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Organ Donation - A Gift of Life
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.
Authorization
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.
Who should ask?
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.
Definition of 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.
What can you donate?
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.
Transplant Areas
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.
Ethical Issues
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."
Impact on funeral services
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 www.transplant.ca
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