ETIKA U TRANSPLANTACIJI SOLIDNIH ORGANA

Lada Zibar, Iva Ižaković, Marin Kuharić

Transplantacijska etika (TE) određena je brojnim povijesnim, filozofskim, znanstvenim, medicinskim, pravnim, sociološkim i ekonomskim čimbenicima. Nacionalne posebnosti Republike Hrvatske (RH) u ovom se području temelje na zavidnom uspjehu u transplantaciji (TX) solidnih organa i uređenoj relevantnoj legislativi koja pogoduje ovom uspjehu. Tako problemi nedostatka organa za TX, doniranja, dodjele i pravedne raspodjele nisu važne teme TE-a u RH, ali globalno ostaju vodeća etička područja u TX-u. U RH je na snazi uzorit Zakon o presumptivnom pristanku na doniranje organa nakon smrti (tzv. zakon opt-out, jer se izjašnjavanje traži za „biti izvan – out” mogućih darovatelja). Nepoznavanje zakona opt-out o doniranju organa nakon moždane smrti, vrijedećega u RH, neusklađenost s običajima i odredbom Kodeksa medicinske etike i deontologije o traženju suglasnosti obitelji za doniranje organa nakon moždane smrti te nedovoljno regrutiranje kandidata za TX u nas se nameću kao sporne etičke teme. Budućnost predviđa mogućnost TX-a organom nehumanog podrijetla kao što je onaj uzgojen u svinjskom organizmu, što otvara nova etička područja i za RH i za ostatak svijeta.

Ethics in transplantation (TX) has been determined by history, philosophy, science, medicine, law, sociology and economics. Croatian national peculiarities are based on the excellent achievements in solid organ TX and outstanding legislation, which supports this success. Thus the prevalent ethical issues in TX at global level, such as organ shortage, donation, allocation and distributive justice, are simply not of major importance in Croatia. There is a model law on presumptive consent for organ donation after death in Croatia (so called “opt-out” law, while a person should declare only if willing to be “out” of the possible donors’ pool). Lack of knowledge of the opt-out law of organ donation after brain death, which is currently established in Croatia, lack of coordination of this law with Croatian Codex of Medical Ethics and Deontology in regard to family permission for organ donation after brain death arise as our particular ethical questions along with insufficient patients’ recruitment as candidates for TX. It is expected to have TX with organs of non-human origin in the future,like the one bred in a swine, which may raise new ethical concerns.