Organ transplantation and the systems of how organs and tissues are harvested is a contentious issue both in Malta and abroad although, more often than not, people understand its importance because the practice often saves lives or markedly improves one’s quality of life.

Most people are well aware of the shortage of the availability of organs for transplantation. Public opinion, however, remains divided on the issue, especially whether the decision on what to do with one’s organs after one’s demise belongs to the deceased, as expressed when s/he was still alive, to his/her relatives after death or to the State’s health authorities unless refusal was expressed during one’s life.

In some other European countries, such as Spain, France and Italy and Belgium, legislation has been introduced allowing people to have the opportunity to opt out (when alive) of giving their organs after their death. So unless a person has explicitly refused to do so when alive, the State has a right to harvest organs after death.

In practice, the opinion of relatives is always sought as this can create a stressful situation of organ harvesting (after death has been confirmed) without relatives knowing. Consultation with relatives (but not necessarily overturning the wishes of the deceased) is even exercised in countries that have adopted the opt-in (informed consent) method by law.

The improvements in modern medicine have significantly eased the problem of organ rejection.

The modern ways of matching compatibility of a donor’s organs with a recipient has made this form of treatment more effective and has also opened new roads to the transplantation of organs or tissues previously not done such as transplantation of skin, the pancreas, intestine and the uterus. Other organs which have been transplanted for many decades are the heart and lungs, kidneys and cornea. In Malta, only kidneys, heart and corneas are transplanted but organs retrieved in Malta and not transplanted here are transported to Italy or the UK, in line with agreements that allow Maltese patients to benefit from transplant surgery abroad in return.

Nowadays, there are better facilities to store tissues, such as corneas, so they can be used many days later, unlike other organs, which have a short time limit from when they are harvested until they are transplanted.

In Malta, organs are usually retrieved once a patient is certified brain dead in ITU through an opt-in system and doctors in the ITU report very low refusal rates. The system here is not regulated by law, nor is the legal status of some means, such as a donor card, which shows a donor’s intentions during one’s lifetime.

There is a low organ donation refusal rate in Malta

The only Maltese laws on this subject are basically transpositions of European directives that deal with regulation, quality and standards of transplantation or blood transfusion procedures. However, there are no legal provisions referring to opt-in or opt-out systems (whether with the involvement of relatives or without), the status of donor cards or any committee/unit that decides on the allocation of live or cadaveric transplants.

Here, such matters only depend on adopted practices and do not have the backing of the law.

There is a low organ donation refusal rate in Malta but there is still a considerable problem of organ shortage. Therefore, the introduction of a suitable legal system is a topical subject for discussion and may help boost the availability of organs or tissue for transplantation, especially in cases of corneas and kidney donation by live donors.

Occasionally, studies have revealed that lack of cooperation by doctors in other wards who do not inform colleagues on the possibilities of organ donation hampers the prospects of a transplant. This can be addressed by new legislation providing for the setting up of a database in hospitals listing those who have shown their wish to be organ donors.

There can also be a policy whereby hospital doctors will need to know the donor status of deceased people.

There is always the need to have trained transplant coordinators in a sufficient number and who are competent in communicating sympathetically with the relatives of deceased patients.

The definition of death (whether brain, brainstem or cardiac) is important. Having a good definition of death backed by law puts minds at rest, especially those worried that organs may be harvested from people not actually dead and that medical treatment to save a patients’ life is continued rigorously until death occurs.

Etienne Grech is chairman of the Parliamentary Health Committee.