Each year the Faculty of Medicine at Memorial University of Newfoundland will accept the donation of 6 to 12 human remains to be used primarily for teaching medical, nursing and pharmacy students enrolled at that institution. This is the only institution registered with the Department of Health in the province that is permitted to have such a program.
According to the manager of Medical School Laboratories, who administers this program for Memorial, their files contain over 800 donor cards received from individuals ranging in age from 30 years and up. By signing a donor card, these persons have given their consent for their bodies to be used for medical education or scientific research after death.
In accordance with the Newfoundland “Human Tissue Act, 1971,” this consent is legally binding and must be acted upon by the next-of-kin, executor/executrix or legally authorized representative of the deceased at the time of death unless that person had reason to believe it was later withdrawn.
To ensure there is an adequate supply for their teaching needs the Medical School usually maintains about 25 bodies. This includes those held in their cold storage facility, which holds a maximum of 16 bodies, and those in use for teaching, which usually numbers about 8 or 9. The remains of 6 to 12 individuals are released each year.
The completion of a donor card is not a guarantee that a person’s body will be accepted by the Faculty of Medicine. Occasionally, circumstances may limit the acceptance of a body. In fact, the School declines about 4 to 6 donations a year.
With the exception of space limitations, which is the primary reason, other reasons for declining a donation can be quite complex. At the time of death, the following circumstances are considered: if an autopsy is required or requested, presence of an infectious condition such as HIV, Hepatitis B or C, presence of open wounds or unhealed surgical incisions, severe obesity and any other medical condition which would make it impossible to embalm, store or use the body for teaching.
Due to the extended length of time the body is kept, the Medical School’s main concern is that a body is intact. Therefore, it has declined remains with colostomies or amputations. However, there are no exact rules. Each case is reviewed individually, in most instances, when death occurs. Although not common, in some cases, where the donor’s condition is palliative, a determination whether to accept the donor is made prior to death.
When a potential donor dies, the Faculty of Medicine must be contacted to determine if the body can be accepted. To do this the informant (i.e. next-of-kin, clergy, physician, etc.) should contact the Manager of Laboratories. Should death occur after hours or on weekends or holidays arrangements have been made to direct all calls.
There is no urgent need to transfer the body to the Medical School immediately. In most instances involving a death on a weekend or at night, the remains may be held by a hospital or resident care facility until the next working day. Should a potential donor die at home, the remains may be removed by a funeral home, who in turn will contact the Medical School on behalf of the family.
To ascertain whether the body can be accepted, the School requires the following specific information from the informant: the name and birth date of the donor, the cause of death, a copy of the donor card or other legal written consent to donate, the original death certificate signed by the attending physician, an indication an autopsy is not requested by law or requested by the family and information regarding the wishes of the donor respecting the final disposition of the remains.
Once the body has been accepted, the Faculty of Medicine will arrange for the transportation of the remains to the Medical School at their cost.
The original copy of the death certificate, the donor card or other written consent to donate and the name and address of the next-of-kin must accompany the body.
When a person donates their body to medical science, all rights to the body, including its final disposition, are assigned to the Medical School. It is then the School’s responsibility to look after the funeral arrangements including all reasonable expenses once the remains is ready to be released. Alternatively, the family may claim the body for private interment at their own expense.
Remains are released from the Medical School to a funeral home approximately 24 to 36 months after the date of death. The final decision respecting selection of a funeral home along with the desired funeral services, again, rests with the School. However, the wishes of the family are taken into consideration.
The Faculty of Medicine is committed to providing a basic, dignified funeral service in accordance with the religious beliefs of the deceased. In most instances the deceased will be cremated immediately upon his or her release to the funeral home with the cremated remains placed in an urn (i.e. wooden or marble) or temporary container. The family may then wish to have a memorial service in a church or funeral home chapel or a short committal service at graveside. Scattering of the cremated remains is also an option.
If cremation is not desired, the School will contribute to the purchase of a casket or provide one which will at least meet the provincial government specifications for indigent funerals. In this case the remains would be placed in a casket for immediate burial at a cemetery chosen by the family. With the exception of the purchase of an expensive casket, the Medical School, as noted, will assume all costs associated with the funeral and cemetery services provided. If the remains are interred, they will also place a small headstone or bronze marker, suitably inscribed, on the grave of the deceased.
The Medical School aims to have an equal gender balance between male and female donors. The ages of most donors range from 50 to 100 years. It has also accepted the donation of fetuses. If you are interested in learning more about the program, you may contact the Faculty of Medicine, Memorial University of Newfoundland, Office of the Manager of Laboratories, St. John’s, NL, A1B 3V6. Telephone: (709) 864-3360. Fax: (709) 864-4987.
A donor information package will be sent to interested persons upon request. The School sends out about 80 to 100 donor packages each year, and a large percentage are completed and returned. Potential donors are asked to complete three donor cards and a donor information form to specify their wishes for the final disposition of the remains. Two donor cards and the form should be returned to the School.
Society owes a debt of gratitude to all those who have donated their body to medical science. However, such acts of considered generosity should not overshadow the compelling needs of those who are left to mourn the donor’s death. The survivors should consider not waiting for the release of the remains from the Medical School before paying tribute to the deceased or saying good-bye.
Even without the remains present, consideration should be given to having some type of funeral service. This may include a designated time set aside at a funeral home or other suitable location for relatives and friends to pay their respects. A picture of the deceased along with other memorabilia could also be displayed to stimulate conversations and find memories. The visitation period could then be followed by a memorial service held in either a church or funeral home chapel. This service of remembrance and celebration will certainly provide comfort to those who mourn the loss and begin the healing process.
According to the Federal Department of Health, Canada’s organ donor rate which has leveled off at 14.5 donors per million, is one of the lowest among western industrialized countries. At a time when the need for organs has increased by 50 per cent, there is cause for concern.
Recently, Canada’s health ministers agreed to establish a National Transplantation Council to address this low rate and the organ donor system. Prior to this, the Alberta Government set up its own Advisory Committee on Organ and Tissue Donation and Transplantation to find out why people are so reluctant to donate their organs when they die.
In addition at a mid-year meeting, the Ontario Funeral Service Association had as guest speakers a representative from the Multiple Organ Retrieval and Exchange (MORE) Program and a funeral director from the province who was a recent recipient of a new liver.
Funeral service organizations both in Canada and the United States have recognized the role they can play, along with their members, in raising the awareness of the need for organ donations. Last year, the International Cemetery and Funeral Association unveiled an organ donor awareness program. The program will provide Association members throughout the United States and Canada with organ donation training and materials for incorporation into their presentations to family members who choose to prearrange their funerals. Under the new program cemetery and funeral home staff will discuss the possibility of adding organ donation documents to an individual’s pre-need file.
Who has the right to authorize organ donation? Although legal authority for the final disposition of your remains rests with the immediate next-of-kin, executor or legal representative, a living adult’s consent to be an organ donor is legally binding after that person dies. In practice, however, hospitals will not accept organ donation if family members object.
When adults who do not indicate their desire to be organ donors or children who cannot legally give consent die, their family or legal representative can give consent. In the absence of a Will, the family members who have the right to authorize organ donation are ranked as follows: spouse of the deceased, adult child, parent, adult brother or sister, aunt or uncle, niece or nephew, grandparent or the next nearest next-of-kin. If the first person on the list withholds his or her consent, no other person can be asked.
When a person does not leave directions about donating their organs, who should ask the family? In some provinces and most U.S. states, the attending physician is required by law to determine whether the deceased is a suitable donor and then ask the family. However, if the physician feels it is against the deceased’s religious beliefs or that it would upset the family, the topic will not be raised.
During the presentation to the Ontario Funeral Service Association, MORE’s representative stated their program had one of the best survival rates in the world, received more organ’s per donor than any other country but was not good at finding donors. In 1998 Ontario had 155 single organ donations; yet, there were over 4,000 head injury deaths.
Success at increasing the rate of organ donations has been achieved in some European countries when specially trained people talk to the family.
Anyone who watches television has undoubtedly seen a villain lying on the ground and the hero bending over the body checking for a pulse either on the wrist or neck. Feeling none, it is assumed the villain is dead. When the heart and lungs stop working and cannot be restarted, a person is considered dead. Although this is still the legal criterion used in most provinces, doctors have introduced the criterion of “total brain death.”
Anyone who watches television has undoubtedly seen a villain lying on the ground and the hero bending over the body checking for a pulse either on the wrist or neck. Feeling none, it is assumed the villain is dead. When the heart and lungs stop working and cannot be restarted, a person is considered dead. Although this is still the legal criterion used in most provinces, doctors have introduced the criterion of “total brain death.” Total brain death normally occurs only a few minutes after the heart and lungs stop functioning, because the brain starves without oxygen which it receives from circulating blood. A body cannot be used for organ donation until total brain death occurs.
As internal organs will be damaged if blood circulation stops, a brain dead organ donor will be attached to a machine which will keep the heart beating and blood circulating until the organs are removed.
The donation of an organ can save the life of a dying person. A multiple organ donor can save many lives. Transplantable organs include lungs, heart, pancreas, liver, kidneys and bowel.
In addition to organs, tissues can also be donated. Tissue donations such as eye tissue, skin, heart valves, bone, tendons, veins and ligaments can provide life-enhancing and life-saving transplants for many others. Survival of an organ depends on how quickly a recipient receives it. Success rates have risen dramatically over the past few years. For example, the success rate for kidney transplant is 90 per cent, heart 80 per cent and liver 75 per cent.
At least two-thirds of all transplantations in Canada are done in Ontario. There are five transplant areas in Ontario, Toronto, Ottawa, Kingston, Hamilton and London. If a patient in Newfoundland and Labrador, for example, were waiting for a liver transplant, he or she would go to London or Ottawa.
Although the donation of one’s organs is the ultimate act of charity, its intrusiveness on one’s body brings with it a number of ethical issues.
Dr. Hub Zwart, an ethicist with the Centre of Ethics at the University of Nijmegan in the Netherlands has studied the issue of organ donation. In a speech to Memorial University’s Medical School in November 1998, as reported by the MUN Gazette in its December issue, Dr. Zwart stated, “We consider that the removal of organs from a dead person is justified if the donor has consented and is dead. We have to be really sure that the person is dead and completely sure about consent.”
With the introduction of “total brain death,” it is more difficult for the patient’s family to actually believe their loved one is dead. This is a source of disquiet for family members, and Dr. Zwart said that from an ethical viewpoint this disquiet must be recognized.
Because family members may be upset, it is also critically important that the wishes of the deceased are clear. Depending on the religious or moral tradition in which a person is raised, there are different reasons for being an organ donor. For example, in the Christian tradition, it’s a matter of charity and sacrifice, while the Islam tradition emphasizes the common good.
Dr. Zwart noted, “Consent is critical because of our belief that others do not have the right to intrude on our body without our permission.”
Organ donation does not mean a closed casket. Regardless of the extent of the medical procedure to facilitate organ removal, the techniques employed by licensed embalmers ensure the integrity of the deceased’s appearance will not be compromised.
The only impact, albeit minor, is in the timing of the release of the remains to the funeral home. This would depend on the complexity of the retrieval procedures and the length of time it would take for the medical team to respond. Notwithstanding these factors, the delay in the preparation of the deceased for viewing should not exceed 24 hours.
There is so much more that can be written or said about organ and tissue donation. In this province the Organ Procurement and Exchange of Newfoundland Program (O.P.E.N.) is responsible for coordinating organ or tissue retrieval from any provincial hospital. For further information contact: Coordinator O.P.E.N., General Hospital, The Health Sciences Centre, St. John’s, NL, A1B3V6. Telephone: (709) 777-6600. From a national perspective, there is (CAT) The Canadian Association of Transplantation. CAT is a non-profit association committed to facilitating and enhancing the transplant process. To contact CAT call (416) 340-3587, or visit their new website at http://www.transplant.ca/