I was asked the following and other similar questions while taking part in radio phone-in programmes during an organ donation campaign I was part of a few years back. None of them has been made up.
“If I donate a kidney or, more important still, a heart, after my death will I be somewhat defective after the universal resurrection at the end of time?”
“If I receive the lung of a criminal will there be the possibility that I will also turn bad?”
“Will my body be disfigured if I donate organs after my death?”
“If I become an organ donor will doctors do their very best to save me or will they let me die if they need that organ for someone younger?”
Such questions show how mistaken are those who believe that the decision to donate organ or organs after one’s death is a simple and straightforward automatic option. Generally, such people look at the issue rationally, concluding that since one has no use for any organs after death, donating them to others is no big deal.
It is similar to donating something that has been left unused for years on end in a box room. Such a position is then strengthened by the altruistic argument that appeals to the positive feeling that human beings experience when helping others. When this comes at no real expense or pain, then the process of donating should become more attractive as it provides a win-win situation.
But things are not so simple.
We and those who love us experience the process of dying more on the emotional rather than the rational level. It is something we would like not to experience. Since this is a preference that will certainly elude us, we prefer not to think of it even though it confronts us daily.
Signing an organ donation card is like signing a declaration affirming the inevitability of one’s death. It is not as easy as many say it is, and this is one of the reasons why there is a discrepancy worldwide between the expressed wish of donating, and the taking of concrete steps to be a donor. For example, in the UK, out of a population of over 63 million there are 16 million people signed in an organ donor register, far less than 90 per cent who say that they are in favour of organ donation.
Quite naturally this is not the only reason accounting for the discrepancy. But an organ donation campaign should also adequately address the questions I referred to earlier.
When I participated in the campaign there were just a few hundred registered donors. The number then mushroomed to over 10,000 as a direct result of it. Today there are 30,000 registered donors, making Malta one of the best countries in Europe for such donations. The positive media coverage afforded to several cases of organ donation in recent years had struck the popular sentiment and must have contributed substantially towards this sharp increase.
However, one should never rest on past laurels. Chris Fearne, the Parliamentary Secretary for Health, is fully conscious of this need, so much such so that during the launch of a White Paper on the subject he clearly stated that there is need for an extensive awareness campaign to empower educators, parents and potential donors to take the leap.
The will of those who had a donor card should be respected
Quite naturally, campaigning should be accompanied by legislation. The White Paper proposed by the government outlines different legal frameworks our country could adopt. Should we move towards the system known as presumed consent, also known as the opt-out system? This means that unless the deceased had expressed a wish in life not to be an organ donor then consent will be assumed.
A number of countries have adopted such a system, but according to liver transplant surgeon and consultant Simon Bramhall (2011), very few use the system in practice.
When in 2013 the Welsh National Assembly was debating (and eventually voted in favour of) the opt-out system, Archbishop George Stack of Cardiff rightly objected to the presumed-consent proposal, saying: “Our bodies are not an asset of the State.” He was supported by several other Church leaders. This is significant since all religions support organ donation and research shows that the influence of religion is very important in taking a decision for donation.
A 2008 survey of Intensive Care Society members in the UK showed that several members of the medical profession believe that the introduction of presumed consent might damage the relationship of trust between clinicians caring for patients at the end of their life and their families. The questions I outlined at the beginning of this commentary give weight to their fears.
I am totally against the adoption of such a system in Malta.
The Maltese are very forthcoming on the subject. When a person dies on a life-support machine (otherwise it would not be possible to donate organs) and doctors approach relatives, the answer is a definitive yes in nine out of every 10 cases. So why should one oblige people to do what they are ready to do voluntarily?
I think that Fearne struck the right balance during a recent discussion on the subject at the University. If an individual has expressed a will against donation, this should be respected. But the will of those who have a donor card should also be respected. The law, however, should be changed so that relatives will no longer have the power to decide against the will of the deceased.
However, in those cases when no preference was voiced, the decision should be taken by relatives, not by the State.
Altruism without compulsion should be the way forward, as shown by the example of Pope Emeritus Benedict XVI. While he was still a cardinal and Prefect of the Congregation for the Doctrine of the Faith, he had said: “I have agreed to give my organs to whoever might be in need. I registered years ago and I always carry this document with me. In addition to personal data, it states that I offer my organs to help whoever is in need; it is simply an act of love.”
joseph.borg@um.edu.mt