Time to change our thinking about organ donation
It’s official. I’m an organ donor. Trust me, I double-checked.
According to B.C. Transplant, I’ve been an organ donor for less than a year. I’ve been a licensed physician for almost 13 years.
It’s not that I didn’t think about it sooner. I’ve had many patients in my career with organ failure who have been on a transplant list. At this moment I can think of easily half a dozen people in my practice who are awaiting an organ transplant.
Since 2001, I have taken care of three patients who were organ donors.
I can remember my fist experience as if it were last week. I was on call for Internal Medicine and ICU as a new staff physician in Alberta. It was the fall of 2002.
It was my first week in my new job. I was called to the emergency room to see a 56-year-old woman called “Rosie” who had collapsed in the emergency room.
She had presented with a headache and had suffered a cardiac arrest while being examined by the emergency room physician.
A CAT scan of her brain showed a massive hemorrhage that was beyond surgery. She was on life support and there was nothing further to be done.
She was now a candidate for organ donation.
I had reviewed the case repeatedly. I had examined my patient, the scans and spoken with the neurosurgeon. It was a massive aneurysm and it could not be repaired. There was nothing more to be done.
As the attending physician in the ICU it was my responsibility to ask her family for permission and then to proceed with the medical testing to determine brain death.
I went to the bedside. I sat with her daughter. We talked.
I explained her mother’s current state and the prognosis. And then I broached the subject of organ donation.
“Did your mother ever tell you her wishes regarding the possibility of organ donation?” I asked.
She looked up at me, her heart broken. This was the worst day of her life. The world had already taken so much from her and here I was asking for more.
“Mom signed a card. It’s on her license,” she said.
The decision had been made. Rosie would be an organ donor.
I spent the next 24 hours with Rosie’s family. I called in the transplant team and followed a variety of protocols.
Rosie saved six lives that day. Her heart went to a young man in Calgary, her kidneys to someone in Edmonton and Saskatchewan, her lungs were a double match in Ontario, as was her liver, and her pancreas saved a life in B.C.
Rosie’s family was no doubt devastated by her death; it was sudden and unexpected. She was otherwise healthy before this event.
I spent hours with her daughter in preparation for the donation.
Although it was indeed her mother’s wishes, this young woman before me was, in many ways, also my patient.
I wanted her to be “okay” with this decision. And indeed she was. Many times she told me how “at least this makes a terrible situation a bit better.”
She knew that both respecting her mother’s wishes and giving these gifts of her mother’s organs would indeed in some way ease the madness of the situation. And it did.
It is estimated that a single deceased organ donor will save at least six lives and affect 70: one heart, one liver, two kidneys, two lungs each changing the life of a recipient.
This in addition to the two cornea, bone marrow, tissue, bone and bowel that can also be transplanted into recipients.
How many patients lives could be changed? How many families affected?
It took me more than a decade after that event to register my own organs for donation.
I’m embarrassed to say that until last year, I just never got around to it.
It turns out, I am not alone. According to the Canadian Transplant Society almost 90 per cent of Canadians support organ donation but less than 25 per cent have made plan to donate their own organs.
Most people do not make their wishes known; others just “haven’t gotten around to it.”
More than 4,500 Canadians are waiting for transplants right now. In 2012, 2,124 organs were transplanted while 256 people died waiting on a transplant list.
Canada has some of the lowest transplant rates in the developed world.
Studies show that transplants are highly successful.
Recently, certain provinces have discussed the option of a presumed consent program to address shortages in organ supply.
Nova Scotia is currently discussing such a program. This would mean that people are presumed to be donors by default unless they opt out.
Currently the opposite is the case in all provinces. We all must actively register to be an organ donor.
But what if the opposite was true?
Certain countries such as Spain, Portugal and Belgium who have default programs have some of the highest rates of transplants in the world.
Further more, studies from these countries show that there is little discrepancy between those who say they support organ donation and those who are among the pool of available organ donors.
Critics of this system say it will force patients into donating organs against their will. Some call it “undemocratic”and cite that it would be forcing a procedure on a patient “against their will.”
I know it is controversial but I’m in favour of a default system.
I don’t think it’s forcing anything on anyone. Firstly, this is not forcing a medical procedure on someone against his or her will.
Everyone has the right to opt out of such a donation.
I know that in theory organ donation should be a gift and not an obligation but I can’t help but think that many of just have not gotten around registering for such a process and that perhaps, if it was indeed done for us, our practice would match our beliefs.
If more than 90 per cent of Canadians support organ donation why not adopt a default program and have the remaining 10 per cent register to be non-organ donors?
There is no easy solution to the problem of scarcity of organ donation in Canada. I don’t propose to have it. I only raise a point for discussion and hope to move the issue forward.
Make no mistake, I love this country. I would not live anywhere else and I certainly wouldn’t practice medicine anywhere else.
I think Canadians are some of the most caring and generous people in the world. We have a generosity of spirit that is a lesson to the world.
But we need to change our thinking and practice on how Canadians approach giving the ultimate gift in this country — the gift of saving a life.
For more information and to register to donate, click here.
© Shaw Media, 2014