Prof. Eytan Mor, left, and Dr. Evyatar Nesher with a kidney transplant recipient at Petach Tikvah’s Beilinson Hospital, which is part of the Rabin Medical Centre. Mor is director of the transplant department and Nesher, the department’s deputy head. (photo from Ashernet)
About nine years ago, a 55-year-old woman with a congenital kidney disease underwent a kidney transplant in the Philippines. Last week, she died following a stroke and her brother, who suffered from the same congenital disease and needed a transplant, received his sister’s kidney, which was still viable, though she had died. This was the first time such a surgical procedure had been performed in Israel, and it is thought that this procedure has been performed only five times in the world. This is also the first time that such a transplant has been carried out between family members. It is hoped that this landmark operation will encourage more live donations of kidneys.
Leading up to the provincial election in Manitoba in April, activists, family members of organ recipients and those waiting for organs pushed the topic of organ donation as an election issue. They reached out to many prominent people to help them spread their message, including Prof. Arthur Schafer, founding director of the Centre for Professional and Applied Ethics at the University of Manitoba.
The centre’s purpose is to promote research specifically in applied ethics across different professions, such as medicine, engineering, pharmacy and nursing. Schafer further described it as “ethics as it applies to controversial, moral, social and political issues in society.”
Organ donation, while supported by most segments of the population, has been an issue with which many countries struggle. As there is most often a gap between supply and demand, some countries are coming up with new ways to tackle the problem.
“Israel used to have just about the lowest organ donation rate of all the Western countries,” said Schafer. “So, historically, and rather embarrassingly, more people died waiting for an organ donation in Israel than anywhere else.”
According to Schafer, the lack stemmed from the common misconception that Jewish law prohibits organ donation.
“But, the very low donation rate in Israel changed after a new law was passed in 2008,” he said. “The new law gave priority [to certain people]. It was still true, after the new law was passed, that medical need was the most important criteria. Someone faced with imminent death would have priority over someone whose need was less urgent but, when patients had comparable need, the 2008 law gave priority to those who’d signed an organ donor card or whose family had donated an organ.”
The policy was nicknamed, “Don’t Give. Don’t Get.” Schafer said what this meant was that, if someone, for religious or other reasons, would not sign an organ donor card, they might end up dying themselves as a result of having a lower priority on the list of waiting patients.
“I suppose it’s the dual moral justification … first of all, a principle of justice or fairness,” said Schafer. “If you aren’t willing to give, you don’t deserve, you could argue, it’s not fair for you to take when you’re not willing to donate.
“Then, there’s also the principle of maximizing benefit, because this law seems to have resulted in saving many lives – which, according to Jewish law, is supposed to be of the highest priority. Jewish law says that saving a life is more important than anything else. Yet, many Orthodox Jews refuse to sign an organ donor card.”
Schafer said that, while the supply gap in Israel is still significant, it has narrowed dramatically since the passage of this new law.
Meanwhile, in Canada and its provinces, there is no priority given at present to those who sign an organ donor card.
As for the current local situation, the Province of Manitoba has passed a law – called Required Consideration – that requires physicians to consider whether someone dying or near death is a suitable candidate for organ donation, and to ask them or the family about donating.
Other provinces, like Ontario and British Columbia, have taken it a step further, passing a law known as Required Request. Doctors must discuss organ donation with dying patients. In both of these provinces, doctors can take themselves out of the process by alerting an organ donation coordinator to the situation.
“Many physicians are quite squeamish about the topic, by the way, especially when a younger person has died tragically in a car accident,” said Schafer. “Their organs might be a potential source of numerous healthy organs that could save lives but doctors feel, due to the severe family grief resulting from the death of a young person, that they don’t want to add to the burden by asking for an organ donation. That’s a fairly understandable reaction. But, I think it’s profoundly wrong. I think that, if your child has died in an accident or suffered from an untimely death, the family might welcome the opportunity to make something morally significant by agreeing to have other lives saved through organ donation. I think many people actually feel this way and that doctors who are reluctant to ask the families about it are depriving them of an opportunity.”
Schafer went on to say that, in many provinces, there is a big push to change the system of organ donation so that it would be a choice of opting out as opposed to one of opting in. The current situation is that, if you do not tick the box or tell your family you want to donate, your organs will not be harvested. Schafer contends that reversing the onus is a good option, as it still gives individuals a choice, but they have to choose not to do it rather than to do it.
“Many European countries have adopted opting-out systems, such as Spain,” he said. “Their donation rates have gone up considerably.”
Another option Schafer suggested is to tweak the compensation system for doctors, giving them further incentive to talk to people about organ donation when there is not the option of referring the matter to an organ coordinator.
“Many people die in community hospitals, nursing homes or in their own homes,” he said. “The family doctor, rural doctor or community hospital doctors are often unwilling to take the time filling out the forms to arrange for organ donation. I think the medical profession itself has been a big impediment to an increase in cadaveric organ donation.
“If you’re in a teaching hospital where transplant operations are occurring, you’re more likely to approach the family or individual and arrange organ donation,” he continued. “If you’re in a community hospital, it takes time. You have to fill out forms, you have to speak to people, and you’re not reimbursed. I think part of the solution to the dramatic gap between the supply and demand for organs requires a change in the medical profession itself or making it a requirement for doctors.”
The possible downside to a change in the compensation system for doctors, however, is to ensure that they still do all they can to save a patient.