Alleged organ harvesting plot: He's led a blameless life, Ekweremadu's lawyer tells court

By Damasus Okoro

ILLNESS has been humanity’s closest companion and so humans at every time have always taken steps and measures that would help them stay alive and equally live in dignity. It is a natural instinct that humans would like to preserve and take care of their lives with all available resources and with all procedures clinically and ethically acceptable.

The case of former Deputy Senate President Ike Ekweremadu and his wife trying to save the life of their ailing daughter Sonia Ekweremadu is something that every responsible parent is expected to do. However, this innate responsibility to take care of one’s child has become a topic for bioethical discourse because of the following: (1) A living donor is involved, not a cadaver (2) The donor is said to be a minor (15 years old) and even if he is 21 years old, it still raises ethical questions: How was his consent extracted?  

Is it evident that he deliberated with the Ekweremadus about the various possibilities and implications to his future health, wellbeing and maintenance? Did a health care professional, in this case a nephrologist sufficiently explain the procedure to David describing the possible risks as to help him make an informed decision? 

Was he given room to ask questions and his concerns taken into consideration and even documented? Was he told that at any point in time he feels uncomfortable with the whole process, he can withdraw his consent even if he has been wheeled into the theatre just before the procedure?

Humans have always looked for means to help one another in alleviating sufferings that come as a result of illness; this has come in different shades. People donate blood to accident victims or anemic patients, people donate some tissues to help other patients get well. There is a difference in this kind of generosity/donations, while one can donate blood and within a short time the blood is replenished, it is not the same with the donation of an organ which does not grow by itself. 

In that way, organ from a living donor has ethical implications especially with the issue of consent and commercialisation of body parts. If it is a donation from a cadaver, there would not be much at stake especially if the donor’s intention is respected. However, there is a whole lot of ethical issues involved from a living donor.

Let’s assume that the intended organ donor to Sonia Ekweremadu, Ukpo David Nwamini is 21years old. Before giving his consent, was he competent, in other words, was he psychologically, intellectually and emotional capable of arriving at such a  decision? Did he fully understand the implication of such an exercise? Was there an enticing monetary inducement associated with it in which way it becomes the commercialisation of the human part? Did he make the decision with coercion or pressure even from his own immediate family? 

It is true that because of the collectivistic nature of African culture whereby everyone participates in the life of the other, within this space, families can arrive at a decision for another member of the family. However, one must add that even within this cultural interrelatedness, the individual’s identity does not dissolve or disappear in the group, the right of the individual is respected even within the group that defines   him/her.  

 Clinical medicine is patient-centred; the autonomy of the person/patient in decision-making about one’s health overrides that of the family/community. In that way, the organ donor, and in this case David, has the final say as an individual within the community or family. No one can take this decision-making responsibility away from him.

Why was it possible for the doctors to find out why they cannot go on with the surgery? Organ donation from a living donor has a lot of ethical issues surrounding it. It is an act of utmost sacrifice that one is giving out part of himself/herself to keep another person alive.

On the flip side, the doctors or social workers and hospital chaplains in the hospital preparing a patient who wishes to donate his organ would like to know the motivation of the donor in such an act of self-giving charity. They would like to be drawn or motivated and appreciate the donor’s sense of charity and even thank the donor. If the donor is a direct family member, eyebrows may not be raised because one is expected to show such act of generosity to a member of the family. 

If it is from a spouse to his/her spouse, it will be seen as a deep sense of love and sacrifice for the donor, the recipient and even their kids as there are lots of risks involved in it. From a third party like the case of David, questions would be asked: why would one be parting with part of his body? They would like to make sure the donor understands all the implications to his/her health and how he/she would take care of the emerging challenges and complications that may arise with such a procedure. I am sure this fundamental inquiry was what led to this revelation and the ensuing bioethical discourse.

The future of this case from a bioethical perspective: If David, without pressure, establishes that he understood and still understands the scenario in question and he was moved out of compassion to save the life of Sonia his fellow youth and he will still be willing to donate his kidney out of generosity then the ethical issue will be resolved. 

If David is truly 15 years of age, then there is no space for further conversation as it will be ethically unacceptable and then the law of the land would be fully applied. We watch from a bioethical perspective how this unfolds.

Dr Okoro, a medical practitioner, wrote from Lagos

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