‘Transplant’ thought-experiments, in which the cerebrum is moved from one body to another, have featured in a number of recent discussions in the personal identity literature. Once taken as offering confirmation of some form of psychological continuity theory of identity, arguments from Marya Schechtman and Kathleen Wilkes have contended that this is not the case. Any such apparent support is due to a lack of detail in their description or a reliance on predictions that we are in no (...) position to make. I argue that the case against them rests on two serious misunderstandings of the operation of thought-experiments, and that even if they do not ultimately support a psychological continuity theory, they do major damage to that theory’s opponents. (shrink)

The paper is concerned with how neo-Lockean accounts of personal identity should respond to the challenge of animalist accounts. Neo-Lockean accounts that hold that persons can change bodies via brain transplants or cerebrum transplants are committed to the prima facie counterintuitive denial that a person is an (biologically individuated) animal. This counterintuitiveness can be defused by holding that a person is biological animal (on neo-Lockean views) if the “is” is the “is” of constitution rather than the “is” of identity, (...) and that a person is identical with an animal in a sense of “animal” different from that which requires the persistence conditions of animals to be biological. Another challenge is the “too many minds problem”: if persons and their coincident biological animals share the same physical properties, and mental properties supervene on physical properties, the biological animal will share the mental properties of the person, and so should itself be a person. The response to this invokes a distinction between “thin” properties, which are shared by coincident entities, and “thick” properties which are not so shared. Mental properties, and their physical realizers, are thick, not thin, so are not properties persons share with their bodies or biological animals. The paper rebuts the objection that neo-Lockean accounts cannot explain how persons can have physical properties. To meet a further problem it is argued that the biological properties of persons and those of biological animals are different because of differences in their causal profiles. (shrink)

Here I develop an account of our persistence that accommodates each of the following compelling intuitions: (i) that we are animals, (ii) that we existed prior to the onset of whatever psychological capacities are necessary for personhood, and we can continue to exist with the loss of those and other psychological capacities, (iii) that with suitable psychological continuity, the person goes with the brain/cerebrum in remnant person and brain/cerebrum transplant cases, and (iv) that it is possible for (...) us to survive gradual large-scale replacement of organic with inorganic parts. With the help of a couple of recent “hybrid” animalist accounts I develop an analysis of our persistence that entails (ii)–(iv) while being consistent with (i). (shrink)

The current debate regarding the suitability of anencephalics as organ donors is due primarily to misunderstandings. The anatomical and neurophysiological literature shows that the anencephalic lacks a cerebrum because of the failure of neuralplate fusion. However, even the incomplete function of an atrophic brain stem is currently accepted at law in most if not all countries as sufficient for brain life: which is to say, cessation of breathing is currently required in order to make the diagnosis of brain death. (...) Because of the extensive incompleteness of the anencephalic's brain, it is not possible to postpone death significantly by mechanical ventilation and intravenous feeding. It is acceptable to maintain life for a short period of time in order to allow organ transplantation subsequent to the declaration of death at the point of cessation of the capacity for spontaneous respiration. The most important issue is not transplantation, but the issue of brain life raised by the case of anencephalics. Since brain life in any significant sense begins only after the closure of the neural tube on the 30th day after conception, it is reasonable to take this as the point at which brain life begins. Laws should be amended in all countries to allow the abortion of anencephalics at any time, in that they do not at any time possess brain life. (shrink)

Animalism is prima facie the most plausible view about what we are; it aligns better with science and common sense, and is metaphysically more parsimonious. Thought experiments involving the brain, however, tend to elicit intuitions contrary to animalism. In this paper, I examine two classical thought experiments from the literature, brain transplant and cerebrum transplant, and a new one, cerebrum regeneration. I argue that they are theoretically possible, but that a scientifically informed account of what would (...) actually happen shows that in none of the cases would the person be separated from the animal. Our intuitions in these cases, when adequately informed by neuroscience, do not conflict with animalism – rather, they suggest a correction of the animalist position: the persisting animal should be at least minimally sentient. Sentience animalism is a new formulation of the animalist account of personal identity that allows us to reconcile facts about our biological persistence conditions with the intuition that human persistence should involve some kind of psychological continuity. (shrink)

It is worthwhile comparing Hylomorphic and Animalistic accounts of personal identity since they both identify the human animal and the human person.The topics of comparison will be three: The first is accounting for our intuitions in cerebrum transplant and irreversible coma cases. Hylomorphism, unlike animalism, appears to capture “commonsense” beliefs here, preserves the maxim that identity matters, and does not run afoul of the Only x and y rule. The next topic of comparison reveals how the rival explanations (...) of transplants and comas are both at odds with some compelling biological assumptions. The third issue deals with our practical concerns, most notably, the possibility of an afterlife. It turns out that the hylomorphic treatment of Purgatory raises the spectra of the “too many thinkers” problem and some considerable unfairness. Contrary to expectations, an animalist insistence on uninterrupted bodily continuity between this life and the next does not involve deceptive body snatching. (shrink)

Animalism, the view that human persons are human animals in the most straightforward, non-derivative sense, is typically taken to conflict with the intuition that a human person would follow her functioning cerebrum were it to be transplanted into another living human body. Some animalists, however, have recently called into question the incompatibility between animalism and this “Transplant Intuition,” arguing that a human animal would be relocated with her transplanted cerebrum. In this paper, we consider the prospects for (...) this cerebrum transplant-compatible variant of animalism, which we call “Transplanimalism.” After presenting its account of three related thought experiments, and outlining its key advantages over Standard Animalism, we raise two concerns for Transplanimalism. First, we argue that Transplanimalism, like other closest-continuer accounts of the human person, encounters difficulties with symmetrical fission cases. Second, we introduce a new thought experiment that pushes Transplanimalism into surprisingly counterintuitive results. As a result of these concerns, we conclude that, despite its attractiveness, animalists should not endorse Transplanimalism. (shrink)

Sydney Shoemaker has argued that, because we can imagine a people who take themselves to survive a 'brain-state-transfer' procedure, cerebrum transplant, or the like, we ought to conclude that we could survive such a thing. I claim that the argument faces two objections, and can be defended only by depriving it any real interest.

Brain transplants and the dicephalus (an organism just like us except that it has two cerebrums) are thought to support the position that we are essentially thinking creatures, not living organisms. I try to offset the first of these intuitions by responding to thought experiments Peter Unger devised to show that identity is what matters. I then try to motivate an interpretation of the alleged conjoined twins as really just one person cut off from himself by relying upon what I (...) take will be the reader's disagreement with Locke's conjecture that a dreaming Socrates and an awake Socrates are two distinct people. (shrink)

The paper presents considerations that weigh against one or another version of the psychological continuity theory of personal identity over time. Such Locke-like theories frequently go wrong, it is argued, in not formulating precisely how the psychological states of an individual person are related diachronically, in failing to capture a truly appropriate causal connection between later and earlier psychological states, and in claiming support from particular cases. In addition, the paper offers examples and other considerations that support an alternative, biological (...) continuity theory according to which you and I are each identical with a human organism. (shrink)

본 논문은 현대 개인동일성 이론의 주류를 점하고 있는 심리주의와 생체주의의 개인동일성 규준을 명확히 하고, 이를 중심으로 개인동일성이 도덕적 책임 귀속의 필요조건인지 여부를 탐색한다. 심리주의는 우리가 특정한 종류의 심리적 특성을 유지함으로써 존속한다고 본다. 본 논문은 로크의 기억이론과 파핏-슈메이커류의 신(新)로크주의를 검토하면서 심리주의의 핵심주장을 분명히 한다. 특히 심리적 연결과 심리적 연속성의 개념을 명료히 함으로써 심리주의는 심리적 연속성을 개인동일성의 필요충분조건으로 간주한다는 점을 밝힌다. 한편 생체주의는 우리가 인간유기체의 종적 특성을 보존함으로써 존속한다고 본다. 본 논문은 생리적 연속성의 개념적 분석을 통해 생체주의는 생리적 연속성을 개인동일성의 필요충분조건으로 간주한다는 (...) 점을 밝히고, 생체주의가 심리주의에 대한 기존의 대안이론인 개인동일성에 대한 신체적 접근과 어떻게 다른지 논의한다. 이처럼 심리주의와 생체주의의 핵심주장을 정리한 다음 본 논문은 양자가 양립불가능하다는 점을 논증한다. 개인동일성과 도덕적 책임 귀속의 문제와 관련하여, 본 논문은 대뇌 이식과 분열의 사례를 검토함으로써 생체주의와 심리주의가 각각 개인동일성이 도덕적 책임 귀속의 필요조건이 아님을 함축한다는 것을 논증한다. 대뇌 이식의 경우 수혜자는 증여자의 성품과 성향, 반응태도 등 도덕적 책임의 귀속과 관련 있어 보이는 심리적 특성을 가질 수밖에 없다. 그러나 생체주의는 두 사람이 동일한 인물이 아님을 함축한다. 반면 심리주의는 심리적 연속성을 개인동일성의 필요충분조건으로 간주함으로써, 개인동일성이 도덕적 책임의 필요조건임을 함축하는 것처럼 보인다. 그런데 분열의 사례에서 분열하기 이전의 행위에 대한 책임은 분열 이후의 두 사람에게 귀속되는 것처럼 보인다. 그러나 분열 이전의 개인은 분열 이후의 두 사람 중 어느 누구와도 동일하지 않다. (shrink)

Both advocates and opponents of the animalist view that we are fundamentally biological organisms have typically assumed that animalism is incompatible with intuitive verdicts about cerebrum isolation and transplantation. It is argued here that this assumption is a mistake. Animalism, developed in a natural way, in fact strongly supports these intuitive verdicts. The availability of this attractive resolution of a central puzzle in the personal identity debate has been obscured by a range of factors, including the prevalence in contemporary (...) metaphysics of a certain conception of the nature of organisms. I end by explaining how the animalist can use intuitive verdicts, usually thought to present a difficulty for the view, as positive evidence for claims about the persistence conditions of the relevant kind of organism. (shrink)

I respond to criticisms by David Mackie of my previous paper on animalism and Lockeanism. I argue that the ‘transplant intuition’, that a person goes where his brain (or cerebrum) goes, is compatible both with animalism and Lockeanism. I give three arguments for this conclusion, two of them developing lines of thought in Parfit's work. However, I accept that animalism and Lockeanism are incompatible, and I go on to consider the difficulties for Lockeanism that this raises. The principal (...) difficulty, concerning the reference of ‘I’, can be met by distinguishing the thinker of an ‘I’‐thought from the reference of an ‘I’‐thought. The reference is always the person thinking the thought, but when the thought is simultaneously that of an animal coincident but non‐identical with that person, there is not a unique thinker. Mackie's criticisms of this view are ineffective. (shrink)

Shoemaker maintains that when a functionalist theory of mind is combined with his belief about individuating properties and the well-known cerebrumtransplant thought experiment, the resulting position will be a version of the psychological approach to personal identity that can avoid The Problem of Too Many Thinkers. I maintain that the costs of his solution—that the human animal is incapable of thought—are too high. Shoemaker also has not provided an argumentagainst there existing a merely conscious being that is not essentially self-conscious (...) but is spatially coincident with a person who is essentially self-conscious. Both the person and the merely sentient being will be transplanted when the cerebrum is. And another thought experiment will make it impossible for Shoemaker to identify the person and the merely conscious being. (shrink)

One might expect functionalism to imply that personal identity is preserved through various operations on the brain, including transplantation. I argue that this is not clearly so even where the whole brain is transplanted. It is definitely not so in cases where only the cerebrum is transplanted, a conceivable kind of hemispherectomy, and even certain cases in which the brain is "gradually" replaced by an inorganic substitute. These results distinguish functionalism from other accounts taking what Eric T. Olson calls (...) the "Psychological Approach" to personal identity, enabling it to avoid some of his objections to them. (shrink)

The possibility of a human head transplant poses unprecedented philosophical and neuroethical questions. Principal among them are the personal identity of the resultant individual, her metaphysical and social status: Who will she be and how should the “new” person be treated - morally, legally and socially - given that she incorporates characteristics of two distinct, previously unrelated individuals, and possess both old and new physical, psychological, and social experiences that would not have been available without the transplant? We (...) contend that this situation challenges linguistic conventions and conceptual binaries, and calls into question the major philosophical approaches to personal identity: animalism and reductionism. We examine these views critically vis-a-vis head transplantation and conclude that they fail to provide an adequate account of the identity of the resultant individual because both neglect the key role of embodiment for personal identity. We maintain that embodiment is central to personal identity and a radical alteration of the body will also radically alter that person, making her a different person. Consequently, a human head transplant will result in an individual partly continuous with the head/brain, and partly continuous with the body donor. We conclude that the resultant person would be different from both the individual whose head was transplanted and the one to whose body the “new” head is attached. (shrink)

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness requires a process of re-identification. Medical (...) interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has. (shrink)

In this paper, we thoroughly investigate the various solutions proposed to solve the problems of transplantation system in Romania. Three types of solutions are especially envisaged: legislative ones, institutional ones and cultural/religious ones. We carefully analyze the main ethical and logistical arguments on presumed consent and its alternatives in Romania: family consent provided by the relatives and mandated choice. Special attention is dedicated both to institutional solutions (organizational, educational and information issues) and to religious arguments and motivations, for there were (...) several indicators of their importance for Romanian bioethical discourse in general and for their prevalence in transplantation debates in particular. . (shrink)

Uterus transplants provide another treatment for infertility. Some might think that we should embrace such transplants as one more way to assist people to have children. However, in this paper I argue that uterus transplants are not something that we ought to fund, nor something that we should make easy to access. First, I argue that any justification of providing uterus transplants must be based on the value of the experience of gestation, rather than on claims of meeting medical need (...) or promoting normal functioning. Second, I demonstrate that such a justification has limited prospects of success. The value of experiencing gestation is unlikely to be sufficient to justify state funding of uterus transplants and, further, we have reason to refrain from enabling such transplants. (shrink)

This volume provides a unique overview of methodologies that are conducive to a successful legal transplant in East Asia and Oceania. Each chapter is drafted by a scholar who holds direct professional experience on the legal transplant considered and has a distinctive insight into the pragmatic difficulties related to grafting an alien institution into a legal tradition. The range of transplants includes the implementation of contractual obligations, the regulation of commercial investments and the protection of the environment. The (...) majority of recent legal reforms in these geographical areas have aimed at improving national economic performance and fostering trade and have been directly inspired by European and North American institutional experiences. There is also, however, a tendency to couple economic reforms, aimed at attracting foreign investment, with constitutional reforms that improve the protection of individual rights, the environment and the rule of law. (shrink)

Transplantation is becoming an increasingly more common approach to treatment of diseases of organ failure, making organ donation an important means of saving lives. Most world religions find organ donation for the purpose of transplantation to be acceptable, and some even encourage members to donate their organs as a gift of love to others. Recent developments, including artificial organs, transplants from nonhuman species, use of stem cells, and cloning, are impacting the field of transplantation. These new approaches should be discussed (...) with bioethical considerations in mind, particularly the notion of human beings as a unity of body and spirit. (shrink)

Uterus transplantation (UTx) research has been introduced in several countries, with trials in Sweden and the United States producing successful outcomes. The growing interest in developing UTx trials in other countries, such as Spain, the Netherlands, Japan, and Australia, raises important questions regarding the ethics of surgical innovation research in the field of UTx. This paper examines the current state of UTx in the context of the surgical innovation paradigm and IDEAL framework and discusses the ethical challenges faced by those (...) considering the introduction of new trials. We argue that UTx remains an experimental procedure at a relatively early stage of the IDEAL framework, especially in the context of de novo trials, where protocols are likely to deviate from those used previously and where researchers are likely to have limited experience of UTx. We conclude that countries considering the introduction of UTx trials should build on the strengths of the reported outcomes to consolidate the evidence base and shed light on the uncertainties of the procedure. Authorities responsible for the ethical governance of UTx trials are advised to draw on the ethical framework used in the oversight of surgical innovation. (shrink)

The development of transplantation technology increasingly places before society a multitude of diverse, complex ethical and legal problems. The subject is the more complex because of the various divergent interests involved. There are the interests of the donor of organs, who has a right to protection of his legal position, and those of the patient in need of an often lifesaving organ. There are also the interests of the donor’s relatives, after his death, and those of the transplantation surgeons. The (...) international dimension of transplantation technology makes the picture even more complicated. Though this article is devoted to the European situation, the problems are similar all over the world. (shrink)

Brain transplant thought experiments figure prominently in the debate on personal identity. Such hypotheticals are usually taken to provide support for psychological continuity theories. This standard interpretation has recently been challenged by Marya Schechtman. Simon Beck argues that Schechtman's critique rests upon ‘two costly mistakes’—claiming that (1) when evaluating these cases, philosophers mistakenly try to figure out the intuitions that they think people inhabiting such a possible world ought to have, instead of pondering their own intuitions. Beck further asserts (...) that (2) brain transplant thought experiments cannot confirm any given theory of personal identity but rather they can only rule out theories. I argue on grounds of the social ontology of personhood that Beck has things back to front. Since our concept of personhood is shaped and informed by contingent de facto norms and structures of the natural world, and as such is heavily normatively laden, the conceptual genesis of personhood must be taken into account. This calls for constructing thought experiments as realistically as possible in order to trigger reliable intuitions. Furthermore, drawing on recent evidence from cognitive science, an empirically informed look at brain transplant thought experiments considering ‘Embodied Cognition’ reveals that Beck's arguments not only fall short for supporting psychological continuity theories, but also suggests an advantage of Schechtman's ‘Person Life View’. (shrink)

This book analyzes the reasons for organ shortage and ventures innovative ideas for approaching this problem. It presents 29 contributions from a highly interdisciplinary group of world experts and upcoming professionals in the field. Every year thousands of patients die while waiting for organ transplantation. Health authorities, medical professionals and bioethicists worldwide point to the urgent and yet unsolved problem of organ shortage, which will be even intensified due to the increasing life expectancy. Even though the practical problem seems to (...) be well known, the search for suitable solutions continues and often restricts itself by being limited through disciplinary and national borders. Combining philosophical reflection with empirical results, this volume enables a unique insight in the ethics of organ transplantation and offers fresh ideas for policymakers, health care professionals, academics, and the general public. (shrink)

Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. There have been philosophical inquiries concerning uterus transplantation in genetically XY women, which includes transgender women and women (...) with complete androgen insufficiency syndrome. We discuss the potential medical steps necessary and associated risks for uterus transplantation in genetically XY women. Presently, the medical technology does not exist to make uterus transplantation a safe and effective option for genetically XY women, however this group should not be summarily excluded from participation in trials. Laboratory research is needed to better understand and reduce medical risk and widen the field to all women who face uterine factor infertility. (shrink)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for (...) an organ leaves U.S. transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China. (shrink)

Head transplantation fits within the broader conceptual space occupied by transhumanists and others who seek to extend the lives of human beings indefinitely. It is reasonable to reflect on whether, under what circumstances, and in what ways human immortality would be good. In this paper, I disambiguate the ways in which immortality might be considered a human good and then argue that immortality is neither necessary nor sufficient condition for objective meaning in life. I also argue that mortality is not (...) a necessary condition for objective meaning in life. (shrink)

In Nepal, live donor organ transplantation is only 14 years old with the first successful kidney transplant made in 2008 and a successful liver and bone marrow transplant made in 2016. However, transplantation of cadaveric cornea dates back to 1998. There are still no cases of animal-to-human organ transplantation in Nepal. There are stringent laws to regulate human body organ transplantation in Nepal which are amended from time to time. However, there is a racket of human traffickers who (...) lure rural people from this low-income country into the illegal organ trade. Furthermore, there is a substantial lack of awareness of organ donation among the general public. This article focuses on the stipulations of ethical, legal, and practical issues of obtaining organs procured from living and brain-dead donors that support the process of transplantation in Nepal. In addition, the article also explores the legal and practical issues of organ trafficking and organ donation awareness in Nepal on the basis of factual data and findings from other studies. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

Canada has a marked shortfall between the supply and demand for kidneys for transplantation. Median wait times for deceased donor kidney transplantation vary from 5.8 years in British Columbia, 5.2 years in Manitoba and 4.5 years in Ontario to a little over 2 years in Quebec and Nova Scotia. Living donation provides a viable option for some, but not all people. Consequently, a small number of people travel abroad to undergo kidney transplantation by commercial means. The extent to which they (...) are aware of the potential risks to their health and the health of the kidney vendors is unclear. Travel abroad to obtain a kidney commercially i.e. transplant tourism (TT), raises ethical issues which include the exploitation of the poor, uncertainty of donor informed consent to nephrectomy, poor clinical care and lack of follow up for the donor, commodification of the body and inequity of access to medical care for donors. Also, TT widens socioeconomic disparities in access to transplantation, differing from the Canadian system of universal coverage for healthcare. The Canadian transplant community has discussed how to respond to patients who plan to travel abroad for TT or return with a purchased kidney. Unease rests in the tension between the duty to care for legitimate Canadian residents and the unwillingness to enable TT. This paper discusses three anonymized cases and the Canadian responses to TT as recorded in academic literature and a formal statement by relevant professional bodies. (shrink)

According to the International Register of Organ Donation and Transplantation, Japan is one of the countries with the lowest number of registered deceased donors. In 2019, Japan was ranked 61st out of 70 countries. The authors of this article have decided to explore the reasons for this phenomenon. In the first part of the work, religious influences (Shinto and Buddhism), the tradition of gotai manzoku, the importance of altruism and the family in the perception of death and organ transplantation by (...) the Japanese are considered. The second part of the article presents the arguments of Alan Shewmon, who believes that brain death is not death in the biological sense. Undermining the brain’s death criterion raises doubts concerning death of patients in irreversible coma, what in result discourages transplantology in Japan. In the third part, the authors compare the results of JOTN, IRODaT and the Fact Book of Organ Transplantation 2018 in Japan from 2010 to 2018. The aim of the article is to explain the cultural determinants of transplantology in Japan, taking into account the influence of philosophical and bioethical aspects of human death. (shrink)

In this paper, changes in identity and selfhood experienced through organ transplantation are analyzed from a phenomenological point of view. The chief examples are heart and face transplants. Similarities and differences between the examples are fleshed out by way of identifying three layers of selfhood in which the procedures have effects: embodied selfhood, self-reflection, and social-narrative identity. Organ transplantation is tied to processes of alienation in the three layers of selfhood, first and foremost a bodily alienation experienced through illness or (...) injury and in going through and recovering from the operation. However, in cases in which the organ in question is taken to harbor the identity of another person, because of its symbolic qualities (the heart) or its expressive qualities (the face), the alienation process may also involve the otherness of another person making itself, at least imaginatively, known. (shrink)

The principal focus of this paper is to consider the implications of head and neck transplantation surgery on the issue of personal identity. To this end, it is noted that the immune system has not only been established to impose a level of self-identity on bodily cells, it has also been implicated in mental development and the regulation of mental state. In this it serves as a paradigm for the mind as the product of cephalic and extracephalic systems. The importance (...) of bodily systems in identity is then discussed in relation to phantom tissue syndrome. The data strongly indicate that, even if surgically successful, head and neck transplantation will result in the loss of the continuity of personal identity. (shrink)

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. (shrink)

Uterus transplants (UTx) provide women without a uterus the possibility of experiencing gestational motherhood. This paper delineates the complex bioethical landscape surrounding UTx, focusing on the critical aspects of informed consent, risk–benefit analysis, justice considerations, and the distinct challenges encountered by both donors and recipients. While not discussing UTx directly, John Harris’ seminal work, The Value of Life: An Introduction to Medical Ethics (1985) in its advocacy for reproductive freedom and informed consent provides an informative starting point for the discussion. (...) As an example, UTx is analyzed within the socio-political context of Mexico. The impact of the Mexican healthcare and legal systems on UTx procedures is discussed and the regulatory measures necessary to ensure that UTx is conducted ethically and equitably are outlined. (shrink)

Organ availability for transplantation has become an increasingly complex and difficult question in health economics and ethical practice. Advances in technology have seen prolonged life expectancy, and the global push for organs creates an ever-expanding gap between supply and demand, and a significant cost in bridging that gap. This article will examine the ethical implications for the nursing profession in regard to the procurement of organs from an impoverished seller’s market, also known as ‘Transplant Tourism’. This ethical dilemma concerns (...) itself with resource allocation, informed consent and the concepts of egalitarianism and libertarianism. Transplant Tourism is an unacceptable trespass against human dignity and rights from both a nursing and collective viewpoint. Currently, the Australian Nursing and Midwifery Council, the Royal college of Nursing Australia, The Royal College of Nursing (UK) and the American Nurses Association do not have position statements on transplant tourism, and this diminishes us as a force for change. It diminishes our role as advocates for the most marginalised in our world to have access to care and to choice and excludes us from a very contemporary real debate about the mismatch of organ demand and supply in our own communities. As a profession, we must have a voice in health policy and human rights, and according to our Code of Ethics in Australia and around the world, act to promote and protect the fundamental human right to healthcare and dignity. (shrink)

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of (...) severe resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants. (shrink)

The paper presents the emergence of the concept of xenotransplantation which is a relatively new issue in the literature on the subject. It is due to the fact that transplants of animal organs are currently in the experimental phase. The main current problem of transplantology is the shortage of organs; hence, the search for new solutions has become an everyday challenge. If a way for the human body to tolerate animal organs could be found, transplant medicine and humanity would (...) be in a completely different place. The authors introduce the concepts of transplantation and xenotransplantation and their origins, then they raise ethical issues related to this type of organ transplantation. Finally, the authors conclude that xenotransplantations have a chance to be “incorporated” in the “transplants” category when the experimental phase of xenotransplantation shifts to the implementation stage. Time will tell whether it will be possible. (shrink)

This paper urges reconsideration of analyses of the alternatives to reproductive uterus transplantation (UTx). I focus here specifically on the adoption alternative. Importantly, my purpose is not to oppose UTx provision. Rather, it is to propose ways in which ethical analysis and provision of UTx can potentially accommodate the concerns discussed here. I argue that the adoption alternative to UTx is too readily dismissed, and that this is a dismissal with significant moral costs. I suggest that the radical nature of (...) UTx as a form of assisted reproduction calls for an equivalently radical socio‐moral agenda for reform and transformation of adoption law, policy and practice, as well as of the norms that prevail within our presently strongly bio‐normative reproductive context. In doing so I widen the ethical frame of responsible provision of assisted reproduction to encompass not just obligations towards donors and recipient, but also our broader social responsibilities to ensure that we are doing our best to meet the significant needs of some of the most vulnerable members of our society. (shrink)

On being told that "translation is an impossible thing," Anatole France replied: "precisely, my friend; the recognition of that truth is a necessary preliminary to success in art." The task of Transplantings is to add flesh and bones to that familiar quip. Indeed, Daniel Weissbort notes that Viereck's study represented a sixty-five year long project. Now, it is finally being brought to print in its full form, with the completion of the final manuscript shortly before Viereck's death. If translation is (...) a special genre in its own right, the translation of poetry, especially from major foreign languages, is a special subset of that genre. What emerges in the imperfect act of translation is an aesthetic dimension that Viereck considers unique in its own right. Transplantings provides new insight into Viereck as a poet of substance, but more than that as a public intellectual. He is critical in probing the work of the major figures such as Stefan George and Georg Heym. To round out this monumental new look at German poetical history, Viereck reviews Goethe, Novalis, and Rilke among others. For Viereck, the difference between the poetical and the political is critical. The quality of poetry is not measured by politics, nor can the worth of political action be defined by commitment to the poetical. The experience of German thought, as well as French and Italian efforts, reveals a divide that can be narrowed but hardly bridged by rhetoric. Transplantings does not simplify the task of the reader. Rather it shows without doubt that the passion of great poetry is part of a national tradition. Efforts at translation indicate how such poetry becomes part of an international culture. This is a major work by one of the great thinkers of the twentieth century. It merits reading, and then, re-reading. "Peter Viereck was that rare scholar who captured the European experience with America, while fully realizing the American encounter with Europe. He did so with consciousness of and compassion for both sectors of Western Civilization" --Irving Louis Horowitz, Society Peter Viereck was a Pulitzer Prize-winning poet, critic, and historian. He held the Kenan Chair in History at Mount Holyoke College. He was known as one of America's conservatism's early leaders and was the recipient of Guggenheim Fellowships both in history and poetry. (shrink)

Face transplantation is a landmark in reconstructive surgery involving vascularised composite allotransplantation. A recent issue of FT for patients who are blind has arisen. Some bioethicists recommend not excluding a patient who is blind, as this may amount to discrimination. From an ethical standpoint, FT for those with blindness is appropriate in selected candidates. This article seeks to add to the clinical evidence supporting FT for those with blindness by detailing a complementary psychosocial perspective. Currently, there is little relevant research (...) about the subjectivity of the blind. This is critical since the arguments against FT for the blind refer to their inability to see their face and to view the reaction of others to their disfigured faces. We begin with a brief look at examples of FT involving blindness and associated arguments. The next part is a multidisciplinary investigation of the experiences of the blind. These are gleaned from a close reading of the literature and drawing inferences, as direct studies are rare. The discussion analyses identity themes of the blind in relation to their faces: as they experience it; the face they wish to show to the world; and how others perceive and react to their face in a saturated environment of imagery and visual communication. Disability and the blind person’s experience of faces are well-founded considerations for medical practitioners and ethics boards in the process of FT decision-making. (shrink)

Developing World Bioethics, Volume 21, Issue 3, Page 111-122, September 2021.

Originally published in 1990, this study of the moral problems bound up with transplant therapy addresses a finely balanced distinction between ethical issues relating to its experimental nature on the one hand and those which arise when transplantation is routine on the other. Among the issues examined are proposals for routine cadaveric harvesting, criteria for organ and tissue procurement from living donors, foetuses, non-human animals and current ethical problems with artificial implants. Written as a contribution to practical philosophy, this (...) book will interest ethicists and health care professionals. (shrink)

Standardizing consultation processes is increasingly important as clinical ethics consultation becomes more utilized in and vital to medical practice. Solid organ transplant represents a relatively nascent field replete with complex ethical issues that, while explored, have not been systematically classified. In this paper, we offer a proposed taxonomy that divides issues of resource allocation from viable solutions to the issue of organ shortage in transplant and then further distinguishes between policy and bedside level issues. We then identify all (...) transplant related ethics consults performed at the Cleveland Clinic between 2008 and 2013 in order to identify how consultants conceptually framed their consultations by the domains they ascribe to the case. We code the CC domains to those in the Core Competencies for Healthcare Consultation Ethics in order to initiate a broader conversation regarding best practices in these highly complex cases. A discussion of the ethical issues underlying living donor and recipient related consults ensues. Finally, we suggest that the ethical domains prescribed in the Core Competencies provide a strong starting ground for a common intra-disciplinary language in the realm of formal CEC. (shrink)

Cognitive deficits were produced in rats by different methods of damaging the brain: chronic ingestion of alcohol, causing widespread damage to diffuse cholinergic and aminergic projection systems; lesions (by local injection of the excitotoxins, ibotenate, quisqualate, and AMPA) of the nuclei of origin of the forebrain cholinergic projection system (FCPS), which innervates the neocortex and hippocampal formation; transient cerebral ischaemia, producing focal damage especially in the CA1 pyramidal cells of the dorsal hippocampus; and lesions (by local injection of the neurotoxin, (...) colchicine) of the granule cells of the dentate gyrus. Following chronic alcohol or lesions of the FCPS, transplants of cholinergically rich fetal brain tissue into the terminal areas (neocortex and/or hippocampus) restored performance almost to control levels, with a time course consistent with growth of the transplants and integration with host tissue; transplants of cholinergically poor fetal tissue (hippocampus) were without effect, as were transplants of cholinergically rich tissue into the region containing the nuclei of origin of the FCPS. Grafts of primary cells enriched in glia and cultured neuroblastoma cells into the terminal areas of the FCPS were equally effective, suggesting that there are multiple mechanisms by which neural transplants can restore cognitive function following diffuse cholinergic damage. In contrast, after ischaemia- or neurotoxin-induced damage to CA1 or dentate granule cells respectively, cholinergically rich fetal transplants into the damaged hippocampal formation were ineffective in restoring performance. After ischaemic damage, however, performance was restored by suspension grafts of CA1 cells but not by transplants containing CA3 pyramidal cells or granule cells; and after colchicine damage it was restored by solid grafts containing granule but not CA1 pyramidal cells. Furthermore, electrophysiological evidence has demonstrated functional, graft type-specific host-graft functional neuronal connectivity. Thus, restoration of cognitive function by neural transplants is possible after damage to either diffuse (cholinergic) or point-to-point (intrahippocampal) forebrain systems, but the transplant must be appropriate to the damage to be repaired. Because the different types of brain damage studied provide analogues of human alcoholic dementia, Alzheimer's disease, and heart attack, these results are encouraging with regard to the eventual application of neural transplant surgery to the treatment of cognitive deficits in humans. (shrink)