Introduction
Organ donation is defined as the process of removing an organ from one person’s body and transplanting it into another person’s body. The procedure happens only after legally obtaining the consent of the donor who is alive or dead at the moment of the surgery. Diseases such as chronic kidney disease, diabetes, and lupus often require kidney transplantation. Out of around 17,000 cases of kidney transplantation taking place in the United States each year, one-third come from live donors (National Kidney Foundation, 2016). Kidney donation from a live donor was the case with the singer and actress Selena Gomez and her friend, actress Francia Raisa (Campione, 2021). Though Francia’s decision to give up a kidney for Selena was glorified in the media as the ultimate act of kindness, some people raised questions about consent and ethics. In the realm of healthcare, being ethical refers to compliance with the core principles of bioethics. This essay argues that Selena Gomez manipulated Francia Raisa into donating a kidney, which makes the case unethical.
Developing the Definition of “Ethical”
Most organ donations, kidney donations included, come from cadavers. However, this type of donation does not meet the demand for organs within the US healthcare system, which is why in recent decades, the focus has shifted to live donors. Kidney donation, which took place in the case of Selena Gomez and Francia Raisa, is among the categories with the highest percentage of live donors. Truog (2015) argues that harvesting organs from live persons raise a whole host of ethical questions and concerns. The author points out three types of organ donation, each of which has its own ethical implications. Firstly, there is a directed donation to a family member, a friend, or otherwise a person that the designated donor knows and loves. There is a non-directed donation in which a donated organ ends up in the general pool and is distributed to recipients as per their position on the waiting list. Lastly, a directed donation to a stranger happens when a prospective donor chooses to give their organ or organs to a person that they specifically selected but with whom they have no prior emotional connection.
Truog (2015) argues that when it comes to directed donations to loved ones and friends, there may be pressure to sacrifice oneself to help. Coercion is not uncommon when it is discovered that a friend or a family member is a match (Truog, 2015). Furthermore, even if prospective donors in directed donations are willing to go through the procedure, because of their love for the recipient, they may underestimate the health and psychosocial consequences. The article concludes that it suffices not to obtain informed consent from a family member or a friend; the assessment needs to be more comprehensive than that.
Informed consent can be defined as consent that stems from an autonomous choice. Any donor must be equipped with adequate information regarding risks, benefits, and likely outcomes. Hays (2015) argues that consent and non-consent are not discrete categories, but there is rather a continuum between “clarity and confusion.” A prospective donor may be willing to undergo the procedure but have certain reservations. What impacts the process in many cases is the decision-making pressure felt by as many as 40% of candidates (Hays, 2015). Research shows that the amount of external pressure correlates with postoperative regrets (Hays, 2015). When prospective donor is pressured, it takes away their autonomy. In this case, one of the most basic principles of bioethics is violated.
Reese, Boudville, and Garg (2015) further elaborate on the issue of obtaining informed consent from kidney donors. In particular, the researchers focus on the health implications of nephrectomy, or kidney extraction. As evidenced by a multitude of studies from different countries, kidney donors have the same life expectancy compared to general populations (Reese et al., 2015). Yet, the fairly invasive and traumatic procedure leaves them at an elevated risk of some conditions. Kidney donation is associated with cardiovascular diseases, such as hypertension, namely, increased systolic blood pressure of 4 mm Hg and increased diastolic blood pressure of 6 mm Hg (Reese et al., 2015). End-stage renal disease is also a possibility for kidney donors (Reese et al., 2015). Moreover, the surgery may incur unexpected costs, a decrease in quality of life, and loss of work productivity, resulting in work absenteeism and missed career opportunities (Reese et al., 2015). Taking all these facts into consideration, one may conclude that consent does not equal awareness.
Being a doctor imposes a set of unique moral obligations on a person. Dalal (2015) explains that medical ethics stem from the Hippocratic tradition who laid the foundations of their most important tenets. First and foremost, doctors need to be committed to nonjudgmental regard. Health professionals have to provide care regardless of their judgment as to the patient’s worthiness (Dalal, 2015). Another ethical tenet is formulated as “primum non nocere” (from Latin “first, do no harm”) which is part of the Hippocratic oath for physicians. The principle of nonmaleficence is especially important when it comes to organ donations because the procedure has literally no health benefits and comes with a host of potential complications. Furthermore, doctors have a fiduciary duty because patients trust them and are vulnerable before their leverage. Therefore, healthcare professionals have to make use of their knowledge, powers, and privileges only to benefit the patients.
The ethical principles regarding confidentiality are also part of US law. Introduced in 1996, the Health Insurance Portability and Accountability Act (HIPAA) included a Privacy Rule aimed at protecting the confidentiality of patients (Tovino, 2016). The Privacy Rule protects all “individually identifiable health information” stored or communicated by a covered entity in any form (Tovino, 2016). “Individually identifiable health information” includes demographic information, a person’s past, present, or future medical history, the medical services that a person receives, and financial healthcare data. Generally, the Privacy Rule seeks to limit the number of situations where sensitive information about a patient is disclosed. However, there are exceptions, such as ensuring public health and safety (Tovino, 2016). Disclosing information to treat another patient as well as communicating to friends, family, and others involved in care is possible after obtaining a patient’s consent.
Assessing the Case in Accordance with the Definition
Based on the literature research, one is now equipped with information to develop the definition of unethical living donor organ donation. Unethical living donor organ donation occurs when:
- a person is pressured to make a positive decision, especially when the timeline for the surgery is tight;
- the recipient uses their emotional ties to the donor to impact their decision;
- the donor does not receive enough information about the risks and expected outcomes of organ donation;
- due to the limited information provided beforehand, the donor experiences physical and moral suffering;
- the transplantation team violates their fiduciary duties;
- the transplantation team favors the recipient over the donor when sharing information and making decisions.
It is safe to conclude that Selena Gomez received a directed kidney donation from Francia Raisa. Prior to surgery, Selena and Francia had known each other for more than ten years. They met each other during a Disney/ABC Family children’s hospital visit, which suggests that they had shared views on charity causes (Campione, 2021). Ever since that visit, the two public persons have kept a bond and been seen spending time together. While Selena was not Francia’s family member, she still had a special place in her life. Though not sharing the entirety of her medical journey with the press, Francia Raisa noted that she had to make a decision quickly. The timeline between her learning that she is Selena’s match and actually going under the knife was fairly short.
In her interview with Self, Francia Raisa acknowledged that organ donation proved to be much more challenging than she expected it to be. The actress said that the social worker warned her about the lows of the postoperative period (Self, 2019). In particular, she was told that Selena’s recovery will be easier because she will receive something that her body needs. In turn, Raisa would give up a perfectly healthy organ, which is significant stress for the human body. Surely, these are speculations, but one may wonder why it was not the medical team that informed Francia about the weight of her decision. Further, the actress admitted that she was surprised with the fact that the surgery left her bedridden for almost two months. As a result, Francia developed severe depression that impacted her quality of life. These facts surely question the amount of information that was at the donor’s disposal.
However, probably the most disturbing fact of this case is the unethical exchange of information between doctors and patients. Francia Raisa said that she was tested for compatibility among Selena’s family members and close people. She learned that she was a match not from the transplantation professional but from Selena herself (Self, 2019). Therefore, the doctor told the recipient first, even though this information was meant to be communicated to the donor only. Truog (2015) notes that in an attempt to protect donors in directed donation, transplantation doctors go as far as making up diagnoses so that matches among family and friends could “bow out gracefully.” Yet, Selena’s transplantation team did not go down this route and compromised Raisa’s autonomy.
Conclusion
Living organ donation is a part of the solution to the scarcity of organs needed by people with chronic conditions. However, living organ donation comes with a host of ethical concerns, which happened in the case of Selena Gomez, the recipient, and her friend Francia Raisa, the donor. Some details of the case suggest that kidney donation was unethical. It appears that the transplantation team compromised Raisa’s ability to give autonomous, informed consent by favoring Gomez when distributing information. It could be that Raisa was given a limited perspective on the outcomes of kidney donation. Moreover, the recipient might have been pressured to consent to the procedure.
References
Campione, K. (2021). Selena Gomez says she is ‘forever grateful for a friend and donor Francia Raisa on World Kidney Day. People, Web.
Dalal A. R. (2015). Philosophy of organ donation: Review of ethical facets. World journal of transplantation, 5(2), 44–51. Web.
Hays, R. E. (2015). Informed consent of living kidney donors: Pitfalls and best practice. Current Transplantation Reports, 2(1), 29-34.
National Kidney Foundation. (2016). Organ donation and transplantation statistics. Web.
Reese, P. P., Boudville, N., & Garg, A. X. (2015). Living kidney donation: Outcomes, ethics, and uncertainty. The Lancet, 385(9981), 2003-2013.
Self. (2019). Francia Raisa explains how she became Selena Gomez’s kidney donor | Body stories | SELF [Video file]. Web.
Truog, R. D. (2015). The ethics of organ donation by living donors. The New England Journal of Medicine, 353(5), 444-447.