On Organ Donation

[artemis]

Make them tax deductible.

As it currently stands, the Organ and Tissue Donation Act prevents payment for organ donation.

There is a trial currently for live-related kidney donors to receive a subsidy of their pay for six weeks, when they donate an organ. I'm not sure of the specifics, but the money is paid to the Employer in much the same way employers are reimbursed for Army reservists doing fulltime Army work. If that makes sense.

 

[artemis]

How about I put it this way.

Do you disagree with my view that all people in Australia should be afforded the exact same level of health care regardless of the personal decisions they make in life?

Matt

I get what you're saying about equitable access for healthcare.

There's a really long answer here, but I don't want to bore people with the intricacies of organ wait-list, organ-matching algorithms and immunology. Suffice to say, increasing the pool of organs available for transplant would only improve the equity of access.

Truly brilliant ethicists and philosophers have debated this subject, and I think you'll find most side with Princess Fiona: if you're willing to take something the health care system offers you (in this case an organ), the truly ethical position is that one should be willing to offer an organ if able (ie upon death). That's justice (one of the guiding principles of medical ethics!)

 

[artemis]

Re: The totally off-topic thread

Yep. But in life and death situations involving loved ones I'm not sure how many people really give "the community" a thought.

Actually, I think you'll find that the knowledge that the organs help other people is a huge factor in helping family members decide. It's very humbling to see how generous people are in their hour of grief.

It's the same principle that occurs when someone dies and a foundation is set up in their memory - it's about preventing hurt/loss for the community. Or when there's a medical error and harm occurs, most people want no one else to come to harm, rather than a payout. Care for the community is a massive driving force for a great number of people.

 

[BAM1748]

I get what you're saying about equitable access for healthcare.

There's a really long answer here, but I don't want to bore people with the intricacies of organ wait-list, organ-matching algorithms and immunology. Suffice to say, increasing the pool of organs available for transplant would only improve the equity of access.

Truly brilliant ethicists and philosophers have debated this subject, and I think you'll find most side with Princess Fiona: if you're willing to take something the health care system offers you (in this case an organ), the truly ethical position is that one should be willing to offer an organ if able (ie upon death). That's justice (one of the guiding principles of medical ethics!)

Actually my question only requires a really short answer either way. The ethics are do people get full care as equals (which is how it works) or you are saying you wouldn't give people equal access based on their past choices in life?

It appears you wouldn't treat everyone equally.

Matt

 

[artemis]

Actually my question only requires a really short answer either way. The ethics are do people get full care as equals (which is how it works) or you are saying you wouldn't give people equal access based on their past choices in life?

It appears you wouldn't treat everyone equally.

Matt

Matt,

I'm not sure exactly the question you're asking?

The statement I was making is that access to an organ transplant is unfortunately not equal because of immunological considerations that DO disadvantage certain groups in society. Increasing organ donation rates will help address this imbalance.

Whether someone would become an organ donor themselves, is NOT part of the assessment for potential recipients.

I can assure you I and all the other transplant professionals, DO treat everyone equally and take offence at you suggesting otherwise.

 

[amaroo]

Interesting topic!

My Mother (80's) has insisted that when the time comes - her body be placed in the hands of science.

We've (wife/I) committed to organ donation.... logical call IMO.

 

[woodborer]

Re: The totally off-topic thread

Yep. But in life and death situations involving loved ones I'm not sure how many people really give "the community" a thought.

In my experience, the decision on organ donation was just a death situation. If I recall my hours in intensive care correctly, discussion about organ donation did not occur until after the decision to cease life support had been made. But I accept what you say - certainly after having made the decision to pull the plug, so to speak, it is then difficult to start talking donations....I seem to recall there was a little time to regain composure though - I seem to recall there is a bit of time after deciding to withdraw life support and it actually happening as some legal boxes needed to be ticked before it happened. As for myself, I have no objection to my organs being used by someone else....they're not much good to me when I am dead.

 

[Pushka]

It would be interesting to hear the protocol with regards to discussion about organ donation once a critically injured person arrives.

At what stage is the organ donation team advised of a possible donor?

At what stage is the family asked if they know their relative's wishes with regards to organ donation?

How long is life support allowed to continue once a family has agreed to donation?

Clearly the life support machinery remains on so the relative seems to be still "alive" when they are then left to say goodbye. That could be confronting and difficult. Perhaps people need the closure of seeing that breathing has stopped?

I mentioned earlier that perhaps some want to depart this earth "intact". Others might be concerned that their medical treatment might be somehow compromised if they are seen as a donor. That could also apply to family asked to consent. Family members might be concerned about the process and so it might just seem "easier" to cope with if they refuse because it removes a layer of complexity for them.

None of these thoughts is meant to be in any way insulting to medical providers but might simply point to lack of knowledge if they haven't had access to much in the way of how hospitals operate. Or scare stories they've heard.

Just random thoughts.

 

[artemis]

It would be interesting to hear the protocol with regards to discussion about organ donation once a critically injured person arrives.

At what stage is the organ donation team advised of a possible donor?

At what stage is the family asked if they know their relative's wishes with regards to organ donation?

How long is life support allowed to continue once a family has agreed to donation?

Clearly the life support machinery remains on so the relative seems to be still "alive" when they are then left to say goodbye. That could be confronting and difficult. Perhaps people need the closure of seeing that breathing has stopped?

Just random thoughts.

Protocol
It's not about the patient arriving, but more to do with determining the extent of injuries. Princess Fiona may be able to expand on this. But there are some types of injuries and some physical signs that might indicate that the patient is brain dead. Once it's determined that the injury/illness is not survivable, then organ donation might be considered. Sometimes family members raise it and discussions may commence.

Remember not every death in hospital is suitable for organ donation - the vast majority, in fact, are not.

When patients are dying in hospital, it's standard care to ask family members what the patient would want. It's about respecting the patient's wishes and these questions are asked about a whole range of things, not just organ donation.

Sometimes many people haven't thought about it, or discussed it. And the opinions here on this board, it's been interesting to see how little people actually understand regarding organ donation which makes me think that we have to redirect our efforts in terms of raising awareness of the issues involved.


Organ donation team notification
Only notified when consent is given. Which is after determination of death.

Family questions
See above (fairly early on, because it's pretty easy to tell who's going to do badly and who's not). Like I said, I've been surprised by the situations in which family members have raised it themselves. I'm not going to go into details, but it's truly inspiring and humbling all at once.

Life support continuation
Continued for as long as it takes to determine patient unsurvivability. Family are given an estimate of how long they "have left".

Testing donors is done very quickly.

Finding an organ donation team can be the tricky part (usually done overnight so as not to upset the elective surgery operating lists). Donation is done in the home hospital, so this may mean that the organ donation team has to be flown in. Various state Government aircraft are used for this purpose (so if you see the Qld Premier's jet arriving at a regional airport at 2am...). This allows time for family to say their goodbyes, allow distant relatives to travel, to make funeral arrangements.

Turning off the machine
For donation after cardiac death, the rules are different in each state, but the breathing tube is removed and the patient's heart will stop beating in its own time. Once there is no heart beat, family have 5 minutes before the patient is taken to the operating theatre. (Perfusion of organs is a time-critical issue).

With brain death, the patient is taken to the theatres still on life support. Life support is removed at a certain point in the donation operation.

I'm not sure that there's much comfort in seeing a loved one lying still on the bed, without their chest rising and falling. It can be very confronting to see a recently deceased person.




I must stress that at all points along the organ donation pathway, the patient is given every treatment and opportunity to improve. Sometimes organ donation doesn't proceed because the patient doesn't meet the strict criteria for donation.

Even in the operating theatre, the donor is treated with the utmost care and respect. It's generally a fairly sombre theatre, and there are some time-critical issues to deal with as well (not to mention you as the surgeon are sleepless!). We see some horrible stories leading to death and operate on many young people whose lives have been tragically cut short. Don't think we're not affected by what we see or do - organ donation surgery is quite emotional.


Most of what I've said here is a fairly inarticulate summary of some very complex medical/ethical issues - my apologies for this, but I can't summarise all these issues into a few lines.

 

[Pushka]

Re: The totally off-topic thread

Thank you for all that info. I'm pretty sure most non medical people have no idea.

One thing for me though is that when one of our family members has passed, one of us will be with them (wherever possible) when their last moments come. That's probably something I'd have to personally deal with - not sharing that last moment. In some ways I'd feel like I had abandoned them.

 

[artemis]

Re: The totally off-topic thread

Thank you for all that info. I'm pretty sure most non medical people have no idea.

One thing for me though is that when one of our family members has passed, one of us will be with them (wherever possible) when their last moments come. That's probably something I'd have to personally deal with - not sharing that last moment. In some ways I'd feel like I had abandoned them.

There's no nice way to say goodbye, I know.

I hope that you would be able to take solace in the fact that the organ donation team will look after them with great care and tenderness. And that a little bit of them (or maybe several bits of them!) will live on, by giving life to another person.

We do care for our patients, even those we meet briefly. And grieve for them when they are gone too, you know.

 

[cove]

Re: The totally off-topic thread

The gift of organs is one of the finest gifts a person can make when his/her life is ending so just make sure your wishes are known.

 

[JohnK]

Look, to be very clear - an opt-out system is not mandatory organ donation.

The majority of people die in a manner that is not conducive for organ donation.

The aim of an opt-out system is to change the culture surrounding organ donation - to lift the veil and make it commonplace (well, more commonplace). Many people have mentioned on this board that when a loved one is dying it's a stressful time. Which it is! Opt-out simply removes the burden of having to say yes to organ donation from the family.

However, as it stands today, even if you say yes, if your family say no, you don't get to be an organ donor.

And as for your organs and would they be suitable? You'd be surprised at what we use in kidney transplants, because it sure beats the hell out of dialysis!

I guess we see things differently.

The government has no say in what I do with my organs. I should not have to spend the time to opt-out of something I don't want.

Also my religious beliefs should be respected. No organ donation. I would prefer no autopsy either.

 

[cove]

I accept that not everyone wants to be an organ donor but from our family viewpoint we should try to help others.
I have been friends with a liver transplant recipient as well as a heart transplant recipient and they have been able to pay the gift forward. My heart transplant friend has a foundation that is assisting many because he can. I saw him pre-operation and he could barely walk and breathing was difficult. Now he has a big grin on his face.

 

[Princess Fiona]

I guess we see things differently.

The government has no say in what I do with my organs. I should not have to spend the time to opt-out of something I don't want.

Also my religious beliefs should be respected. No organ donation. I would prefer no autopsy either.

Do those same religious beliefs permit organ transplants?

 

[artemis]

Do those same religious beliefs permit organ transplants?

I've never met a patient of any religious affiliation who refused a transplant on the basis of religion.

Not even JWs... (Refusal of blood - yes, solid organ - no. go figure!)



But here are some position statements from some of the major religions within Australia...

Position Statements | Organ and Tissue Authority


And just for the feelgood angle - I think there are plenty of cross-religious or cross-cultural transplants. It's truly lovely to see...!

 

[Princess Fiona]

I've never met a patient of any religious affiliation who refused a transplant on the basis of religion.

Not even JWs... (Refusal of blood - yes, solid organ - no. go figure!)



But here are some position statements from some of the major religions within Australia...

Position Statements | Organ and Tissue Authority


And just for the feelgood angle - I think there are plenty of cross-religious or cross-cultural transplants. It's truly lovely to see...!

Me neither, that's why I was curious to know.
As far as I'm aware all of the major religions ( including Christian, Judaism, Islam and Buddhism) either support organ and tissue donation and transplantation and/or believe that it is an individual's right to choose.

 

[cove]

Thanks for your posts artemis. Your latest one on Position Statements I had not seen.
Tomorrow night we will talk about this subject in between lots of champagne and singing.

 

[artemis]

Thanks for your posts artemis. Your latest one on Position Statements I had not seen.
Tomorrow night we will talk about this subject in between lots of champagne and singing.

What's tomorrow night?

And sorry for all the posts - transplantation is what renews my faith in humankind. Every. Single. Time.

 

[cove]

Christmas carol time requires great food,champagne and other drinks. I try hard not to miss it. It is a big part of banking the good times with friends and after some lubrication we believe we can sing but the neighbors might doubt it. There are five medicos in our group this year. We lost one of our group since last year.