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Lungs don't grow on trees: The ethics of increasing organ donation rates for transplantation and their relevance to the Asia‐Pacific region

Since the first successful lung transplant operation in 1983, over 25 000 patients have received lung allografts, and worldwide lung transplantation (LTx) is now an established therapy for individuals with severe lung or pulmonary vascular disease. Despite this, the uptake of LTx as a treatment option in the Asia-Pacific region is not uniform, with considerable variation between countries. This heterogeneity reflects inherent cultural and society differences that exist between nations, but also, highlights the many ethical deliberations that transplantation in general, represents for any society. This review aims to illuminate a number of the contemporary ethical donor issues that frame the context and applicability of LTx across Asia-Pacific societies. For those countries that do have active LTx programmes, there is a growing disparity between the number of patients waiting for transplant and availability of donor lungs, reflecting that the demand for transplantable organs continues apace despite static organ donation rates. The shortage of legally donated organs has led to strenuous efforts to increase the organ donor pool. Public education initiatives that espouse the merits of organ donation as a ‘Gift of Life’, have unfortunately, only had minimal impact on increasing organ donation rates (http:// www.australiansdonate.org.au/11655+0+facts-andfigures.htm#, accessed June 5 2007). Beyond this, individual centres have developed novel strategies to further increase rates of LTx. These include the use of extended-criteria donor lungs, donation-after-cardiac death (DCD) retrieval of lungs (as distinct from the usual donation-afterbrain death), and living-related lobar transplants. The shortage of donor organs has also, unfortunately, led to less ethical and morally questionable practices such as organ trafficking and the use of executed prisoners as organ donors. Each of these strategies is laden with its own specific ethical challenges.