A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation” Alessandro Nanni Costa, J. M. Simo ´n i Castellvì, Antonio G. Spagnolo, Nunziata Comoretto, Jean Laffitte, Håkan Ga ¨bel, Francis L. Delmonico, Ferdinand Muehlbacher, Walter Schaupp, Alexandra K. Glazier, Valter D. Garcia, Mario Abbud-Filho, Jose O. Medina-Pestana, Mariangela Gritta Grainer, Pier Paolo Donadio, Anna Guermani, Riccardo Bosco, Francesco Giordano, Blanca Martinez Lopez de Arroyabe, Marco Brunetti, Martí Manyalich, Gloria Pa ´ez, Ricardo Valero, Rafael Matesanz, Elisabeth Coll, Beatriz Dominguez-Gil, Beatriz Mahillo, Eduardo Martin Escobar, Gregorio Garrido, and Felix Cantarovich Ethical Principles of Organ Donation MAIMONIDES J. M. Simo ´n i Castellvì O nce upon a time, a man insulted a physician called Mai- monides, and his Jewish religion, within the hearing of the king. The king ordered him to take out the heart of that bad man, but the doctor looked after that poor bad man, gave him food, cured him and even paid for his medicines. His heart though changed. After some time, once again the king and the doctor met that man. Isn’t this he who insulted you and your religion? Yes, My Lord. Why didn’t you obey my order? I did obey you, My Lord! I have changed his wooden heart and I have given a human and peaceful heart! So, it is possible to operate without a knife, the king said! Rabbi Moshe Ben Maimon, also known as the RAMBAM, was born in the Spanish city of Co ´ rdoba in 1135. He was a rabbi, a physician and a philosopher. The medieval Arabic poet Al Said Ibu Sural al Mulk wrote about him: “Galen’s art healed only the body, but Abu Imram’s (Maimonides) the body and the soul”. Maimonides said that it is impossible for the truths ar- rived at by human intellect to contradict those revealed by God. Saint Thomas Aquinas held him in high esteem. A beau- tiful daily prayer of a physician is attributed to him. . . . Thou hast created the human body with infinite wisdom. Ten thousand times ten thousand organs hast Thou combined in it that act unceasingly and harmoniously to preserve in the enve- lope of the immortal soul. They are ever acting in perfect order, agreement and accord. Yet, when the frailty of matter of the un- bridling of passions deranges this order or interrupts this accord, then forces clash and the body crumbles into the primal dust from which it came. . . . Almighty God! Thou hast chosen me in Thy mercy to watch over the life and death of Thy creatures. I now apply myself to my profession. Support me in this great task, so that it may benefit mankind! . . . Today, we can discover our errors of yesterday and tomorrow we can obtain a new light on what we think ourselves sure of today. BIOETHICAL CONSIDERATIONS Antonio G. Spagnolo and Nunziata Comoretto I n the past half-century, solid organ transplantation has be- come standard treatment for a variety of diseases, potentially restoring patients with terminal illness to normal life (1). The technique of successful transplant operations has given rise, for both individual and society, to several ethical questions. Some of them are common to those arising from the ethical implications of all developing techniques, such as the weighing of risks involved in early experimentation, the likelihood and degree of success in particular cases, the need for informed and free consent on the part of those involved and the justification of investment in terms of resources and personnel. However, there are some ethical questions pecu- liar to the concept of transplantation, that is, those related to the transference of organs from one individual to another (2). One of the first moral quandaries in transplantation, in fact, concerns whether it is right to remove a healthy organ from a healthy person (in violation of the Hippocratic aphorism “do not harm”), even if the aim is to save the life of another per- son. Another is whether or not individuals have the moral authority to mutilate their bodies (3). Currently, the major ethical problems in organ transplan- tation come out of the shortage of organs, as presently thousands of people are on waiting lists for transplants and their lives are dependent on the recruitment of organs (4). Moreover, the number of people needing transplants is expected to grow in the next decades, especially due to the aging of the baby boomer population and the increase of kidney disease due to hyperten- sion and diabetes (5). The organ shortage has motivated a host of efforts to in- crease organ supply, some of which are controversial, such as the acceptance of expanded criteria for increasing cadaveric donors pool (for instance, older and sicker donors), donation after car- diac death (so-called nonheart-beating donation) and the in- creasing number of living organ donors (outside of the living related donation) (6). The purpose of this essay is to explore some of the eth- ical issues involved in transplantation and particularly those The authors declare no conflict of interest. S108 | www.transplantjournal.com Transplantation • Volume 88, Number 7S, October 15, 2009