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Commentary Last Updated: Dec 29th, 2009 - 00:29:00

Organ donation should remain a gift
By Linda S. Heard
Online Journal Contributing Writer

Dec 29, 2009, 00:11

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Nobody can predict when his/her time is up. But after reading an article on the BBC website titled �Wales seeks organ opt-out powers,� I�ll think twice about prolonged visits to the land of my birth if the Welsh Assembly has its way.

To be fair, its motives for wishing to introduce a system of �presumed consent� whereby doctors will have the right to remove organs from the dying -- provided they haven�t expressly registered their opposition on a register -- are beyond reproach. Wales simply wants to save more lives.

Apparently, an overwhelming majority of Welsh people say they are in favor of organ donation but only 28 percent have submitted their written agreement to the National Health Service. Last year, more than 150 waited in vain for a transplant and there are currently 500 sufferers on the list. There will also be a further safeguard. Family members will be given the opportunity to object.

There is surely no greater gift than donating a heart, lung or kidney that will save a life, or a cornea that could brighten the world of someone consigned to live in perpetual darkness. I greatly admire anyone who goes out of his/her way to sign-up to this magnificent unselfish act and it is certainly a shame that so few bother to append their names to the list or are reluctant to do so.

Moreover, I suspect that the thought doesn�t even cross most people�s minds as gifting an organ, no matter how worthwhile, is inextricably bound to their own demise. So, in this case, an assumption of consent would be expedient in providing more available organs.

There is no disputing the practical benefits which could be massive. But, unfortunately, the issue is far from cut and dried.

Firstly, there will be a number of ordinary folk, who will either not realize that they can opt out from the presumption of consent or who might procrastinate about doing so. Then, there will be others who don�t have family around them when they draw their last breaths, especially in a country not known for its close family ties. The homeless, for example, would be particularly vulnerable as would overseas visitors, bearing in mind that medical personnel would need to make swift decisions and would not necessarily have time to check someone�s nationality.

Secondly, it�s worth thinking about how such an assumption might affect the decision-making of a doctor. Would he or she go the extra mile to save a seemingly terminal older patient when a few wards away there is, say, a young man urgently in need of a new heart? Most organs are taken from people on life support machines. If consent were to be assumed, would those machines be turned off more quickly? Would family members come under pressure to prematurely consent to shutting down a loved one�s oxygen source? It�s worth mentioning that the majority of transplanted organs are taken from people while they are still technically alive; for example, those believed to be brain dead.

However, there have been instances where patients were assumed to be brain dead and weren�t. One such is Zach Dunlap of Oklahoma, who moved his foot and hand just as doctors were getting ready to remove his organs and went on to achieve full recovery. And, earlier this year, a man from Paraguay opened his son�s coffin hours after he was pronounced dead and found him alive. In the event that child�s organs had been removed, such an act would have been tantamount to murder.

Thirdly, there are religious considerations to be taken into account. Whereas most Christian churches bless organ donation or take the view that it is up to the individual, not all faiths are as clear on the subject. Within Islam, there are mixed views. Some Islamic scholars say donating organs following death is permissible. Sheikh Mohammed Sayed Tantawi, the grand sheikh of Al-Azhar, is one. Others, such as Sheikh Khalfan Al-Esry of Oman, say it is forbidden. Differences are mainly over what constitutes death. Almost all agree that organs should not be sold for profit.

Judaism is similarly divided on the topic. While strict Jewish law forbids the mutilation of or interference with a body, modern Jewish scholars generally encourage organ donation to save lives but are less keen on donation for research purposes. Ultra-orthodox Haredi rabbis, however, take the view that terminating a life in the case of brain death is murder and insist that all body parts must be returned to the ground.

Adherents of Japan�s ancient Shinto beliefs believe injuring a dead body constitutes a serious crime, while gypsies are largely against organ donation due to their belief in an afterlife. How would Welsh doctors be able to ascertain an individual�s religious beliefs in such cases as road accidents where time between harvesting an organ and transplanting is of the essence? And how could they explain to a late arriving mother or father why their deceased child had no eyes?

Lastly, presumed consent could well be the slippery slope toward compulsory organ donation in the future, which I strongly oppose because for two reasons: my body belongs to the Creator and not the state. Furthermore, a gift of life should be just that . . . a gift. Anything else is theft. A number of European countries, which have already instituted a presumption of consent, don�t see it that way. On the contrary, they celebrate massively increased rates of transplant.

There are other ways of achieving similar goals, such as government media campaigns and discussion in schools and universities. GPs could be asked to find out their patients� views and register them. Alternatively, a mandated choice system could be introduced for anyone applying for a driving license or passport whereby a short form could be sent to a central organ transplant database to which all medical personnel would have instant access. Foreign visitors and anyone without a fixed address should be automatically exempted from being donor candidates.

Admittedly, if I were the one languishing in a hospital bed praying for a heart while struggling to breathe I might have a very different take on this. But I would like to think that even then I would be able to retain a modicum of objectivity.

Linda S. Heard is a British specialist writer on Middle East affairs. She welcomes feedback and can be contacted by email at

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