Transplants: the role of relatives

It has long been considered the prerogative of close relatives to decide on medical decisions on behalf of older relatives or, in a case of emergency, on behalf of other members of the family who are not in a position to decide for themselves.

Such an attitude, held with the best of intentions, may at times goes against the wishes of the individual concerned.

The recent announcement by Health Minister Joe Cassar makes it clear that this attitude must change. Relatives will have no say in deciding on medical procedures, including transplantation of organs from people who had made it clear prior to their death that they willed their organs for transplantation.

For this to happen, it is necessary that a donor card or other evidence is available when it is most needed; for instance, at the time of a traffic accident.

Why has there been such marked resistance to donation of organs? Firstly, the number of people carrying a donor card in Malta is not high. This puts the onus for making a decision on the relatives, often at a most inauspicious time, immediately after a tragic accident, when they are least ready to take such a decision.

The availability of a donor register that can be easily accessed would overcome the need for carrying a donor card, or a suitably marked identity card for this purpose.

One might add that young people in general may not have such an eventuality in mind most of the time, and therefore put off registration indefinitely.

Older people may decide they have nothing to contribute. There is a continuing need for education and information made available by the authorities to explain why registering as a donor is a necessary as well as an altruistic action the like of which is hard to conceive.

A second issue could be the fear in the mind of some people that organs may be removed too hastily, even before the body is truly dead.

It is a fact that organs have to be removed as expeditiously as possible in order to ensure they do not deteriorate. Again, it is essential that the public be reassured that, with the current diagnostic procedures, such an eventuality is ruled out.

Surgical procedures on a dead patient are exactly of the same kind as those carried out on a living patient, with the same degree of care and respect for the body being operated on.

It might even be argued that ensuring the maximal use of organs after death is an obligation on society. In a number of European countries this has been taken a step further by the introduction of an ‘opting out’ system, which ensures that, where the particular individual has not made it clear that s/he objects to transplantation, organs will be removed automatically.

Malta is not ready for such draconian action, which makes it more important that society encourages the concept of registration as organ donors.

There are a number of other situations where patients are not in a position to decide for themselves about a course of treatment.

This holds particularly in situations relating to resuscitation or when taking extraordinary measures to prolong life in, say, a comatose patient.

A ‘living will’ prepared when one is in reasonable health, with a clear mind, would oblige the medical authorities, as well as well-meaning relatives, to follow the wishes of the patient.

There is obviously a lot of educational work to be done to ensure that the average person understands the need for such legislation, to avoid unnecessary worry and anxiety, as well as to ensure that the autonomy of the individual is given due importance.

Prof. Cauchi is a former chairman of the Bioethics Consultative Committee.