View on donated life: Construction of philosophical ethics on human organ donation.

With the emergence of organ donation and donation technology, the previous indivisibility of the human body becomes divisible, and different human organs form a new life subject. With reference to specific case studies in China, a new life, consisting of donated organs from different bodies by donation, can be called "donated life." Donated life is a win-win action between altruism and egoism, that is, to save the lives of others and to regenerate the organs of donors or their relatives. Due to the emergence of this kind of life, traditional social ethics theories based on the marriage-related family find it difficult to difficult to explain the new realities. Thus, new thinking about social ethics is necessary.

INTRODUCTION

Organ donation and transplantation, for donors, is a kind of helplessness from death, while for recipients, it represents the hope of survival. The technology of organ transplantation provides a place for philosophers and social scientists to structure new concepts and theories. We have previously put forward a “new view on life” and “new view on filial piety,”1 which are helpful in understanding the value of organ donation. But now it seems that these previous studies are far from enough. It is necessary to build the corresponding ethical concept of philosophy of science and technology, to accept and support the promotion of the technology in public health, its acceptance in mass psychology, and its advocacy in social culture, and subsequently, to establish support mechanisms in the social system. It is of great practical significance for medical ethics scholars to go deep into the subject and experience the actual and moral situations of organ donation and transplantation for academic research and theoretical innovation. (Human organ donations include cadaver organ donation and living organ donation, and the organ donation in this article refers to cadaver organ donation.) We shall examine two case studies.

“DONATED LIFE”: A NEW CONCEPT OF LIFE THAT URGENTLY NEEDS TO BE ESTABLISHED

Case 1: Renewal of Guoguo2

Guoguo, named Yu Yixuan, a 13‐year‐old girl of sunny disposition from Chongqing, China, liked writing novels, poetry, and drawing pictures. Guoguo always felt that time was precious, and cherished every minute. Unfortunately, she left us forever. On the morning of September 21, 2016, Guo Shuang, her mother, a researcher on child psychology, got a call from the schoolteacher, saying that her child could not stop vomiting and had felt uncomfortable since midnight. She suggested the parents send Guoguo to the hospital immediately. At noon, the child was sent directly to the intensive care unit due to respiratory failure.

It was so sudden that Guo Shuang and her husband were totally unprepared. The top authoritative chiropractic neurologists in Chongqing advised that there was no opportunity for an operation.

The family fell into the depths of despair overnight. On the early morning of September 22, the ICU director expressed his condolences to them for losing their child and hoped they would accept the brutal fact. The director also told them that if they were willing, there was another option to keep Guoguo alive. Before the director mentioned the words, they suddenly understand the implication and blurted out, “Organ donation, we agree.”

From that moment on, they calmed down, and, even found some small comfort in their hearts. “Absolutely, our daughter can continue to live in this way, and she will be born again!” “Her heart can beat in another person’s chest, her liver can save one who waits in hope, her kidneys can save two lives, and her corneas can help two people to regain their eyesight. Her organs will be in the bodies of several people who can go on to live healthy lives… ,”

The couple were invited to the 2017 Memorial and Promotion Campaign of China Human Organ Donation and delivered a speech. “This is the most valuable, meaningful and right decision we’ve made in our lives. Looking at the smiling faces of the recipients, we feel sheer joy deep in our hearts. So we are grateful for the program of organ donation, grateful to the people who accept our child's organs, so that our daughter's life can be reborn in another form. More families can find happiness with these donations." The mother added, “The smiling faces of the donees and their families, who have regained their new lives, are also the best gift for me and my family.”

The "renewal" of Guoguo and her mother's words totally reflect the value of organ donation in this real case. Also it shows the importance of timely communication with donor families, such as parents, during the donation process.

With the development of three technologies of vascular anastomosis, organ preservation and immunosuppression, human organ transplantation technology is developing and maturing. At present, 1.3 million people worldwide have received organ transplants, and more than 50,000 people receive organ transplantation globally each year. After careful consideration, we found that organ transplant technology not only saves lives and restores health, but at the same time gives people more philosophical and ethical information on the life sciences.

The previous view on life held that human life is a complex system with a multilayered structure, which has an essential unity, not separable into parts.3 The emergence of organ donation technology changed people’s views on the relationship between the whole and the parts in a life system, from an inseparable unity to a local separability, from fragility to tenacity. In other words, the original unified integrity of a human body became independent, detachable parts. Led by modern science and technology, the independent organs in vitro can live as an independent unit for a certain time, which creates the conditions and possibilities for the organs from a dying body to be transplanted into another body. So a new life is recreated. This new reborn life created by donation can be called “donated life,” which forms the viewpoint which we call “view on donated life.” This profound change in human organs and life brought about by science and technology has to become fundamentally reacquainted with the value of philosophy and social science. This opens the way for a new moral consensus,4 so as to support and standardize it.

Life as traditionally understood stems from heredity and reproduction, and is produced by the sexual intercourse of parents. It is the result of natural evolution and is the most brilliant flower in the universe. However, with the development of science and technology, the method of transplantation can be used to endow the dying with a new life. This renewal, on the premise of other organ donation, as a new way of life, changes the model of human life. “Reborn life” refers to the recipient's life after organ transplantation, from the viewpoint of subject consciousness. It may also be treated as a new kind of shared life, because from the perspective of the completeness of life’s constituent, it is a new life form of “you have me, I have you.” It explores a new form which mixes lives together, and provides a new way to safeguard the human being. It has enriched the connotation of philosophy and social science. It has a huge impact on and challenge to traditional social culture. There is a need to strengthen philosophical and social science research on donated life in China.

LIFE DONATION IS A WIN‐WIN BEHAVIOR FOR BOTH SIDES

In recent years, a wide variety of discussions have focused on the substantial changes that artificial life has made in social ethical relations and related issues of social ethics. By contrast, attention to changes in the fundamental social ethics of life caused by life donation is far from enough, while ethical issues in the process of organ donation and transplantation operation are much discussed. Artificial life generated by technology and other means is on the level of human genes and cells, when the person's life consciousness, also termed personality, has not yet formed, so it only involves such issues as moral relations between the maker and the cellular genetic source, not the conscious, ethical, and emotional problems of the main body itself. By contrast, organ transplant life is different. Its locus is life with subject consciousness, namely life with personality, and will naturally involve such problems as moral relations and emotional entanglements, which is the most fundamental difference between organ donation and other forms of artificial life.

Human life can continue with sustenance from transplanted organs, even when important organs essential for the maintenance of life fail to work and/or are damaged. The fundamental change in organ value must be simultaneously paralleled by changes in people’s values. Modern science and technology enable the separation of the human body into independent survivable life organs when transplanted to another person, thus facilitating the sharing of life between donor and recipient. It is a win‐win situation of modern science and technology, and human life. In the past, many academics have held that “altruism is one of the motivations of donation."5 “Donating life” has become an important form of life existence, health restoration and life regeneration. Therefore, it is necessary to put forward the notion of "donated life," which will be further explored in the second case study.

Case 2: Three letters from Wu Yue‐the recipient, to the donor6

In September 2013, Wu Yue, a girl from Nanjing, China with an incurable disease of lymphatic leiomyoma, had transplantation surgery and received the lungs of a shepherd boy who accidentally died in his early teens. Wu Yue called the donor boy Brother Cowboy, and wrote him a letter every year for three years. She said in one of the letters, “I often imagine what you are like. I imagine your dark skin, small but strong body, your smile and your shining teeth. You must have been an innocent and loving boy. How I desire to show you the world. It is far bigger and more complicated than the one you ever lived in. I also hope you can still love the world after you have seen its reality. You will still be honest and true to yourself. Beside my parents and friends, you are the only one to support me in my persistence in life, and you are also my most loyal listener.” In another letter, she wrote, “Shortly after the last letter, we attended the 15th anniversary of the Lung Transplant Center of Wu Xi People’s Hospital. That was my first live broadcast, with no experience but lots of problems. Everyone present gave me great encouragement and respect, both doctors and peer patients. People were so excited to participate! Seeing so many young and vigorous faces, do you have the same feeling as I, amazed at the magic that life continues? I don’t know how your lungs struggled to work with the ventilator to sustain my life when I was in a coma at the Gu Lou Hospital in Nanjing. At that moment, I felt that I was the closest to the situation when you were leaving. At that moment, I felt like I could feel your desperation to live. With that strong desire for survival, and the support you gave me, I woke up on the 14th night of coma. All the doctors present were amazed at the “incredible” miracle. There were so many professional doctors caring about my illness and praying for me. I know I was not alone in the fight. But it was surprising that the strength of us two was so strong.” In the third letter, she wrote, “Before I met you, I was just an ordinary girl. Because of you, my life is different. I get a lot of attention. More and more media contact me, and more and more peer patients chat with me to share their stories. I am so happy and so grateful to be needed, because I can share my story with them. At the same time, I also know I have a long way to go and I need time to become more mature. Fortunately, you are with me, and I can be true to myself, and actually do something to really help others. It is far more important for people to learn more about organ donation than to know me personally.”

These letters reveal the heartfelt gratitude of the recipients, and illustrate the greatness and nobility of organ donation. They help people further understand that organ donation has contributed enormously to the continuity of human life and improvement in quality of life, which requires public acceptance and support. “Donated life,” as an important interdisciplinary concept for life philosophy of natural science and social science, is a new concept that requires urgent and systematic conceptualization and theorization.

SOCIAL DETERMINANTS FOR DONATION

Donated life increases the weight of social factors in the constitution, rebirth and nurturing of human life, and social relationships become essential in the nature of donated life. With the combination of the organs and tissues from two persons as the essential elements, donated life shows a different formation of life from the traditional pattern that features just the parents’ bisexual reproduction. More specifically, donated life is based on the combination of two lives respectively resulting from bisexual reproduction, constituting an alternative style of bio‐philosophy in terms of life formation, rebirth of life, health restoration, and treatment of diseases.

On the other hand, due to the fact that generation of this life is based on social relations, various factors like the value orientation of social ethics, the state of social relations, the nature and mechanism of the medical system could constitute decisive influences on its survival. The following questions deserve serious consideration and thorough study. Will society allow another person to donate his or her body organs? How to donate? Which waiting recipient can get priority for donation? What rewards could the donor and his/her families get? These problems, which originally belonged in the category of social and political economy, now directly affect whether donated life can survive. In a sense, the system based on social ethics, which provides human life with an alternative form of existence, is the social determinant, and thereafter becomes the basis of a new social relation. The former theory of social ethics in the framework of family which features marriage and bisexual intercourse cannot explain and summarize the new relationship: new thinking is needed.

In 2015, China successfully implemented organ sources, and achieved a transformation from the use of death penalty organs to citizens' donation organs, which has won the commendations from relevant international organizations. There are still some issues with organ shortage, for example, in 2017, data from organ donation administration departments in China showed there were 5,146 human organ donors in China, about 16,000 organ transplant operations were performed, but 300,000 people needed organ transplants that year, and the satisfaction rate was about 1 in 19. Donation‐orientated principles, policies, regulations and mechanism still need further improvement, which is a problem for motivating potential donors and establishing an efficient and effective donation system. This is an international problem which accounts for a worldwide shortage of organs. New solutions need to be further explored.7