Doctors MUST Have the Right to Harvest Your Body Parts

WTHERE is a desperate shortage of donor organs. The solution, says Professor Vivienne Nathanson, head of ethics at the BMA, is not donor cards but to let doctors simply take whatever they need..

WHEN I was in my 20s and still in medical school, my parents called with the terrible news that a family friend had been killed in a traffic accident.

He was about the same age as me, just out of university and with his whole life ahead of him and I knew his mother and father would be devastated.

A few months later, I asked how they were coping and learnt that they were bearing up remarkably well. When I enquired how this could possibly be, my parents told me they had been able to donate their son’s heart, lungs and kidneys to people waiting on the donor transplant list.

list.

The family had discussed this before his death and so, when this moment arose, they were able to take great comfort not only in fulfilling his wishes, but also in the knowledge that some good had come of the terrible tragedy of his untimely death.

As medicine has advanced, the need for organs has increased and the number of those available hasdecreased for the very same reason.

We are able to sustain life longer and in a more sophisticated fashion so organ transplants are more effective for more conditions.

However, at the same time, fewer people die in simple, uncomplicated ways that leave their kidneys or hearts in perfectly transplantable condition.

And so the waiting list gets longer. According to UK Transplant, the national regulatory body, 7,000 people are currently waiting for organs. These range from kidneys to livers and we medical ethicists scrabble around for new solutions.

Time is never on our side: every year, 400 people will die on that list. It’s a terrible fate: knowing that a new organ could save your life, but that very thing probably depends on another’s death.

While some debate a market in the sale of organs, and others work at the advanced science of making artificial organs, the only workable and realistic solution is to change the way we run our donation system.

Currently, you have to opt in to organ donation that is to say, you have to sign a form, carry a card or make it clear to friends and loved ones that if you should die, any organs that can be harvested should be.

I would like to see us reverse that policy in favour of an opt- out scheme as run to great effect in many countries such as Belgium and Spain where one has to give a clear indication that the body should be left intact at death and no organs removed.

The most commonly expressed objection to this is what happens if the body has not reached an irreversible condition we are still alive but unable to fight for our rights, and that someone is lurking in the shadows, Burke and Hare-style, desperate to get at our still-warm organs?

In donors whose heart is beating, death is established by brain stem tests before organs are removed. If tests show the brain stem is not functioning, this means that basic functions such as breathing and temperature control would not go on if life support systems were removed. From here, there is no chance of recovery.

This is not the same as being in a vegetative state. In that condition, the brain stem is intact; it is the part of the brain that determines alertness which no longer operates.

These people are still alive and therefore not candidates for donating organs.

Some critics argue that, even so, what if the patient had not wanted his or her organs to be harvested but had simply not got round to opting out and his family knew that? Could they interfere at this late stage? Donation should not go ahead if it would cause serious distress to the relatives. The system needs to have good brakes on it.

Any change in the law would need to be accompanied by a publicity campaign stressing the need for families to talk about this as much as possible. We all agree we don’t talk enough about what can happen in the future.

Death is an awful taboo in this culture and few of us talk enough about what can happen in the future. More discussion can only be positive, whether it works in favour of the transplant system or not.

Some say that instead of worrying about donor organs, we should be putting all our money and effort into preventive care so that these situations don’t arise.

That would be rather hard on those thousands of people who are already ill the children being born with cystic fibrosis who may need heart/lung transplants in 30 years’ time, and the men and women who have hepatitis through no fault of their own and will need new livers.

And there will always be people who become suddenly and devastatingly ill.

One of the saddest things I have ever been told by a transplant co-ordinator is of the number of people he meets who refuse to donate the organs of their loved one, only to call back the next day to say that after much thought, long conversations with friends or families, or even after viewing a pertinent episode of Casualty they have changed their minds.

And he has to explain that 24 hours on it is too late.

Life is precious to all of us. We can help each other to enjoy more of it and be respectful to our dead at the same time.

But communication is the key, and opting out the way forward..

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