There has been some significant discussion in the last
couple of weeks surrounding the concept of Organ Donation and Presumed
Consent. To put this discussion into
context we need to understand what presumed consent is, as it applies to organ
donation is.
The
presumed consent or opt-out system allows people to register their
unwillingness to donate after death. If there is no registered opt-out the
default or presumed position is that they wish to donate their organs.
Koffman
& Singh 2011
Ann R Coll Surg Engl. 2011 May; 93(4): 268–270.
That’s it! Instead of
the present system where you or your loved ones have to declare your intent to
donate organs the reverse occurs where it is assumed your consent is assumed
unless you or your loved one’s indicate otherwise.
This subtle difference is significant due to the reality
that the demand for donated organs far outweighs the availability of donor
organs. People die waiting for a donor
organ. Does presumed consent increase
the number of the available organs.
Yes. Studies indicate that in
this type of system organ donation does increase. One study is cited below, but it is important
to note that other factors do effect the increase in donations.
Results:
In
the four best quality between country comparisons, presumed consent law or
practice was associated with increased organ donation—increases of 25-30%,
21-26%,
Conclusion:
Presumed consent alone is unlikely to explain the variation
in organ donation rates between countries. Legislation, availability of donors,
organisation and infrastructure of the transplantation service, wealth and
investment in health care, and public attitudes to and awareness of organ
donation may all play a part, but their relative importance is unclear.
BMJ 2009;338:a3162
Those who know me and know my family’s story often bring up the
subject of organ donation with me. We
have been through the process once (Russell) and the possibility does exist
that Susan could go through this process as well. This issue hits very close to home. What some may not know is that we know the
circumstances under which Russell’s donated heart became available. We also know a family who donated their child’s
organs several years ago. When Russell
was listed for transplant I had a lengthy discussion with this family about the
process they went through. It helped me
understand the gravity of the situation and be able to sympathize with a family
posed with the question “to donate or not to donate.”
Dispelling
Myths
Organ Trolls do NOT exist
Organ Trolls do NOT exist
Some people believe that if you sign your
donor card or indicate a willingness to donate your organs that there are
ghouls who roam hospital corridors looking for willing donors to abscond with
their organs. I have talked to many
First Responders and Emergency personnel who unequivocally state that they have
never looked for an organ donor card or ever given a second thought to doing
anything than saving someone’s life. Many
medical professionals do not even know how the process works. They have no secret phone number they call
when they think they may have a ”suitable candidate.” All of this behind the scenes work is done by
the appropriate organ donation organizations.
The idea that appropriate medical might be withheld from a person just
to harvest their organs is absolute balderdash.
To summarize, if you are unfortunate enough to sustain a life
threatening injury the medical staff has an ethical, legal, and moral duty to
do everything in their power to save your life.
The consideration to donate organs is only discussed after the medical
team has done everything in its power to save you and has exhausted every
avenue. This is when the discussion to
donate organs can take place and NOT before.
Families cannot be cut out of the decision making process
Another theory I hear again and again is that
if you declare your wish to donate your organs that the family does not need to
be contacted or asked if they agree with the wish to donate. This is not true. If family is available and is competent to
make a decision they will be asked for consent (even if a signed donor card
exists). The family can counter the wish
to donate. Even if there is a signed
donor card the family can rescind the request and the medical staff will
respect the decision of the family. Families
are always respected and consulted. This
is especially important when you consider presumed consent. Even if legislation were passed to enact
presumed consent. It is still incumbent
on the transplant team to discuss this with the donor family. If at that point they refuse, then again the
wishes of the family would be respected.
Presumed consent is not a license for Doctors to do what they want
without consulting families. Any law
that would take away this right of donor families I would vehemently oppose.
From my statements above, some may ask, why presumed consent can
make a difference. If families can still
refuse what difference does it make? I
think presumed consent changes the conversation.
It must be one of the most difficult tasks for anyone to go to a
family that is in the midst of a crisis to ask them if they would consider
organ donation. Something I would never
want to have to go through. I think
having presumed consent in place can take some psychological burden off of the
family. Being a family and to actively
make the decision to sign paperwork to allow organs to be taken and used for
organ donation must be a huge psychological burden. If presumed consent is in place it places
less burden on the family. They can
simply not oppose. It may not seem like
a big difference but given the magnitude of the decision I think it does have
an impact. Anything that makes that
moment easier is huge.
Organ Donation is an amazing process. It encompasses strong emotions for those who
experience loss and those who receive a monumental gift. What makes this issue even more difficult is
when people do not have factual information on the topic. This has become abundantly clear as I hear people
call into radio talk shows. I hope
people get better informed on this issue.
What I have stated above merely scratches the surface of this
issue. I just thought it was good idea
to share some of our experience; having been through the process. It is a conversation worth having.
No comments:
Post a Comment