Tony Smith, John McCall and Janice Langlands: No money to be made in NZ from organ donation

COMMENT

Barbara Sumner Burstyn claimed that organ donation resulted in organs being used by private companies to make money, and that a medical diagnosis of brain-death was insufficient to be confident death really had occurred.

She also claimed that public opinion was deliberately manipulated to give the public the false impression that organ donation saved lives.

The column contained reference to practices that do not happen in New Zealand and was ill-informed and lacking in appropriate local context.

For example, the case of the Taiwanese woman who was declared brain-dead by London doctors but regained consciousness three months later in a Beijing hospital, is an urban myth originating from loose reporting in a Chinese newspaper. This person was never brain-dead and the term was incorrectly used.

It is possible for some organs to be donated before a donor's death - for example, a kidney - but most organ and tissue donations are made after the death of the donor. Here, not only must the donor be dead but the family agree to donation.

Brain-death is a term often misused and misunderstood by both the public and the media. This results in confusion between coma, unconsciousness, brain-damage and brain-death.

Brain-death is specific: it means the entire brain has died and the person will never recover. When a person becomes brain-dead, they become both medically and legally dead.

A specific medical diagnosis of brain-death is made only after a series of repeated tests on the brain by two separate doctors, one of whom is a specialist.

Brain-death can only happen when the patient is on a ventilator and in an intensive care unit.

The diagnosis of brain-death and any subsequent organ donation in New Zealand and Australia is covered by the recommendations of the Australian and New Zealand Intensive Care Society.

No patient fulfilling the criteria for the diagnosis of brain-death under this document has ever subsequently developed any clinically detectable brain function.

It is incorrect for Sumner Burstyn to claim that the term and diagnosis of brain-death were created by the Harvard Medical School to enable doctors to harvest organs for transplantation.

It was, in fact, derived from the recognition that there was a group of patients who lost all clinically detectable brain function (including the ability to breathe), with none of them subsequently ever regaining any clinically detectable brain function.

Indeed, this group of patients all go on to have their hearts naturally stop within a short period, even when left on a ventilator.

The doctors caring for the severely brain-damaged patient in an intensive care unit are there to do their best for the patient. Only when it is clear that brain-death has occurred, and this has been confirmed by testing, is organ donation possible.

While there might be commercial gain for some organisations involved in tissue donation in other countries, this is not so in New Zealand. Organ transplantation is available only for patients in the public health system, and all those involved are salaried public servants. No one works on a fee-for-service basis, and organs are never bought or sold.

The New Zealand Eye Bank is dependant on fundraising and sponsorship to cover the full costs of the service. Donated skin is used only for burns and trauma victims and is not available privately for elective cosmetic surgery, as described by Sumner Burstyn.

The only people to gain from organ and tissue donation are the recipients who have their lives saved or transformed.

Organ and tissue donation saves or transforms lives. In New Zealand the diagnosis of brain-death is a medically secure one, and no individuals or companies make any commercial gain.

Anyone seeking information can contact the National Donor Co-ordination Office on 0800 4DONOR or 0800 43667.

* Dr Tony Smith is an intensive care specialist and John McCall a liver transplant surgeon at Auckland City Hospital. Janice Langlands is a National Organ Donor co-ordinator.