The Economy of Eyes: Examining the Ethical Status of For-Profit Entities in Eye Banking Open Access
Ahmad, Samera (Spring 2020)
Abstract
Corneal transplant is the most common transplant performed in the United States, with more than 80,000 performed in 2018. The industry has grown rapidly in recent years thanks to the introduction of new processing techniques. Business changes have also occurred in the past few years, with the recent introduction of for-profit entities into the eye banking industry. These for-profit entities are participating not just in the traditional functions of an eye bank, such as the recovery, processing, and distribution of tissue, but also participating in corneal transplant research and development. For-profit entities in a human donation industry raise several ethical questions, and a dedicated examination of the ethical concerns with for-profits is essential to understand and evaluate their role in the eye banking industry.
To achieve this examination, I begin with an interview survey that was performed with corneal surgeons and eye bank leadership on their attitudes toward for-profit entities in corneal donation. There were several positive outlooks noted, such as the ability of for-profit entities to perform more research and innovation. There were also several ethical concerns, most frequent of which where the potential of for-profit to exploit donor generosity, the loss of local tissue with for-profit entity expansion, and loss of donor trust if notified of for-profit entities in corneal banking. I then focused on these three most frequent concerns to see if a more comprehensive ethical analysis could illuminate if these concerns were relevant to for-profits or offered any reason to reject for-profits in eye banking. I determine that none of the concerns in the interview actually provide an incontrovertible reason to reject for-profits, and that ethical differences between for-profits and non-profits might instead originate from the structural differences in their business model. Most notably, for-profits allow for the participation of investors and shareholders in their business, which creates conflicts of interest between the duty to donors and the duty to investors. I conclude that for-profit entities in eye donation must address these conflicts of interest in their operations, and I suggest several interventions to help ensure the ethical management of conflicting interests to investors and donors.
Table of Contents
CHAPTER ONE: INTRODUCTION 1
Donation Pathway 3
For-Profit Entities in Donation 4
The Ethical Challenge of For-Profits 5
Structure of Thesis 6
Concerns in the Literature 7
CHAPTER TWO: INTERVIEW STUDY ON FOR-PROFITS IN CORNEAL DONATION 9
CHAPTER THREE: EXAMINING ETHICAL CONCERNS OF INTERVIEWEES 10
Profiting from Donated Tissue 10
Profiting from a Gift 11
Profiting from Human Tissue 13
Damage to Donor Trust 18
Loss of Local Tissue 23
Justice and Non-Local Distribution 24
Donor and Recipient Outcomes in Non-Local Tissue Distribution 25
Conclusions 27
CHAPTER FOUR: CONFLICTS OF INTEREST AND CORNEAL DONATION 29
The Ethics of Conflicts of Interest 30
Duty to Donors in Corneal Donation 31
Conflicts of Interest and For-Profit Eye Banking Entities 32
Conflicts of Interest in the Pathway from Donor to Recipient 38
Recovery 39
Processing/Distribution 42
Research 45
Interventions to Help Mitigate Conflicts of Interest 46
Improving Informed Consent and Transparency 47
Limiting Eye Bank Size 50
Research 53
Conclusion 54
CHAPTER FIVE: CONCLUSION 57
References 61
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