Organ Donation: Have You Made Your Decision?

Today’s article has been written by our physician contributor.

Several times per week, I see patients who need a heart, liver, kidney, or lungs. In Canada, there are 4,500 people waiting for organ transplants. 2,000 patients receive organ transplantations each year and unfortunately, about 200 people die each year while waiting for an organ.

What is organ transplantation?
In this age of wondrous technology and scientific advances, we are now able to surgically take organs from one person and put them in to another person, in place of damaged or diseased organs. Most organ donation for transplantation is done in the setting of “brain death,” which is the current legal definition of death in Canada. There are strict medical criteria to determine brain death. Once this occurs, the heart may continue to beat, and with mechanical ventilation (a breathing machine) the other organs can remain functional while a suitable recipient is located.

We have had success with heart, lung, kidney, and liver transplants. We can also transplant stem cells (to attempt to cure patients of blood cancers) and pancreatic tissue, although these are generally from living donors. The organ donor and the recipient are matched by blood work to ensure the organ has the smallest chance of rejection, but there is always a chance the organ is recognized as foreign and attacked by the recipient’s immune system. To minimize this risk further, we use medication to suppress the recipient’s immune system.

What is the ethical thing to do?
This is a difficult question. There are debates regarding the definitions of life and death, with legal, social, and cultural aspects. Certain cultures or religions also have specific views on organ donation. Furthermore, there is some political controversy regarding organ allocation. For example, should active alcoholics be given a donated liver? I can speak to the system here in Edmonton, Alberta. The answer is an overwhelming “No.” A person must prove their sobriety and go through a designated rehabilitation program before they will be considered for a liver transplant. Similarly, in Alberta, lungs will not be transplanted until a recipient has been free of smoking for at least 6 months. These measures improve the chances of successful surgery and function of the implanted organs, and reduce the risk of damage to the new organs. However, there remains controversy with smoking/alcohol related organ disease and mixed feelings regarding “self-induced” organ injury such as alcohol-related cirrhosis (liver disease). It is prudent to remember, there are many organ diseases that are genetic or auto-immune that can occur in any person, at any time (for example, cystic fibrosis, primary biliary cirrhosis, lupus). I would urge compassion in your decision to donate your organs.

How does one become an organ donor?
This depends on where you live. There are two main methods for determining consent. Some countries, such as Canada and Germany, use an “opt in” system, which means that only those who have given explicit consent are donors. Other countries, such as Spain and Austria, use an “opt out” system (also know as “presumed consent”). This means that anyone who has not refused in writing is considered to be an organ donor. To make matters more complicated, in some countries, family members may be allowed to decline their loved ones wishes, even if the donor has already opted in. Evidence supports the fact that countries with presumed consent policies generally have higher organ donation rates. If you are interested in policy regarding organ transplantation, I have included a few perspectives in the links below. I am a supporter of bringing presumed consent policy to Canada with the expectation of improving organ donation rates, while still respecting each person’s ability to decline in accordance with their wishes.

Regardless of your choice to become an organ donor, inform your family of your wishes, and ask that they be respected. Clear communication of your wishes can provide your loved ones with a sense of relief and closure at a difficult time.

You can do a tremendous amount. You, one person, can save lives and improve the quality of life for other Canadians. I understand that thinking about your own death is sobering, and for some, upsetting. However, I implore each of you to consider this eventuality and to make plans, both in terms of a legal will, personal directive, and wishes regarding your organs. In the event of an accident or unpredictable event, the organs you would no longer need could save multiple lives.

I urge you to consider becoming an organ donor. The thousands of children, mothers and fathers waiting for an organ will thank you.