Is there anything more heroic than saving a life? Whether it's saving a child from drowning or pulling a driver from car wreckage, we are fascinated and profoundly moved by people who perform selfless acts on behalf of others. When it comes to donating an organ however, many consider this form of selflessness as somehow perverse. Yet, whether the donors are alive and offering a kidney or deceased and donating all available organs, are not such acts equally as heroic as rescuing a child from a raging river?
Organ transplants are routine today, but across the globe ignorance still rules many people's feelings about them. In many cultures there continues to be a social taboo; many people also contend that their religious beliefs force them to object to the very idea of donating an organ, in life or after death. Dr Abrar Khan, the Director of transplantation and hepatobiliary surgery at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi believes educating the public about organ donation is vital.
"There is always a lack of awareness, even in the US," he said. "Here, however, as there has never been a focus on donation, only on receiving transplants, the awareness is much less. This must be changed through a large and comprehensive information and educational campaign." Dr Khan performed the first kidney transplant in several years in the UAE in February as part of SKMC's multi-organ transplant programme. Since then, in total he said, "four living related-kidney transplants" have taken place "with many more in the pipeline". Dr Khan added that it is "important to note that these were done using the latest technology for the donors, using a laparoscope to remove the kidney. Also, these transplants were done by a team based here in Abu Dhabi".
Although things are progressing well for the centre here, two recent news stories about organ transplants highlight a common problem: a limited number of donors. In Greece, an Australian man switched off his son's life support machine and allowed his organs to be used for transplant operations. Doujon Zammit's organs helped save the lives of four people. The story received extensive coverage in Greece because Doujon was left brain-dead after being viciously attacked on the island of Mykonos. The beating was allegedly at the hands of a group of Greek nightclub bouncers, lending greater poignancy to the use of his organs to save the lives of other Greeks.
Greece has the lowest rate of organ donations in Europe and following the successful transplants and the positive press coverage of the actions taken by Oliver Zammit, the country's medical community is trying to use this momentum to encourage others to donate organs whenever possible. One hospital in Athens has dedicated its transplant centre to Doujon. The other recent story was reported by the Arabic daily, Al Madina. The newspaper revealed that 3,000 patients in Saudi Arabia are awaiting kidney transplants. There are a limited number of organ donors in the kingdom despite government offers of SR50,000 (Dh48,900) in cash to donors. There have also been calls for the introduction of a national donor card system.
Dr Khan revealed there is also a waiting list at SKMC, but it is not as long as the one in Saudi Arabia. "Currently, we have about 100 people waiting," he said. Health facilities everywhere are grappling with how best to shorten the waiting lists. One approach is an "opt-in" policy. A person agrees to donates his organs at the time of his death if they can be used to save another person's life. The person can also have control over which organs he donates. Opponents of the opt-in policy argue that it does little to increase the number of available organs.
As a result many countries now follow a "presumed consent" policy. When someone dies, suitable organs are removed automatically, unless that person has made an expressed wish not to donate his organs. There are legal problems with this approach, however, as it can be argued that presumed consent cannot in fact exist and hospitals, in reality, are procuring organs without consent. Nevertheless, presumed consent guarantees a steady supply of organs and waiting lists can be more easily avoided.
Dr Khan believes presumed consent should be adopted as health policy, but it may take some time for it to be introduced in the UAE. "Whereas presumed consent is the ideal way, it may not be an ideal first step in a country where a cadaveric donation has never been done," he said. "We should start step-by-step, and then once the public is aware and informed, we can change to an opt-out method." There is another issue relating to rights after death and the use of cadaveric donors. If a person is brain-dead and being kept alive by a life support system, is that person really dead?
This has proven to be a major issue in Japan where heart transplants were banned until 1999. It may sound a little gruesome but a heart transplant works best if the heart is still beating when it is removed from the body. It proved a little too gruesome for Japan where a clear definition of the point of death remains a contentious issue. Although the heart transplant ban has been lifted, the country reportedly has the lowest rate of organ donors in the developed world.
Beyond opt-in and presumed consent, there have been calls to include financial inducements, as Saudi Arabia has done, as a means of encouraging organ donations. Taking this a step further is the creation of a market where organs can be bought and sold. This, of course, strikes many as unacceptable and at the moment no country sanctions such a practice. Although policy makers find it difficult to introduce a framework for organ donation, no major religion has raised serious objections to the practice. Inviolability is one thing, but the opportunity to save a fellow human being is considered sacred by many. With respect to religious teaching it appears individuals have their own thoughts about what organ donation means and whether it is right or wrong. This is the challenge: understanding the beliefs of individuals while creating a framework that addresses the health needs of the general population.
At the end of the day, the basis of organ transplants comes down to the procurement of organs, in particular, those from cadavers. How this process is handled and perceived, however, is extremely important. By maintaining a high level of respect and dignity and conducting effective educational campaigns, the problem of developing a framework that addresses the need to meet the demand for organs will ultimately be solved.
Peter Donnelly is a science correspondent for IIR Middle East in Dubai