and the society are not ready for such a diagnosis. It is necessary intensive public awareness on this issue. I believe that such an information campaign could result.
Now Lets discuss donor criteria defined by Georgian legislation.
The Health Minister, by order of April 14, 2007 N 419 / l was determined, the selection and testing of donors and recipients criteria” according to which dead body organ donor criteria is: (4)
A) Brain death, and B) age less than 65 years;
B) Should not have sepsis, active tuberculosis;
C) Should not have potentially metastasing malignant disease;
D) Should not have AIDS, syphilis, C and B hepatitis, chronic kidney disease, malignant tachycardia;
E) Warm ischemia time should be no more than 30 minutes, cold ischemia time – no more than 36 hours.
To all these, is needed the family (relative, spouse) consent to donate organs. Accordingly, it is clear that in order to transplant the organ to the person, it is necessary the donor to satisfy “healthy” person criteria, In order to avoid after transplantation aggravation or infection by any disease. It also defines those cases, the applicant would be excluded from the ability to be a living donor; excluding circumstances include the age, if a person is less than 18 years, or more than 65 years, it cannot be a living donor. Other criteria are also taken into account;
F) hypertonia 140/90- c) Diabetes d) aleuronic (250 mg - more than 24-hour urine), e) clearance of less than 80 ml / min - a f) urolithiasis disease and other pathologies that cause functional and organic kidney injury;
G) microscopic hematuria; h) of the internal organs of chronic diseases: lung chronic Disease, malignant processes;
H) And so on.) I) thrombosis and thromboembolism;
I) J), obese (no more than 30% of ideal weight).
Currently in Georgia doesn’t exist effectively functioning donor bank, donors and potential donors' list. From my point of view it's important to create an efficient body, with its own technical equipment. The Web site, which allow any citizen of Georgia, be registered as potential donors. Provide his/her personal data and in case of need he/she will be contacted. Also, if we consider that in Georgia in 2011 has entered the electronic ID cards, managing of this process will be more simplified. It is also important to protect the privacy of donors. The Law on Human Organ Transplantation’ prohibits the disclosure of the identity of the donor, but the 49 - article establishes certain exceptions; a) if the organ which has to be transplanted threat health of the recipient or any other human being; B) demand of the court decision on the basis of the legal system; C) In accordance with the established rule it specifically is required by Minister for Health and Social Affairs.
To sum up, It is necessary to regulate legislature about organ transplantation in Georgia. We must implement above mentioned innovations in it. 21st century has given to us various technological possibilities and we must use it in order to let citizens of Georgia live long and healthy lives. 

References:

  • 1. Additional Protocol to the Convention on Human Rights and Biomedicine, on Transplantation of Organs and Tissues of Human Origin, (Strasbourg, 24.I.2002)
  • 2. Georgian law “about transplantation of human organs and tissues’’
  • 3. Criminal Code of Georgia ,2011
  • 4.The Health Minister Of Georgia, order of April 14, 2007 N 419 / l about ‘’The selection and testing of donors and recipients criteria”
  • 5. Биоэтика на рубеже тысячелетий. Обзор материалов V Всемирного конгресса по биоэтике (Лондон, 2000). — «Медицинское право и этика», № 2, 2001, с. 12-22.
  • 6. Белкина Г.Л., Корсаков С. Н. И.Т.Фролов и становление отечественной биоэтики // Биоэтика и гуманитарная экспертиза. М., 2008.
  • 7. Биоэтика и гуманитарная экспертиза. Вып. 2 / Отв. ред. Ф.Г.Майленова. М.: ИФ РАН, 2008. 230 С
  • 8. Закон Республики Беларусь от 4 марта 1997 г. №28-З "О трансплантации органов и тканей человека"; По состоянию на апрель 2008 года
  • 9. Joint Commission on Accreditation of Healthcare Organizations. Health care at the crossroads: Strategies for narrowingthe organ donation gap and protecting patients. 2004: 1–46.
  • 10. Dobbels F, De Geest S, Cleemput I, et al. Psychosocial and behavioral selection criteria for solid organ transplantation.Prog Transplant 2001: 11: 121–130.
  • 11. House RM, Thompson TL II. Psychiatric aspects of organ transplantation. J Am Med Assoc 1988: 260: 535–539.
  • 12. Herzog D, Martin S, Yandza T, Alvarez F. Hepatic insufficiency and liver transplantation in a patient with COACH syndrome. Pediatr Transplant 2002: 6: 443–446.
  • 13. Steinberg D. Kidney transplants from young children and the mentally retarded. Theor Med 2004: 25: 229–241.
  • 14. Cheyete C. Organ harvests from the legally incompetent: An argument against compelled altruism. Boston Coll Law Rev 2000: 41: 465–515.
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