Čelovek

The ideological foundations of the family (relational) model of organ donation are explored. Using the example of this model in modern China, the influence of cultural traditions on the development of innovative medical practices is shown. In China, the family model of organ donation is based on Confucian ideas about the human personality, where the emphasis is on relationships between people, rather than on the autonomous expression of will of an individual subject and their desires regarding the posthumous use of the body. In this context, it is assumed that family members best understand and reflect the last wishes of the deceased regarding the disposal of his body, that is, they are considered as “translators” of the deceased’s value systems that he expressed during his lifetime. The family model of organ donation, considered using China as an example, reflects the specifics of Chinese bioethics, which seeks to combine scientistic attitudes and traditional ethics, that is, while maintaining the influence of traditional Chinese culture. The latter can interact with the development of science and technology and in some aspects even stimulate it. In addition, the article considers the problem of synchronization of chronologies in decision-making about donation. In the process of making such a decision, both the temporality of the past can be actualized, as demonstrated by the experience of countries relying on traditional values in decision-making (China and a number of Asian countries), and the temporality of the future, associated with both the development of new value-based bases for decision-making and the analysis of the consequences of choice. It is shown that the choice in favor of organ donation is associated with the process of value reflection carried out under time pressure. At the same time, the lack of information and psychological stress accompanying the search for a solution determine the further perception of the practice of organ donation. In this regard, the development of a communication strategy regarding organ donation in interaction with relatives of the deceased is of great importance.

From the first successful kidney transplant to the present day, the shortage of donor organs has been one of the key factors influencing the transplantation`s development. The set of methods and ways in which states and their citizens cope with organ shortages can be referred to as the transplant economy, meaning that an economy is a system focused on maximizing the satisfaction of needs with resources limited. The present study aims to identify the various manifestations of transplant economies, as well as their characteristics and possible differences in Western, Asian and other transplant systems. The necessary data was collected, based on which the current status of transplantation economic models of different countries was analyzed. On the foundation of the results obtained, proposals to reduce the shortage of organs for transplantation and qualitatively improve transplantation economies in the future have been put forward. Overall, it can be said that this study provides a better understanding of how countries around the world deal with widespread organ shortages. The results of the study can be used, among other things, to reform health care policy and create a system that would better serve the interests of donors, recipients and society as a whole.

The analysis of legal regulation of Russian transplantology indicates certain contradictions. Until now, the Law of the Russian Federation of December 22, 1992 No. 4180-1 “On Transplantation of Human Organs and (or) Tissues” is in force. At the same time, the basic provisions of human organ (tissue) donation are defined by Article 47 of the Federal Law of November 21, 2011 No. 323-FZ “On the Fundamentals of Health Protection of Citizens in the Russian Federation”, which predetermined a whole layer of by-laws that significantly changed the procedure for the removal of human organs. The stability of Russian legislation in this area determines the general conclusion about the exhaustion of legal opportunities for the development of this industry. The article examines foreign experience in regulating transplantology, using the legislation of France, Holland, Canada as a basis. It is shown that social institutions have a noticeable influence on the posthumous: family, public opinion, institutional readiness of the healthcare system. The article presents an analysis of the discussions around economic incentives for posthumous donation and its vision through the concept of an altruistic gift. The role of the family in making a decision on posthumous donation is outlined. In the vast majority of countries, even in the presence of a lifetime expression of will on posthumous donation, the opinion of close relatives is of decisive importance. At the same time, there are legal difficulties in formalizing a common family decision. In Russian legislation, when legalizing such a model, additional difficulties will arise due to the lack of an official concept of family (it is absent from the Family Code of the Russian Federation), the consolidation of its legal capacity, and the difficulties in formalizing the unified will of a collective subject. Other gaps in Russian law are identified that should be taken into account when searching for ways to develop domestic transplantology.

The article presents the ethical and spiritual aspects of understanding donation as an act of giving or sacrifice in the context of modern transplantology practice. Medical care related to organ donation and transplantation occupies a unique position: it is in this area that a deep and comprehensive discussion of ethical and moral (spiritual) issues is needed, as well as the formation of a field of mutual communication. Doctors, patients, donors and their family members face a major dilemma when it comes to transplanting vital organs, which are culturally endowed with important personal, spiritual and symbolic meaning. For example, a heart transplant is the replacement of a diseased organ that can no longer ensure normal human life with a healthy heart taken from another person. On the other hand, it is the transplantation of an organ that was the center of one person’s spiritual life to another person who is symbolically deprived of such a center. In the context of the statistical data that researchers obtain when studying the influence of the religious factor on the understanding and ethical interpretation of the practices of transplantation of vital organs in countries around the world, the symbolic image of donation as synergy can become the key to verbalizing those internal attitudes that are latently present in spiritual culture and are capable of giving impetus to such development of biomedical discussions that will be in harmony and consonance with religious teachings.

The article is an interdisciplinary study of the Christian problem of cardiocentrism. The traditional criteria of life in Christian anthropology were breathing and heartbeat; they were considered to be manifestations of the soul that God breathed into man. Advances in medical science have led to a factual overcoming of traditional criteria for human death, such as cessation of breathing and cardiac arrest, in favor of a new criterion: brain death. Although organ donation has been legitimized by the Orthodox Church, the question of criteria for human life remains debatable. The theological position excludes the presence of the soul in any separate organ, but this does not exclude the special spiritual connection between the organs and the soul. This question is of particular importance in relation to the heart, in addition to its physical function it is also given a spiritual role in Christian anthropology. The problem of cardiocentrism in the context of transplantology seems to be very serious and requires special research.

The paper focuses on the metaphors related to organ donation and transplantation in order to highlight the implicit images of human being. In a brief analytical review, conceptual metaphors as scientific terms within the medical and biological discourse are considered. On the other hand, the author addresses verbal and visual metaphors used in public service advertising on organ donation. The ethical aspects and value-ladenness of these metaphors are brought into discussion. It is argued that the category of gift still holds a special place in the verbal and visual metaphors in public service advertising on organ donation. However, in scientific and professional medical discourses related to transplantation, there is a predominance of technical metaphors stemming from the Modern worldview. The image of human being as a mechanism or machine can effectively perform explanatory and heuristic functions in natural sciences. At the same time, mechanistic metaphors not only reflect historically formed ideas about human being but also transmit them into the future and suggest certain ways of how human being can be dealt with. When used within scientific discourses, technical metaphors in relation to the human being might be perceived as something common and ethically neutral. However, when transferred into the area of public social advertising, such metaphors might presumably cause tension in public opinion. Like any other metaphor, the human-machine image has its limits of applicability. Going beyond these limits and turning into a kind of mechanistic myth, this metaphor reduces and depersonalizes the human being, subsequently causing ethical collisions within biomedical practices. Such reduction is also related to other artifact metaphors. Analogizing human body and organs to an object leads in transplantation to the implicit predominance of a reduced image of human being whose body has merely an instrumental value as a scarce resource.