Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture.

IF 1.3 4区 哲学 Q3 ETHICS Hec Forum Pub Date : 2022-06-01 Epub Date: 2021-02-17 DOI:10.1007/s10730-020-09436-2
Md Sanwar Siraj
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引用次数: 11

Abstract

Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders issued fatwa, or religious rulings, in favor of organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthcare outcomes, prevent poor people from being coerced into selling their organs to rich recipients, and protect the solidarity and progeny of Bangladeshi families.

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孟加拉国死者器官移植:生物伦理、宗教和文化的动态。
1982年10月,孟加拉国首次开始活体亲属器官移植,1988年开始普及。死后供体角膜移植始于1984年,活体供体肝脏和骨髓移植分别于2010年和2014年开始。《人体器官移植法》于1999年4月13日在孟加拉国正式生效,允许脑死亡和相关活体捐献者捐献器官用于移植。在立法之前,宗教领袖发布了支持器官移植的法特瓦或宗教裁决。该法案于2018年1月8日由议会修订,修改后不久于1月28日生效。然而,除了少数死后角膜捐赠外,重要器官的移植,如肾脏、肝脏、心脏、胰腺和其他身体部位或器官,在孟加拉国仍然不存在。本文讨论的主要问题是,为什么在孟加拉国没有来自已故捐赠者的重要器官移植。除了收集二手资料外,我们还与资深移植医生、患者及其家属以及公众进行了访谈,以了解死后器官捐献用于移植的情况。我们还采访了一名医学生和两名悲伤咨询师,以了解向家属提供咨询和获得同意从脑死亡患者那里获得死后角膜捐赠的过程。我们采访了一位专业的解剖学家,以了解为医学研究和研究目的而捐赠遗体的过程。他们的叙述表明,移植医生可能不愿宣布脑死亡,因为1999年法案的规定不明确和模糊。这项研究发现,孟加拉国人有很强的家庭关系,并且对于允许分离死者亲属的身体部位进行器官捐赠用于移植,或将尸体捐赠用于医学研究目的感到焦虑。从宗教的角度来看,死后捐献器官用于移植通常被视为一种错误的行为。尽管在伊斯兰教中侵犯人体是被普遍禁止的,但经政府咨询的宗教学者已经以拯救生命的必要性为由,批准了死后器官捐献用于移植。对生物医学、宗教和文化动态的评估得出的结论是,死后器官捐献用于移植的障碍被认为是宗教的,实际上可能源于文化态度。信仰、信仰、宗教、社会规范、仪式和更广泛的文化态度与生物医学和死后器官捐赠和移植的相互作用是非常复杂的。尽管克服器官捐赠用于移植的障碍具有挑战性,但在孟加拉国,有必要开始移植来自已故捐赠者的重要器官。这将确保改善医疗保健结果,防止穷人被迫将器官出售给富裕的接受者,并保护孟加拉国家庭的团结和后代。
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来源期刊
Hec Forum
Hec Forum ETHICS-
CiteScore
3.70
自引率
13.30%
发文量
34
期刊介绍: HEC Forum is an international, peer-reviewed publication featuring original contributions of interest to practicing physicians, nurses, social workers, risk managers, attorneys, ethicists, and other HEC committee members. Contributions are welcomed from any pertinent source, but the text should be written to be appreciated by HEC members and lay readers. HEC Forum publishes essays, research papers, and features the following sections:Essays on Substantive Bioethical/Health Law Issues Analyses of Procedural or Operational Committee Issues Document Exchange Special Articles International Perspectives Mt./St. Anonymous: Cases and Institutional Policies Point/Counterpoint Argumentation Case Reviews, Analyses, and Resolutions Chairperson''s Section `Tough Spot'' Critical Annotations Health Law Alert Network News Letters to the Editors
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