Organ transplantation has been a major breakthrough in the treatment of disease, but it also raises social issues such as organ supply and demand imbalances, rejection, and illegal organ trafficking, as well as human uniqueness and ethical controversies. Ethical and policy discussions, along with advances in immunosuppressive drugs, are needed to address these issues.
Organ transplantation is the technique of moving a person’s own organs to another part of the body or transplanting organs from another person outside the body to replace damaged or non-functioning organs. It is recognized as one of the most effective surgical methods to date. However, the history of how this idea was first raised and studied is not as old as you might think.
As far back as the 19th century, people believed that diseases were caused by an imbalance in the body’s fluids, which are the fluid components of the body, due to an incorrect lifestyle or environmental factors. Accordingly, they believed that disease could be cured by changing the individual’s environment or lifestyle, or by restoring the balance of fluids through vomiting, purging, or bleeding. However, some surgeons began to view the body as a structure made up of organs and tissues with specific functions. They proposed the idea that disease could be treated through surgery to remove diseased organs and tissues or to restore their function.
In July 1883, Swiss surgeon Emil Theodor Kocher attempted to remove thyroid tissue from a patient suffering from a goiter and transplant it into another patient suffering from the after-effects of thyroid removal. Although the transplanted patient did not live long, this attempt to treat a complex condition by swapping organs is considered the first organ transplant. It became the prototype for all subsequent organ transplants and signaled the beginning of organ transplantation research.
Since then, doctors have continued to improve organ transplantation through research and experimentation, but they’ve encountered unexpected barriers. The biggest problem with organ transplantation is rejection. Rejection is when the immune system attacks the transplanted organ or tissue because the body considers it foreign. In 1980, French physician Jean Dausset discovered that rejection is driven by white blood cell antigens. This led doctors to recognize that the body’s immune system was the key cause of rejection, spurring the development of immunosuppressants.
Immunosuppressants are substances that artificially suppress the body’s immune system, reducing the ability of immune cells to attack. Just as the development of penicillin played a pivotal role in the history of antibiotics, the development of cyclosporine in 1972 was a landmark event in the history of immunosuppressants. Derived from a soil-dwelling fungus, the inhibitor was potent and had few side effects, dramatically increasing the success rate of liver transplants from 18% to 68% at the time.
Organ transplantation has made great contributions to restoring human health through surgical treatments. However, there are still a number of unresolved issues. One of them is a societal problem: the organ supply-demand imbalance. There are many people in need of organ transplants, but there are not enough donors. In South Korea, the number of people waiting for organ transplants increases significantly every year, but the number of brain-dead donors barely exceeds 250 a year. According to statistics from the National Center for Organ Transplantation and Management, the average wait for an organ transplant is four to five years. Because of this, many patients never receive an organ transplant and often die while waiting. In addition, the demand for organs exceeds the supply, leading to extreme problems such as illegal organ trafficking.
Another problem is that organ transplantation raises ethical issues related to human uniqueness and the definition of life. Organ transplantation is a technology that transcends the previously taken-for-granted boundaries of the individual body. For example, in the case of a head transplant, if all of the organs below the neck belong to someone else, who is the recipient of the head transplant? Furthermore, it raises the question of whether medical advances and money will allow people to choose their own bodies.
Organ transplantation has made great strides in introducing new values and ways of thinking about disease and expanding the range of treatments available, but the policy and ethical issues that underpin these technologies still coexist alongside the scientific advances.
