Family first in organ donor cases

COMMENT - By STEPHEN STREAT, STEPHEN MUNN, JANICE LANGLANDS, BRUCE KING and WILLIAM SILVESTER

A Herald editorial suggesting families should not be able to over-rule a person's decision to donate organs after death has brought the following response from five medical professionals.

We would like to reassure New Zealanders that healthcare professionals involved in organ donation do not share the stridently utilitarian views of those who see a newly deceased human being simply as a possible source of organs for transplant.

There are sound reasons organs are not removed from the dead bodies of people whose families object to such removal. These include an appreciation that bodies are not mere chattels but remain of emotional, spiritual and cultural significance to the family, even in death.

Organ removal without family consent is contrary to what the responsible professional agencies have determined to be best medical practice in New Zealand and Australia.

Incidentally, the adverse effect on subsequent organ donation of organ or tissue removal without family consent has been seen to be profound and long lasting in other countries. Such an event occurred in France in 1991 after a highly publicised incident of a boy's accidental death and the taking of his eyes without specific parental authorisation.

We can too readily envisage the way such an event would be reported by the New Zealand media and the subsequent effects.

We support organ donation and transplantation. We also support the concept that every family should discuss donation and understand the wishes of all its members.

Such discussion leads to robust mutual understanding and will accurately reflect the true level of support for organ donation in society.

However, we oppose legislative or other administrative measures that seek to exclude families from sensitive and compassionate involvement in decision-making.

We agree with the views of prestigious United States ethicist Professor Jim Childress: "Organ transplantation is a very complex area, because the human body evokes various beliefs, symbols, sentiments, and emotions as well as various rituals and social practices.

"From a rationalistic standpoint, some policies to increase the supply of transplantable organs may appear to be quite defensible, but then turn out to be ineffective and perhaps even counterproductive because of inadequate attention to these rich and complex features of human body parts.

"Excessively rationalistic policies neglect deep beliefs, symbols, sentiments and emotions and the like, and that deficiency marks many actual and proposed policies."

The Herald editorial last Thursday, which advocated that family wishes should not be decisive, contained a number of common errors and misconceptions.

The assertion that to exclude families would be kinder to all concerned, including the family, is patronising, manipulative and factually incorrect.

Organs do not become available. Rather, organ donation becomes a possibility. This does not occur in the trauma of the emergency rooms but after brain death has occurred many hours to some days later, in the calm of the intensive care unit.

There are many problems with donor registers. For example, reliance on a driver's licence or a registry entry does not take account of people changing their mind and communicating this to their family.

Incidentally, 57 per cent of the 3.2 million registered with the Land Transport Safety Authority have Not Donor on their licences.

New Zealanders can remain confident that organ donation will be discussed with the families of potential donors at the appropriate time, in the intensive care unit after the death of their loved one.

This discussion will cover many issues including the wishes of the newly deceased (if known), as well as the processes of organ donation, organ retrieval in the operating room and subsequent transplantation.

It will also cover the views of family members and will be done in a sensitive and compassionate manner.

Unlike accepted practice in Spain and some other countries, doctors will not manipulate, persuade or coerce family members to conform to the expressed wish of the newly deceased to donate.

In fact, it is distinctly uncommon for family here or in Australia to object to organ donation when this has been the expressed wish of the person who has died.

In addition, it is not unusual for families to generously offer organ donation when these wishes have not been made known.

There is considerable ill-informed opinion about this complex area and we welcome further opportunities to publicly discuss the realities of organ donation and of subsequent organ transplantation.

We applaud the Government's move to create a national agency responsible for organ donation [Organ Donation New Zealand] and are confident that the agency will, among its administrative and educational functions, provide reliable and accurate information on these matters.

As far as we are concerned, New Zealanders can be confident that organ retrieval will not take place against the objections of family and that people who die in our intensive care units, and their loved ones, will continue to be treated with respect and compassion.

* Stephen Streat is an intensive care specialist at Auckland City Hospital.

* Stephen Munn is director of the NZ liver transplant unit at the hospital.

* Janice Langlands is manager of the national transplant donor co-ordination office.

* Bruce King is president of the New Zealand region of the Australian and New Zealand Intensive Care Society.

* William Silvester is a Melbourne intensive care specialist, and medical director of the Victorian organ donation service.