In this blog post, we will examine the medical advancements in organ transplantation technology alongside the emerging ethical and social issues surrounding it.
Organ transplantation is a technique that involves replacing a damaged or malfunctioning organ by moving an organ from another part of the body or implanting an organ received from an external donor. It is recognized as one of the most effective surgical methods to date. However, the history of when this idea was first proposed and researched is not as long as one might think.
Until the 19th century, people believed that diseases arose when the balance of bodily fluids—the fluid components of the body—was disrupted due to poor lifestyle choices or environmental factors. Consequently, it was thought that diseases could be cured by altering an individual’s environment or lifestyle, or by restoring the balance of bodily fluids through methods such as vomiting, purgation, or bloodletting. However, some surgeons began to view the body as a structure composed of organs and tissues with specific functions. They proposed the idea that diseases could be treated through surgery to remove diseased organs and tissues or to restore their function.
In July 1883, Swiss surgeon Emil Theodor Kocher attempted a procedure in which he removed thyroid tissue from a patient suffering from goiter and transplanted it into another patient experiencing post-thyroidectomy complications. Although the recipient did not survive long, this attempt to treat complex symptoms by replacing an organ is considered the first case of organ transplantation. It became the prototype for all subsequent organ transplants and served as the starting point for organ transplantation research.
Since then, doctors have sought to advance organ transplantation techniques through various studies and experiments, but they encountered an unexpected barrier. That obstacle was rejection—the greatest challenge in organ transplantation. Rejection occurs when the body recognizes the transplanted organ or tissue as a foreign substance, causing the immune system to attack it. In 1980, French physician Jean Dausset discovered that rejection is determined by leukocyte antigens. This finding led doctors to recognize that the body’s immune system was the primary cause of rejection, prompting them to accelerate the development of immunosuppressants.
Immunosuppressants are substances that artificially suppress the body’s immune system, thereby reducing the attack capabilities of immune cells. Just as the development of penicillin played a pivotal role in the history of antibiotics, the development of “cyclosporine” in 1972 was a groundbreaking event in the history of immunosuppressants. Extracted from a fungus found in soil, this immunosuppressant was highly effective yet had few side effects, rapidly boosting the success rate of liver transplants from 18% to 68% at the time.
In this way, organ transplantation has made a significant contribution to restoring human health as a surgical treatment. However, several unresolved issues remain. One of these is the social problem of the imbalance between organ supply and demand. The reality is that while there is an overwhelming number of people in need of organ transplants, there is a severe shortage of donors. In South Korea, the number of patients on the organ transplant waiting list increases significantly every year, yet the number of brain-dead donors barely exceeds 250 annually. According to statistics from the Korea Organ Transplant Center, patients on the waiting list must wait an average of 4 to 5 years. As a result, it is common for many patients to die while waiting, unable to receive a transplant. Furthermore, as demand for organs exceeds supply, extreme problems such as illegal organ trafficking sometimes arise.
Another issue is that organ transplantation raises ethical questions related to human identity and the definition of life. Organ transplantation is a technology that transcends the boundaries of the individual body, which were previously taken for granted. For example, in the case of a head transplant, if all the organs below the neck belong to another person, who exactly is the person who received the head transplant? Furthermore, questions arise regarding whether medical advancements mean that, with enough money, one can freely choose their own body.
Organ transplantation technology has achieved significant success by introducing new values and ways of thinking regarding disease and expanding the scope of treatable conditions. However, the policy and ethical issues underpinning these technologies continue to coexist behind the scenes of scientific achievements.
