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The e-mémoires of the Académie Nationale de Chirurgie

Legal problems related to living donor transplantations

CARVAIS P

Seance of wednesday 20 october 2004 (TRANSPLANTATIONS A PARTIR DE DONNEURS VIVANTS)

Abstract

In order to be accepted by citizens, law should plan social order inadvance, at least at the time when customs are changing. Neverthelesslaw is often behind the times. It is able to regulate habits ratherthan to anticipate them. Scientific and technical progress, especiallywhen it is biological, is so fast, but so difficult to control, that itbecomes uneasy for the legislator to fully integrate it into the law.So we are restricted to experimental laws! This is the case as far asliving donor transplantations are concerned by bioethical laws. Thistechnique, which is rarely developed in southern Europe, in contrastwith some northern countries, is now being discussed. Many surgeonspromote this technique for the excellent results in terms ofthe survival rate (the schedule of surgeries, transplants withoutischemia, better compatibility - even if it is only “emotional”- andso on). Living transplantations appear as the alternative to cadavericones. These are not sufficient to save enough patients registered onthe waiting lists from death due to the lack of available transplants.However the road will be long to reverse the common practise, evento complete it, especially because legal problems come from thedonor’s side. Aware of the difficulties inherent to this new surgicalprocess, legal authorities wonder what to do. Lawyers have to answertwo types of questions: on the one hand, the general questionconcerns essentially whether to take the organs from dead bodies orfrom living ones theoretically. This is about “the rights on the humanbody”. Who is the owner of the human body whether alive ordead? Who is able to dispose of it and what are the limits of suchauthorisations? On the other hand, the specific and practical questionconcerns only the removal from living bodies. It is about “theduties which concern the donors”. Who belongs to the potentialdonors’ community? What kind of protection is there for the donorafter organ removal?