Introduction
Technological progress in the field of organ transplants has ensured that human power over life is a reality laden with both hope and threat. Organ transplant therapy, which has undergone remarkable developments, concerns a body that cannot be treated as a merely physical and biological entity but as a constitutive part of the person. Its use can resuscitate and regain a transfigured and definitively possessed personal integrity in Christ. Should the name of the donation based on the criteria of consent, free and anonymity, legitimize attacks on the integrity of the body to save lives? Are we sure that we will remain in the donation system in all acts of donation, whether on a living or deceased person? What does organ donation really mean?
Donor, Recipient, Doctor
Living donors and deceased donors
Any transplant from a living donor affects their bodily integrity. This
intervention causes a mutilation in a living person, although it is a saving act
of someone who with a serious illness who could only be cured by a transplant.
This act exposes the donors to the risk of the operation and the fact that they
now have only 1 kidney or a part of their liver.
All relevant information must be given as complete as possible by the doctor to the potential donor about the intervention, the immediate consequences, and the possible known complications. After this informed procedure, it is necessary to give the potential donor an adequate amount of time to think before making a decision, which must be prior to the tests, as these could affect the donor’s decision, especially if it is a parent. No individual should be forced to donate parts of their body to save others. We wonder if without this principle of consent, which must come from the person concerned, it is still possible to speak of a donation. And even with consent, what is usually the motive of the potential donor? Is it altruism to save a life? Is it obligation out of duty? Is it the interest in a guilt-free or narcissistic satisfaction?
Human freedom is fragile; therefore, consent must be further protected. Hence, the need for the presence of an ethics committee to confirm the quality of information and the collection of consent. In addition, the exercise of giving, although it can also be selfless, sometimes hides a sense of self-justification, a strengthening of self-image, or even a pursuit of material benefit. Do these question the true meaning of the donation, which is intended to be entirely selfless? Perhaps, but should we dream of a pure donation?
Transplant from a deceased donor differs from many aspects of living donation where the donor is still alive and is can exercise conscious and voluntary acts. In deceased donation, we are faced with a person in a state of brain death and artificial survival who during their lifetime expressed a desire to donate an organ for a therapeutic purpose or else did not express it because they refused to give either or ignored this kind of therapy.
Regarding the question of death, it is not for medicine to define human death or even its precise moment. All medicine can do is to observe that death did take place, using accepted criteria for brain death. To claim that a person has died in no way means that that person has lost all respect for the living; otherwise, we fall into dualism. Funeral rites, as old as the first vestiges of humanity, prove this. For example, in the Old Testament Bible, the family makes an effort to maintain the uniqueness of the deceased through care and embalming (Genesis 49:29), believing that death is not nothing but the transition to a new state (Genesis 50:2-4). In the New Testament, the body of the deceased is not neglected either; we see Stephen recall the burial of Jacob (Acts 7:16), the disciples of John the Baptist come to take his corpse and bury it (Matthew 14:12), and Jesus magnify the care of the corpse indirectly, affirming the importance of the body itself after death “by spreading this perfume on my body, she (the woman in Bethany) prepared my burial” (Matthew 26:7-13).
Pope Pius XII also pointed out that “putting the corpse on the same level as that of the animal or of something is an erroneous act. The body of this corpse was this abode of the spiritual soul, a constitutive part of the human person whose dignity it shared (...), and the body is intended for the resurrection” (Speech of Pius XII).1 Therefore, should it be pointed out that the corpse cannot be the object of transplant because we would no longer respect it as a human if we took away what contributes to its being? The corpse is no longer a subject of law, but it is not deprived of the respect due to its body previously carrying its person. The dead person cannot give something of themselves since they are deprived of all freedom and responsibility. However, that person was able to leave a will specifying organ donation. Relatives have the duty to respect this choice relating to an act that the potential donor was aware that they could not later confirm at the time of organ transplant. If the deceased did not express neither refusal nor consent, France, for example, introduced the presumed consent. Fortunately, the law gives citizens the freedom to refuse in their lifetime to be a potential donor and to report this in a national register. But is it necessary to lay down the requirement of a voluntary and individual act, or is it necessary to suppose the consent of any brain-dead person in the name of solidarity to save people in danger? Is there not a risk, in the latter case, of having an authoritarian and technical solution that does not take into account any symbolic resistance, which can pour the body in a functional, instrumentalist way, into an impersonal and anonymous space? Does this principle of presumed consent not modulate the principle of the inviolability of the body, by applying it only to the living person, to allow a contract of care or a donation for the benefit of the community? Is this not an alienation of the individual from a form of social management of the physical thing, which can sometimes be motivated by the best reasons for public health?
The transplant of an organ from a corpse, whether by express of consent before death or by presumption, concerns and affects the family and relatives. We cannot bury everything under a veil of silence. The family has the right to speak.
Recipients
Receive or suffer or die
One of the conditions that promotes psychological equilibrium is normal human
health. This is because “health and good complexion are better than any law, and
a vigorous body is preferable to a great fortune (...)” (Ecclesiastes 30:13-16).
The potential recipient is mostly in poor health and requires replacement of failed organ or tissue to survive or to improve their quality of life. This patient lives in a drama, dominated by the disease that fills their existence and monopolizes their body. Some patients can overcome the psychological effects of their illnesses and channel their suffering by becoming aware of the ephemeral daily life and even by sometimes making a step of faith, which helps them to look at their eschatological destiny. This way of living the disease is not the vision of everyone, and, even if it was, it does not prevent the practice of transplant therapy, which can ease the suffering and pain and avoid death most of the time.
Receiving a donation is not a right
Does organ transplant give the recipient the right to obtain an organ of a third
party? Pius XII explains that it is allowed in cases of necessity to sacrifice a
particular member to save the whole of the individual organism (physical
organism) and that it is also allowed to sacrifice this member for the benefit
of another organism of the social body that humanity forms (moral organism). But
the Pope also insists on the essential difference between these 2 organisms, as
well as on the relation of the parts with the whole in these 2 types of
organism; the physical organism of a human is a whole in itself, and its parts
are united and interconnected for their existence. However, the moral organism,
that is humanity, is a whole only in terms of action and purpose. And if
individuals are parts of it in the functional sense, they are not in their
personal existence, ontologically, and we cannot impose on them as a requirement
of the right to donate an element of their body.1
Consent is a necessity
The potential recipient must express their consent to the transplant even if
they are compatible with the donor and if the medical examinations are favorable
for the transplant. It is by consent that the patient’s autonomy and their
ability to judge their own good are confirmed. To achieve this, a dialogue is
necessary between the doctor and the patient, allowing the mutual exchange of
information; this exchange must be as complete as possible and accessible using
simple and direct communication methods. Above all, the doctor must explain all
elements of the proposed treatment so that the patient can make their decision.
Doctors
Although the doctor, in organ transplant cases, is first and foremost the agent of the community serving the interests of the healthy to whom the care of the ill people would be subordinate and is able to give the patient their dignity and their sense of uniqueness, the doctor also has a primordial and essential role.
Reassurance
In living-donor transplant procedures, the doctor must reassure the donor that
the transplant procedure in no way justifies the relaxation of requirements in
terms of medical ethics, since his interest as a doctor for scientific for the
progress in scientific knowledge remains secondary in relation to his major
concern for the patient. This is why the doctor must in no case substitute the
proposal for the information. That is, the doctor must not ask the donor to fix
a procedure by creating a more or less latent form of constraint that can lead
to forced choices but indicate to the potential donor what can be done as
neutrally as possible.
Justification
For the potential recipient (or the donor), the doctor must justify their
conduct (accept or refuse a transplant) by preserving the patient’s interest.
Indeed, the doctor cannot take any measure or attempt any intervention without
the patient’s consent because the doctor does not have powers or rights until
given either explicitly or implicitly.
Communication
The consent process for the living donor and recipient opens a therapeutic
alliance between the doctor and the donor and between the doctor and the
patient. This alliance allows for the mutual exchange of information, the
building of trust, and negotiations toward a common therapeutic aim. The
formulation of the request for consent often poses a problem for the doctor. How
can the information be communicated to the donor and recipient? Doctors tend to
have a specific language to describe things, to classify them, and to list them.
Is it possible to translate this “language” at the end of information? Is there
a risk of betraying the message as in any translation? Also, the doctor will
never be able to say everything and things unsaid may be as important as what is
said.
Regarding deceased-donor transplant procedures, the doctor is faced with the problem of encountering a refusal document. To avoid that this document promotes a certain freedom for doctors through the donor’s families and allows them to put pressure on families with the argument that the deceased was not registered, the dialogue between the medical professionals and family is an essential and human approach and makes it possible to ensure that the deceased person does not object to the transplant of their organs.
To conclude these points, among questions raised by the 3 promoters of organ transplant (donor, recipient and doctor), in which sometimes there remain no clear answer, lies the problem of the human body, living or dead.
Facing a Body: Theological Aspects
“Everything seems to oppose the spirit and the flesh,” writes Xavier Lacroix.2 “The activity of one would oppose the passivity of the other, freedom, dependence; ardour and clarity on the one hand, weakness and opacity on the other; for the flesh death, for the spirit eternal life.” But the upheaval that the incarnation of Christ and the hope in the resurrection of the body change our vision of the body henceforth devoted to a future and not to nothingness.
Bible
In the Bible, man is a body and his body is nothing other than himself, contrary to Platonic thought where the soul resembles that which is divine and the body resembles that which is mortal. We perceive not a body containing a soul but a living soul. The human being is a body, but it is not only the body but also breath of life and a free and conscious subject. Humanity is now seen by God through the Man Jesus Christ, the Word who restored the original beauty of our body and its end by choosing the latter to be born. It is through our bodies that we are members of Christ (1 Corinthians 6:15) and the temple of the Holy Spirit (1 Corinthians 6:19). The Christian does not worship the body and does not plunge into incorporeal idealism or disembodied mysticism. The Christian is invited to sanctify the body. Indeed, Saint Paul exhorts the Christian, in the name of the mercy of God (Romans 9-11), to offer his body in living sacrifice, holy and agreeable to God. It is obviously not a question of the body as distinct from the soul but of the whole man acting in and through his body, which is the necessary place of his existence and of his action and of his relation to God., to other humans, and to the world. This self-offering, a response to the mercy of God the Saviour, must manifest itself in the life of Christian communities (Romans 6:19).
Eschatology and dignity of the body
For the Christian, the body has dignity because man was created in the image of God, saved by the death and the resurrection of Christ, and called to the resurrection. Saint Paul (1 Corinthians 15) recalls the link between the resurrection to come (the paschal body of men) and that which occurred in Jesus because if “the dead will not be raised, neither has Christ been raised.” But what will be the identity of the resurrected body and the difference in its qualities compared with the body buried in the grave?
“Sown corruptible, the body rises incorruptible. Sown contemptible, it rises bright with glory, sown in weakness, it resuscitates full of strength, sown animal body, it resuscitates spiritual body” (1 Corinthians 15:42-44). The human body carries a story. Events have marked our corporeality. To believe in the resurrection of the flesh is to believe that the living God can recover not only our human body structure but our human history.”3
I am my body
What constitutes the singularity of being so familiar and so strange to itself is that it manifests itself in its specific difference only at the junction of a body (a living matter) and a thought (a spirit); this is why it remains the most difficult reality to think. The adventure of all existence consists in giving bodily conditions the dimension of meaning, in maintaining it in its opening by which it is understood as precisely human. Because if man is able to emerge from the simple living and to become more and more human, it is only ever from a primordial gap that opens the living to the mind; this opening is one that enables speech and thought and intended to inhabit humanly in the world.
From birth to the Parousia, the body has a history. Its future cannot be reduced to the development of data determined once and for all. A true story contains events, which are all successive events, deaths, and births. Its entire history can be understood as the progressive revelation of its true identity.
From beginning to beginning, toward beginnings that have no end, humans have revealed and discovered their true face. The living present is an open present, open to a dimension that is not the future itself but in the future. It is from this emergence of an irreducible and unpredictable novelty that the proper human dimension of the body is revealed. It takes resurrection and transfiguration to really understand the human body.
The New Testament inscribes each person’s resurrection in that of Jesus Christ. The resurrection of the latter is closely linked to the work of His life, His suffering, and His death. Easter faith affirms that Jesus persists humanly beyond death because God guarantees the definitive and irreversible character of what He wanted to achieve in His human history, while confessing the change that occurred in the Paschal act. What resuscitates is not the material being of Jesus Christ; what constitutes Him most deeply himself before God, therefore, is His historical carnal reality.
Evolution of Christian Ethics Concerning the Mutilation of the Body and Transplants
The encyclical Casti Connubi of Pius XI stated that “individuals have no power over their limbs except that which relates to natural ends. (…) They cannot destroy them, nor mutilate them, cannot surrender by other means unfit for their natural functions, except when it is possible to provide otherwise for the good of the whole body.”4 Some moralists have understood this text after several years as a ban on all forms of mutilation of a healthy body, including the ablation of organs for transplant. This encyclical was followed by certain ethical reflections that are articulated around the following major principles. (1) Sovereignty over the body belongs to God and not to man. God alone is master of our body, while we are only its managers. (2) Direct mutilation is lawful if it is to save the entire human body. (3) Mutilation is lawful if it is done for honest physical or religious purposes, such as plastic surgery, correction of a sexual abnormality, and circumcision. But mutilation inspired by a desire to control fertility, or to attract compassion, is morally unjustifiable. (4) One can donate regenerating body parts like muscle tissue, skin, and blood. (5) The ablation and transplant of nonrenewable organs is illegal. (6) Ex vivo transplants cannot be justified by the principle of totality. It is forbidden to mutilate oneself so that another is healthy. The transplant of an organ from inevitable surgery is only acceptable.
In our opinion, the Pope did not have this restrictive vision; he simply wanted to state a principle that applies to all ordinary cases of mutilation, without condemning or approving organ transplants.
Pope Pius XII refused to consider the body of a deceased individual as part of the whole of humanity. But he fully accepted the principle of the ablation of tissues and organs from a corpse for therapeutic and even scientific purposes, provided that the body is treated with respect and that the rights and feelings of the family are not violated. He approved the donation of tissues, organs, and even the whole body and called for careful public education, which helps families agree to the transplant from the body of a deceased close relative. He considered that the transfer of a tissue or an organ from a dead person to a living being is not a transfer from human to human because the dead person was a human but is not anymore; the dead person is deprived of personality, which alone can be the subject of law. However, that does not mean that the deceased has become a simple thing. On the contrary, the deceased remains imbued with the dignity of the human person created in the image of God and called to the resurrection. Therefore, the fact of disposing of a corpse to save an ill person, with full awareness of the respect due to the deceased, is positively justifiable. The Pope attaches importance to human freedom: no one is obliged in the name of human duty or of Christian charity to donate an organ from their body.5
The Catholic Church ethically prohibits transplants of the brain and sex glands because it considers that the distinctive marks of personality are linked to the brain and that the sex glands mark the genetic individuality. For other transplants, no modification can take place in the deep being of the recipient. The Church considers, in the case of the living donor, that life, and therefore the body, is a gift from God that people cannot dispose of as they please; rather, the person has the choice of using life for love of neighbor after carefully questioning their conscience. For the body of a deceased, the Church does not place absolute value on the integrity of the corpse. It prefers the transplant from a corpse rather than from a living being because no one should harm their health or endanger their life.
John Paul II places transplant medicine within fraternal charity.6 The Christian is challenged to love their neighbor according to new modes of action (transplantation is one) to the very end of themselves. Transplantation is an act of donation, a magnificent response to the call to communion and to love; the combination of love of communion, solidarity, and absolute respect for the dignity of the human person constitutes the only legitimate context for organ transplantation. A living person can donate an organ if it does not endanger their own life or personal identity for a just and proportionate reason. By donating an organ during their lifetime to save a life after their death, the person takes the Easter route of Jesus who, by dying, brings life to the world.
For the Catholic Church, transplants appear as a field where the noblest values of human life are exercised. They concern solidarity, sharing, gratuity, justice, and requirements of autonomy, body size, and respect for suffering and death.
Questioning the 3 Pillars of Organ Donation
Explicit consent and responsibility
Organ donation is an act of passing an organ to another who needs the organ to
survive. This act cannot be separated from social practices organized by law
where it finds its anchor and its beginning of realization.
This act necessarily implies free and informed consent. The latter presents itself as both a principle and an ideal. It is a principle in the sense that freedom and clarity are the basis of consent and constitute its determining elements. It is an ideal in the sense that the implementation of the principle is not self-evident and presents difficulties that never suppress the value of the principle itself, which remains an irreducible requirement.
The act of giving presupposes a deliberation that takes into account the
dialectic of means/end: who wants the ethical goodness of the end wants that of
the means and vice versa (the end does not justify
the means). Organ transplantation cannot be an obligation imposed on the will of
the donor, although it is effective and can save a life.
This deliberation followed by a decision takes concrete form in a speech. If it is positive, it releases the orientation of the desire of the one who gives and opens their desire to the one to whom they give. If it is negative, it gives off another orientation that must in no case make the person to whom we ask to donate feel guilty or even exclude the result from the solidarity movement on which we often play to encourage people to donate their organs.
If the word was silent, the public has no power over the body until the potential donor explicitly gives it before their death. We fear that, in the name of solidarity, power is expressed in this way: “I allowed you to be born, I protected you, now that you are dead you belong to me,” thus sliding from a donation to a kind of contribution. The corpse is the present symbol of an absence. It is not an organ reservoir. It is a symbol of a being who could have been loved. Hence, it is important to communicate with the family who has the right to express themselves. Respecting the sensitivity of the family affected by the death of one of its members does not mean that we support their right to authorize organ retrieval from their deceased. It is up to the potential donor alone to consent or refuse to donate one or more organs during their lifetime after death. The family is not the heir to the body. If there is a need for family intervention, it will only be under the prerogatives of relation.
Free and anonymous donation
In archaic societies, which were studied by sociologist Marcel Mauss,7 the donation is not only a form of economic relationship between 2 or more individuals. It also represents the general form of relations that unite the multiple personalized powers (human, animal, vegetable, or divine) that populate the cosmos. The obligation to return the exchange responds to a cosmic vision based on the principle of a permanent circulation of living forms. Modern society has refused this type of donation because it understands that any fully constrained donation is no longer a donation and that any donation that is not private and made freely risks being transformed into an exchange value.
The trade ban is based on the following principles: (1) the principle of the unavailability of the body, which is an aspect of its inviolability; (2) the principle of justice because the donor’s consent can be disrupted for financial interests, which could expose them to medical dangers; and (3) the fact that the poor will always be the donor and never the recipient.
The body is not a thing, and the graft becomes one with its personal “me.” When a person sells their organs, it is as if they are extracted from them, giving up things that are not essential to the world. This person in some way becomes a means for the recipient to live or for science to advance. Some people justify organ trading with rather utilitarian reasoning, arguing that they will have organs to transplant and that they will save the greatest number of lives. However, they do not realize that this act will destroy the highest values of humanity: the dignity of the person and the respect due to the body, as well as generosity, altruism, solidarity, and even any possibility of a personal bond between the donor and recipient.
Value of the link
When we talk about donation in the language of the market, we are talking about
the value of the exchange and that of the link. The first is manifested by
reducing the values of things to their quantitative equivalents, represented by
an amount of money. This exchange value differs from the usage value, which
recognizes only the immediate use of the thing and excludes any link. With
regard to donation, things take on different values depending on their ability
to nurture social ties. We understand that a personal connection is made between
the donor and the recipient; otherwise, it may be impossible to continue talking
about organ donation. It is by expressing the value of the link that we prove
that we are not mere objects.
Free donation
The concept of gratuity from the Latin “gratia” originally represented an
ambivalence; it applies to the 2 parties involved: “The one who receives with
favour, and the one who is received with favour.”8 Over time, the
meaning evolved towards the religious: grace received graciously and giving rise
to recognition. It then moved toward the meaning of giving for pleasure,
arriving at the current notion, which refers to several senses, among others:
(1) do something for nothing, with no use value; and (2) for the donor: give
without return requirement, freely without obligation.
In our opinion, an organ donation can remain free even when it is returned; because it is free does not mean it is a donation without reason, or unjustified donation, or without foundation. Indeed, the observer who notes the unilaterality of the donation sees only the fact as such in time and space without realizing this donation circulates in an endless chain, that is, when we feel that that the recipient owes much to others or have received much in life.
The nonabsence of return
The donation for Mauss is the act by which the subject conquers his
subjectivity: man is revealed to man by man. It is the establishment of
difference and the discovery of similarity: the idea of return supposes that
another is another self who must act like me. That is, the subject gives not to
receive but so that the other gives in turn.
The need for organ donation does not always mean that there is no return as this return is characterized by something other than commercial return. In the market, the price of a thing is equal to its value, whereas, in donation, the debt is never settled, and this lack of balance stimulates the donation. This donation dynamic is not based on the donated organ but operates directly between people in a bond created by this donated organ or tissue.
The gratitude and recognition that the donation arouses are important returns for the donor because it seems impossible to us that the recipient, in our human experience, can be indifferent to the attitude and behavior of the donor. Only life, with God as the source of life, is a pure gift because it can give without cause, without reason, and without calculation.
Can we speak of anonymous organ donation? The donation lives, among other things, on a personalized link created between donor and recipient without calling into question the concept of free donation. Keeping anonymity as one of the pillars of the donation system means giving more importance to the donated object (the organ) than to the interpersonal relationship that can be created. It is putting the recipient in front of something to which he is entitled as a citizen belonging to our social body, in the absence of any personalized gratitude. The act of organ donation is the opposite of an anonymous impersonal practice; it preserves the value of the given in the one who gives and the one who receives.
If anonymity is not fully in line with the logic of donation, there is a wise rule that currently avoids the media excesses of organ transplant and the emotional or psychological problem between donors and their relatives and recipients.
Organ donation is not just contingent; it exceeds means and instrumentality because it is placed under the sign of finality. Its strength acts with respect for others. There is no such thing as a pure donation. For this, the medium term between the brutal objectification of the exchange and the subjectivism of the symbolic link is solidarity. The latter retains more public circulation from the market and free donation. Free access prevents the market and advertising prevents withdrawal into the individual sphere by promoting equality and justice.
Organ Donation as an Act of Love
By giving, we only give back what we have received from God who came to us
and loved us for free. He gave himself freely for our salvation and invited us
to love our neighbors. However, the salvation brought by Jesus Christ did not
change much the course of our daily lives. For example, He did not remove evil,
injustice, wars, and diseases because, in the eyes of Jesus, it is the
revelation of the gratuitousness of God for humans that constitutes salvation.
It is not the murder of a human that can save humankind, but a God who is a
permanent gift, completely free to humans. The love that God has for us is
selfless and perfectly free. God has nothing to gain because He lacks nothing;
rather, He limits Himself for us and crucifies Himself for us and this for no
reason other than a love without reason. Given the magnitude of the gift of God,
any calculation on our part becomes scandalous (Matthew 18:32). This capacity
for gratuitousness given to us by God does not make it automatic, it does not
depend only on desire, but more necessarily on the will of humans and on their
choices and decisions, which are only personal. Gratuity calls on us to conquer
our independence and our autonomy from determinism: it is in gratuity that
freedom is achieved.
To question the legitimacy of organ donation necessary for the survival of
another human can seem paradoxical and even scandalous to those who profess a
moral of life and who adhere to the Gospel. Is it not an eminent form of love;
is not this an act by which we donate not only an organ but something of
ourselves? The agape defined by the donation does not expect a return; it
ignores the possibility of the counter donation in its action. The person giving
does not incorporate within their actions an anticipated response because they
have refused any equivalence. The agape that does not require reciprocity is
explained by Jesus’ request to His disciples to love each other not only as He
loved them (John 1:12-13) but to love themselves, which is the very love with
which He loved them. If this love goes so far as to sacrifice a life for
another, organ donation, although it is not required by natural ethics, is
evident for Christian ethics.
The earthly life of the body is not the supreme good for the Christian; it has its true value only when the person is ready to spend it in the service of God for eternal life (Mark 8:35). Whoever puts their life above everything, who has no other concern than to keep it, loses the sense of real life, which is life in Christ. For a Christian, it is not just about prolonging life here but really living.
It is true that, through organ donation, we lose something from our body, especially for a living donor; however, this loss takes on importance through the movement of love, which, moreover, must also be with the person who consented to the organ donation. “When I distribute all my goods to the hungry, when I deliver my body to the flames, if I miss the love I gain nothing. Love takes patience, love does service, it does not envy, it does not show off, it does not swell with pride, (…), it does not seek its interest, (…)” (1 Corinthians 13:1-5).
Conclusions
A true organ donation is a way of freely adhering to our being of donation, translating at best our recognition of the donation of our Origin and that which others in before us have made to us. Organ donation is a donation in return meaning that one is not God, the Origin of oneself. This kind of donation, which escapes the categories of having, arouses in others the desire to give.
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Volume : 18
Issue : 1
Pages : 16 - 23
DOI : 10.6002/ect.rlgnsymp2020.L3
From Usek, Lebanon
Acknowledgements: The author has not received any funding or grants in
support of the presented research or for the preparation of this work and has no
potential declarations of interest.
Corresponding author: Charbel E. Chlela, 2323 Jounieh, Lebanon
E-mail:
charbelchlala@usek.edu.lb