What I know is we are trying to systematize kidney donation/transplantation. The Department of Health has already organized an ethics group that will deal essentially with organ transplantation. So there is concern. The Kidney Center (National Kidney and Transplant Institute) is also trying very hard to systematize it and what do we mean by systematizing it? It means studying needs-for example how many need renal transplantation?

   So how do we compare with other countries? In the United States for example, I'd say they're very organized. By state, from what I hear. They have a waiting list, a priority list; they are listed according to certain parameters. They have set up criteria.

   I think we are trying to set up those criteria. These things have been set in other countries, kaya meron silang waiting list, meron na silang statewide program. Tayo siguro we are still on the criteria level-meron na rin tayong attempts, meron na tayong Organ Transplant Law which talks about who can donate, how should the donation be obtained, people carrying IDs that say if I die I'm willing to donate my heart, my organs. That brings us to a medium level of advancement. Kasi we are addressing it and we have some legal instruments that will make it possible.

   MOb: Organ donation is not really viewed nicely by people.

   Dr. Reyes: It has something to do with symbols. The symbols of a whole person. Pag tinanggalan mo parang kulang na yung tao.

   MOb: Parang you can't treat people like car parts or something.

   Dr. Reyes: Oo, yung objectification of the human being. Napapasali dun. That the kidney is part of a person, so if you consider the kidney as something that can be taken out in exchange, parang you are objectifying the whole person as a commercializable thing. A thing, rather than a human being.

   But there's a philosophical concept of difference between a live and a dead person. Because a dead person cannot own, and so some philosophers would point out that the organs of a dead person are no longer his/hers. But important symbols to the people who love him/her and who relate with him/her. Kaya it's more important to the person relating with him/her rather than to the dead person himself/herself. But that is a very difficult concept-because of our sentimentality as human beings, and sentimentality cannot be reasoned with.

   MOb: As you said we are just in the process of developing a lot of the mechanisms that would make organ donation work in this country. Compared with other countries that have established mechanisms and they are dealing with finer points-

   Dr. Reyes: Finer points, ethical points. What is also important to remember is organ transplantation has definite benefits for a certain set of diseases. Make the person live a better quality of life-that is what we all aspire for. And it has been proved that organ transplantation is really a technology that is beneficial.

   MOb: At least as far as kidney transplants-

   Dr. Reyes: Oo, or corneal transplants. Also, blood transfusion is life-saving.

   MOb: But for heart transplants-

   Dr. Reyes: Medyo [debatable] pa yun. [Together with] pancreatic transplants for diabetics, limbs (reattachment of hands, etc). The best [results] are in blood transfusion, corneal, kidney, and now liver transplants-medyo nagi-[improve] na.

   MOb: Which brings us to the question, How far are we willing to go in endangering one life for the benefit of another?

   Dr. Reyes: That is the question. In fact, yung issues of brain death-the redefinition of death based on brain, rather than before cardiorespiratory cessation. Nung araw, madaling madali-papakinggan mo yung heart, titingnan mo kung humihinga pa, that's it. But now even if humihinga ka pa they can declare you brain-dead, because your brainwaves are flat. I'm not diminishing it. It's a very strict set of criteria.

   But there's always this little, little concern about this conflict, this tension-prolonging the life of this person and saving the life of another person: couldn't there be a possibility that somebody is still alive, but because you are more concerned about the other life you'll now transplant? That's why there's an ethical conflict there-whose interest you're serving. That you'll now be serving the other's interest at the expense of the other.

   Kaya sila pinag-separate-hindi isang group yung nag-oopera sa donor at sa recipient. But hindi rin yung talagang [independent]-of course there is communication between these two groups. It's not like they're really very independent. There can be no such thing that they're completely ignoring each other. Some people are therefore pushing for a redefinition of brain death.

   MOb: Some people are very vocal about it-they say the difference between "dead" and "brain-dead" is just a matter of semantics. That they're only extending the definition of brain-dead to serve a purpose.

   Dr. Reyes: Precisely, to serve daw the purpose of being able to collect organs. So medyo question mark for that.

   MOb: We're in need of debates.

   Dr. Reyes: Yes. That should be a healthy kind of argumentation because it brings out our values, what's important to us. In the end [what will emerge are] the values of the community, through discussion, through argumentation. Civil society, ika nga. So what I'm trying to say is in the end these things will have to be settled. Maybe we'll not have a hundred percent agreement but something has to be done about it.

   MOb: And at the same time the facts come out, and we realize there's so much information out there that we need to process. And it makes us react not with emotion but with logic.

   Dr. Reyes: That's right. A little more logic, a little more reason than beliefs or attachments to symbols.

   MOb: A couple of years ago there was this report (Philippine Daily Inquirer, June 22, 2000) that was kind of controversial. This group, the Kidney Patients Association of the Philippines they called themselves, proposed that death-row convicts be kidney donors, and in exchange, they'd have their sentence commuted. What are the ethical implications of this?

   Dr. Reyes: The bottom line is consent. If death-row prisoners say yes, they are willing, then fine. It's just like anything else. Pero may second level of reasoning diyan-na if they do, they're sentence would be commuted to life sentence. As I said, consent. But it's not just consent-the consent must be free of coercion, and the offer of the commutation of sentence [gives it an element] of coercion.

   MOb: It also gives the idea that you are also doing something similar to selling, but not with money.

   Dr. Reyes: Oo. May coercive element din yun e-like money is coercive, depending on how much you are going to give. Kung malaki talaga it is very coercive. Kase yung payment, some people give payment to cover mga incidental expenses-mga transportation, mga being bothered getting out of work, food, yung mga ganun. So that would not be coercive. But if you give much more than that to a poor person that could be coercive.

   Which brings me to the point of freedom. The extreme interpretation of freedom is absolute freedom. Freedom as long as you don't infringe on the freedom of others. Pero more and more we realize there's really no complete freedom. Freedom is not absolute, freedom cannot be complete, freedom will always be relative. Relative on the outside, but more importantly on the inside. You don't know what's going on inside. For example. There is a group of people who are socialized not to be free. They have no concept of what it is to do and be. Then how do you introduce the concept of freedom to a group of people who have been so dependent and not free?

   So back to the death row convicts. My answer is: I'll treat the convicts like any other individual whose organ is going to be asked for donation. It should be done in a context of freedom.

   MOb: Another controversy involving death-row convicts in 2001, this time in China. The New York Times reported that in China, death-row convicts were treated as possible organ donors. However, it was said that the executions were done to coincide with scheduled surgeries-in other words, if someone needs a transplant, they could do executions. This raises a lot of issues.

   Dr. Reyes: Using people as technology. The horror there is manipulation of the medical community; the medical community manipulating people to fit medical needs. I look at it from, first, a utilitarian viewpoint. Sasabihin, 'E mamamatay naman talaga na e. So why don't we make it useful, to save somebody else's life.' But the bottom line is, agreed ba itong tao na ganun ang gagawin sa kanya, na death row ka pa rin, you agreed to donate your kidney, but let's make it a little more convenient, so that we will time your execution when somebody needs it. That assures kasi na fresh yung kidney, and magagamit ng tama. I cannot judge that decision as unethical.

   But the judgement of ethicality is what has been told this convict. Prepared ba siya sa ganung klaseng sitwasyon? Yung, sana sa isang linggo pa siya, e ngayon na kailangan yung organ, bigla na lang siyang bibitayin. That's not fair. So I'm looking at the ethicality of the act from what the convict was told, how prepared the convict was.

   MOb: But the report also says that even if the convict is not yet technically dead, they already extract the needed organs.

   Dr. Reyes: Oo, para mapabilis, para fresh, para buhay pa yung organ. That part is unethical. If the premise is that of a cadaver donation, then the bottom line there is brain death. Kung hindi brain-dead yung convict, I think that is an ethical violation.

   MOb: Now we go into the selling of organs.

   Dr. Reyes: First, we'll talk about selling per se. The way I analyze it is ganito: sino ba yung sasabihin nating unethical dito? When you talk about unethical behavior, merong gumagawa, merong actor. Sino yung moral agent, sino yung sinasabihang oy, mali yung ginagawa mo-yung nagbebenta, yung tumatanggap ng benta, o yung context?

   Let's look at the seller. One can look at it from the point of view of autonomy-Excuse me, ako ito. Ari ko ito. I have freedom to do whatever I want to do with what I have. Who can tell me what I should do with what I own, e sigurado ako na akin to. Ang objection dun by itself is the commercialization that will further extend to the whole human being. If you start commercializing bits and pieces of the body, there are implications to the commercialization of the whole human being. The bottom line to us is the human being is not an object. The concept of the dignity of the human person. If you commercialize, that is what you are attacking.

   MOb: In other words commercialization equals dehumanization.

   Dr. Reyes: Yes. Dehumanization, trampling on dignity. So sasabihin na naman, 'E aking dignity naman to e.' Meron pa ring implikasyon yan. The loss of the dignity of one human being affects the dignity of the whole. That's why we object vehemently to violation of the dignity of any single human being because it reflects our own dignity. The dignity of the community of human beings. But we will look at it a little less negatively if the reason is poverty. Meaning, we look at the intention. Ano ba yung intention-gustong pag-araling ang anak niya, may sakit yung isang anak na kailangan ng operasyon, mahal, and this is the only way of doing it. So we'd look at it with a little more understanding and compassion if we know what the intention is, and the intention is to make somebody's condition better. So we [as individuals] can't really pass judgment, even if in the beginning [our stand on organ selling is absolute].

   Now let us look at the receiver. We can't pass judgment on them either, because it's their life. Lahat tayo kasi we have aspirations to exist and to live a good life. We [as individuals] cannot really fault them. We can't say, unethical ka. [We all have] the right to a good quality of life.

   So that leaves us to the context, the society. We are living in an unjust society-unjust society if the society allows, brings about a situation where a person has to sell his organs in order to survive.

   MOb: What you're saying is the scenario of people selling their organs is just one manifestation of an unjust society.

   Dr. Reyes: Yes. In an unjust society it's very difficult to be ethical. The context of ethics is a just society where there is really respect for each other, and there is support where we can all live with a high quality of life. I'm not judging this person who sold, I'm not judging this person who received, I'm judging the circumstances in the society that brought about this context.

   MOb: But there emerges a double bind-if this is just a manifestation of an unjust society, and it continues, doesn't that just bring more injustice?

   Dr. Reyes: Yes, yes. As long as we allow something like this, it becomes a vicious thing. It just makes it worse. If this is an unjust society that will allow commercialization, that will not consider human dignity, the worse indignities will happen. That's where we come in-making people aware that it is not a good situation.

   MOb: In the selling of organs there are also issues where people come out, and they're willing to donate organs, tapos they're going to use it for publicity naman.

   Dr. Reyes: That brings us to the issue of intention. Sa ethics, hindi lang yung act ang importante. You also look at the motivation, and from the motivation, in a reflective way, what that makes of the person. So in ethics we would like persons to be good, so we can assume that their acts will be good. Kasi if you are a good person, you can predict that the act will be good. Good acts are always reflective of your being a good person.

   Ang accepted motivation is, when you donate, it is not for your own good. It is for the good of the other person. [Your becoming good yourself] is incidental. It's not the motivation. I'm not so happy with that kind of motivation, yung may pagka-self-glorification. Even if some philosophers say na [giving focus] on the self is natural, is normal, the Filipino society ayaw yung nagmamayabang. Ang gusto nga natin in fact is if we do something good, do not leave your mark. That is the highest form of doing something good. That is the Filipino way of doing things.

   Motivation is very important to us. From the outside, who can know the motivation that is inside anyone? The bottom line is ethics is also very personal. It's your own assessment of what is moral to you. Only you can know what your motivation is.

   MOb: What are the prospects of ethics in the issue of organ transplant?

   Dr. Reyes: I have great hopes. For one, nakikita na ng DoH the need for an ethics committee, na merong oversight committee. Lumabas na ang mga issues, so that a rational system-I'd like to call it compassionate rationality-is put in place. And that there is a growing development in ethics in the Philippines. There's the Philippine Bioethics Network, merong Southeast Asia Bioethics Association, centers are putting out their own bioethics committees. There is a growing awareness on the need to discuss the ethics of things. That's why I'm very optimistic that one day we will have a compassionate and rational system of organ exchange/donation program.

   MOb: What specific part does the medical community play in this issue?

   Dr. Reyes: Lagi na ngayong nagko-consult sila e. So they are very aware. People are examining specific policies.

The best thing to say is the [medical] community is more aware. If a community is more aware, more informed, what can happen is a healthy discussion and debate that can lead to more rational compassionate policies. And lead to a more rational, compassionate society.