Death is never an easy subject to get around.
Last month the motorsport world was once again hit by tragedy, IndyCar and ex-F1 British driver Justin Wilson lost his life weeks after his thirty seventh birthday. On Monday 24th August 2015, Wilson succumbed to his injuries and altruistically gave his organs to six people, saving their lives.
Each year, people die while waiting for a transplant. In the course of 2013 alone, over 63,000 million people were placed on the transplant waiting lists of the twenty eight Member States of the European Union. To give a sense of dimension, that is the equivalent number of the current UK population. In that same period 4,100 patients died while waiting for a transplant. This official figure although being a hefty reality to take in, it still is an underestimated figure of deaths due to organ shortage. The reality is that patients that have become too ill to undergo an organ transplant are normally removed from the lists and their later deaths are not noted towards the official figures. The toll of avoidable deaths is then greater than what is widely accepted and unfortunately it is not the only consequence of organ shortages; the less debated subject of the incremental need to subject living donors to surgery and possible complications, is also a direct result of the unavailability of organs. In 2001, for the first time ever, the number of living donors in the US surpassed the number of the deceased ones. But let’s not fool ourselves, although the growth of deceased donors would save many lives and reduce the necessity of submitting so many living donors to surgery, it would not eradicate the need of the latter. The organ recovery and transplantation process is a complex one, involving key factors such as: need/accessibility, timing, compatibility and a network of health professionals at many different levels.
Also, the laws around donation vary from country to country, allowing potential donors to permit or refuse donation, or give this choice to the relatives. While in some countries, such as the UK, the potential donor has to register to be a donor (opt-in), in others, like Portugal, the register is, for people that wish to be a non-donor (opt-out). Spain is another example of opt-out system, but even though the presumed consent is in place, the families are still consulted and have the last say prior any organ recovery (presumed consent in theory, but informed consent in practice).
Many argue that a system of opt-out would be the solution for the organ shortages; however Spain, the world leader in organ donations, claims that the real difference was felt after the professionalization of its medical sphere with implantation of intensive care specialists as transplant coordinators in each hospital. This was also noted at a smaller scale in Portugal, where the opt-out system implemented in 1993 had a small impact in the numbers of donors, contrasting to what happened in 2009 when the number of deceased donors escalated, after the 2008 system restructure and designation of one hospital donation coordinator per hospital with appropriate facilities.
Others go further and say that an opt-out system goes against the most fundamental principle of being a donor, the voluntary capability of making a donation, to give the ultimate gift of life. Nonetheless, many misconceptions around organ donation and transplantation are still existent, possibly fuelled by sensationalist news and alarming misconstrue ideas.
A small summary of the facts that may help the demystification of being a donor, I would say are the following:
- A person’s cause of death determines what organs and tissues can be donated
- Until death has been declared, donation is not even part of the equation. For the hospital and the medics who respond to an incident, their sole efforts are to save the lives of the victim. The doctors will do everything in their power to save the lives of the individual. Only after all life-saving measures have been explored is donation considered.
- After a series of tests, a physician independent of the transplant team, usually a neurosurgeon or neurologist declares the patient brain dead (no brain activity). This is done in accordance with accepted medical practice.
- The donation process only starts after the family is offered condolences, the consent is obtained and the patient’s medical history does not rule out donation
- Each organ is allocated based on different criteria: medical urgency, degree of match to the donor and time on the waiting list.
- Donors are treated with the utmost respect and no disfiguration is caused when retrieving the organs.
- General details can be given to the family donors about the recipients and vice-versa; however names are not normally disclosed.
- Some transplants fail, even with the aid of immunosuppressant drugs some recipients develop infection and ultimately reject the organ, returning to the waiting lists once again.
- No economical remuneration is offered to the donor or to the families.
No one should feel pressurized into making rushed decisions, or should they feel bad for opting not to be a donor.
Awareness campaigns and initiatives, such as the European Day for Organ Donation & Transplantation, exist not only to honour the donors and their families, but also to encourage the debate and education on a subject that not often is a topic of conversation. By letting our loved ones know our views and wishes, we not only make our intentions clear but also safeguard the ones we love by waiving the burden of such decision on a time of great suffering and confusion. As a familiar, the concept of brain stem death can be overwhelming. How can one accept that the person he/she loves that is still warm to touch, breathing (machine assisted) and with a healthy pink complexion is dead? Many families do understandably struggle with this notion, making it harder for them to accept organ donation.
On the other hand, if we or one of our loved ones needed an organ, would we then accept a transplant? Wouldn’t we feel an everlasting gratitude for such act of selfless kindness?
Organ donation represents a new life, a palpable sense of hope that rises more often than not from the depths of sorrow and grief.
Ultimately, the decision of being a donor as any other heath decision should not only be conscious but above all a well-informed one.
For extra insight into the organ donation subject, have look at the data visualization by clicking on the image below.