[Ethical problems in organ transplantation].

Since the early 1960s transplantation surgery has rapidly developed into a flagship technique of modern high-tech medicine with convincing therapeutic success. However, transplantation surgery also raises a number of serious ethical issues. The majority of solid organ transplants are procured from so-called brain-dead donors, i.e., from individuals with irreversible loss of all brain functions. This imposes the question whether and how the well-defined irreversible brain death can be equated with the death of an individual. The distribution of organs from brain-dead donors raises additional ethical questions and concerns. In the face of an increasing shortage of donor organs, what are the best criteria for setting priorities among the recipients? Is it urgency, need, or cost-effectiveness of the transplantation? And how can these parameters be appropriately defined? Moreover, as living organ donation (kidney, liver) becomes rife we are faced with the question of what voluntariness means in such exceptional conditions and how voluntariness can be adequately assessed. Finally, serious ethical concerns evolve from the so-called 'transplant tourism' and 'organ trafficking', accounting for approximately 5 to 10 % of all kidney transplantations world-wide.