Siraj Md Sanwar
Department of Government and Politics, Jahangirnagar University, Dhaka, Bangladesh.
Asian Bioeth Rev. 2021 Apr 10;13(3):283-296. doi: 10.1007/s41649-021-00170-6. eCollection 2021 Sep.
The Human Organ Transplantation Act came into officially force in Bangladesh on April 13, 1999, allowing organ donations from both living and brain-dead donors. The Act was amended by the Parliament on January 8, 2018, with the changes coming into effect shortly afterwards on January 28. The Act was revised to extend a living donor pool from close relatives (e.g., parents, adult sons and daughters, adult brothers and sisters, uncles and aunts from both the paternal and maternal sides, and spouses) to include certain other relatives such as grandparents, grandchildren, and first cousins (Section 2:4). The Act was also revised to allow individuals to prioritize family members in receiving their organs after their death (Section 7c:3). The aim of this paper is not to carry out an ethical analysis of the Act as a whole but only to focus on aspects relating to priority access for family members to organs. Despite Islam encouraging Muslims to be sympathetic, and to save the life of any member of humankind (Quran 5:32), saving the life of a relative through organ donation is even more highly valued. The collective and extended structure of the family impacts on the provisions of the Act that only allows Bangladeshis to legally donate their organs to save the lives of relatives and allows individuals to prioritize family members. Recent progress in the practice of organ transplantation raises a number of ethical dilemmas around the allocation of available organs in the context of organ scarcity. A key purpose of introducing incentive into the system of organ allocation is to increase the number of donations from living relatives and initiation of vital organ donations from brain-dead donors. However, allocation criteria based on a living organ donation incentive system would appear to be unethical because there is no provision in the Act with regard to financial compensation for a distant relative donor's post-operative care in the absence of healthcare coverage. Receiving organs from a distant relative without giving financial compensation for post-operative care places them in a grave health condition and violates the biomedical principle of non-maleficence. An incentive system around brain-dead donors would appear to be ethical as the amended Act allows individuals to prioritize relatives in receiving their organs after death. This provision is intended to initiate the transplantation of vital organs (e.g., kidney, liver, heart, pancreas, bone marrow) from brain-dead donors as families might bear the cost of keeping the organs alive for transplantation. Regular reassessment of the impact of the Act is necessary to maximize the donation rate of transplantable organs using ethical means.
《人体器官移植法》于1999年4月13日在孟加拉国正式生效，允许活体捐赠者和脑死亡捐赠者进行器官捐赠。2018年1月8日，议会对该法案进行了修订，修订后的法案于1月28日生效。该法案修订后，活体捐赠者范围从近亲（如父母、成年子女、成年兄弟姐妹、双方的叔伯姑舅姨以及配偶）扩大到包括某些其他亲属，如祖父母、孙子女和第一代堂表亲（第2:4条）。该法案还进行了修订，允许个人在去世后优先将器官提供给家庭成员（第7c:3条）。本文的目的不是对该法案进行全面的伦理分析，而仅关注与家庭成员优先获得器官相关的方面。尽管伊斯兰教鼓励穆斯林富有同情心，并拯救人类的任何成员（《古兰经》5:32），但通过器官捐赠拯救亲属的生命更受重视。家庭的集体和扩展结构影响着该法案的规定，该法案仅允许孟加拉国人合法捐赠器官以拯救亲属的生命，并允许个人优先考虑家庭成员。器官移植实践的最新进展在器官稀缺的情况下围绕可用器官的分配引发了一些伦理困境。在器官分配系统中引入激励措施的一个关键目的是增加活体亲属的捐赠数量，并启动脑死亡捐赠者的重要器官捐赠。然而，基于活体器官捐赠激励系统的分配标准似乎是不道德的，因为该法案没有规定在没有医疗保障的情况下对远亲捐赠者术后护理进行经济补偿。在没有对术后护理给予经济补偿的情况下接受远亲的器官会使他们处于严重的健康状况，并且违反了不伤害的生物医学原则。围绕脑死亡捐赠者的激励系统似乎是符合伦理的，因为修订后的法案允许个人在去世后优先将器官提供给亲属。这一规定旨在启动脑死亡捐赠者的重要器官（如肾脏、肝脏、心脏、胰腺、骨髓）移植，因为家属可能承担维持器官存活以便移植的费用。有必要定期重新评估该法案的影响，以便用符合伦理的方式最大限度地提高可移植器官的捐赠率。
