Rattling the bones – or the potential transplant organs at least…

Have you noticed how rattled the Live Organ Transplant Industry is becoming over the latest questioning of their practices? I say “live organ” because a dead organ is good to no one. Whether the patient to whom those organs belong is dead or not is the matter under discussion…

On Thursday, Dr Nick Tonti-Filippini (of our local John Paul II Institute for Marriage and the Family fame) had an op-ed piece in The Age “Why I have refused a renal transplant for 20 years”. He began this column by saying:

THE claims made by Associate Professor James Tibballs about brain death — reported in The Age this week — are well founded and are not a threat to organ donation as some have claimed.

Yet the Industry is running scared (is that how you spell “scared”? Or is it “scarred”? Perhaps both might be appropriate in this context…). In today’s edition of The Age, there is a letter from the members of ANZICS. No, not the boys from Gallipoli, but the Australian & New Zealand Intensive Care Society. The letter is headed “Brain Death Facts”. Here is a part of it:

WE WRITE to correct misinformation and vigorously disagree with Nicholas Tonti-Filippini (Comment & Debate, 23/10).

First, the Australian & New Zealand Intensive Care Society (ANZICS) has clearly stated that when X-rays have shown a devastating brain injury, brain death can be determined by clinical testing with 100% accuracy. ANZICS also provides clarity on those circumstances when brain blood flow imaging is required to diagnose brain death.

Second, the determination of death by clinical testing of brain function does comply with Australian law.

…The public can have full confidence in the determination of brain death. ANZICS believes that it is unethical for others to raise doubt in the public mind regarding the certainty of the determination of death.

So, there you have it. Once again we have the assurance: You know you are dead when the law says you are dead.

Dr Tonti-Filippini, in his article, suggested that:

Death of the brain stem alone is not death. Diagnosis of death requires evidence of the damage to the other parts of the brain such that all function of the brain is destroyed. I advise families to ask for an image showing loss of blood supply to the brain. They can then be confident that death has occurred.

The ANZICS boys respond:

Fifth, it would be unethical and unnecessary to submit every patient to a brain blood flow scan simply to show the patient’s family a picture.

Why? Because it would use up precious time when we need to get access to those living organs.

Now will everyone just please shut up about people not being dead when we start chopping them up and just let us get on with the job? Afterall, we ARE the doctors. Not you.

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3 Comments

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3 responses to “Rattling the bones – or the potential transplant organs at least…

  1. Tony

    David,

    I don’t have a problem with this issue being discussed and pressure being brought to bear to help prevent inconsistent or ‘liberal’ practice.

    What I find a little disturbing is the way you characterise the practitoners. Again, just to be clear, I don’t have a problem with asking hard questions.

    I’ve worked as a volunteer in a hospice for over 10 years and the people involved — some of them will be the ones that decide when a person is dead — are not an ‘industry’.

    They range from the ordinary to the extraordinary in terms of the work they do, just like the rest of us. And I’ve never worked in a place where any kind of self-interest is so much in the background.

    Your argument, like any substantial argument, is not helped by this thinly disguised attempt to paint those you disagree with as ‘the bad guys’.

  2. Schütz

    I am not judging the many doctors and nurses who in their daily work seek to help desparately ill people through organ transplants.

    But it is an industry, Tony. Organ transplants are expensive and costly – the surgeons who carry them out are well remunerated for their work. Organ transplants are a part of a hospital’s “business”. If they have the parts they will get the patients and hence they will get the money for providing the service. (A question: who “owns” the donated body parts?) So, if the number of available body parts falls (due to adverse publicity about parts being taken from live patients for instance) so does the hospital’s ability to offer this (lucrative) service.

    I apologise for pointing out the cynical and unpleasant side of what is undeniably a life-saving procedure. The concern is simply that we do not sacrifice a (less-useful) life in order to save a (more useful) one.

  3. Tony

    David,

    Last week I donated blood. That’s an ‘industry’ too. Some people make a regular living out of it, others do well. And, yes, it needs to be regulated and occasionally reviewed and people need to ask tough questions about if it’s doing the right thing by donors and patients. No problem with that.

    But the implication of the ‘industry’ tag is only significant if the person who declares the patient dead — ie the critical issue in this — has his/her snout in the trough. I’m sure it can happen. I’m sure practitioners make mistakes that are both honest and the result of neglect.

    But you’re suggesting more than that. The power of parenthesis:

    So, if the number of available body parts falls (due to adverse publicity about parts being taken from live patients for instance) so does the hospital’s ability to offer this (lucrative) service.

    Could just as easily be expressed as:

    So, if the number of available body parts falls (due to adverse publicity about parts being taken from live patients for instance) so does the hospital’s ability to offer this (life saving) service.

    The concern is simply that we do not sacrifice a (less-useful) life in order to save a (more useful) one.

    Is it? I could understand this if doctors were declaring ‘dead’ people with disabilities or old and frail people. But, even if the laws are a little to imprecise for your liking, the people involved are facing immanent death. So the utilitarian argument, as important as it is in the broader ‘life’ agenda, is not one that I think influences this particular area.

    Personally I feel that an organ donation is a free gift. The issues about how it it given are not unimportant, but when I weigh up the risks of my contributing to saving a life and a doctor declaring the inevitable a few hours, or even a few days ahead of time, I think it is a risk worth taking.

    If the professionals had sole discression about when that moment arrives and had a commercial interest in the ‘industry’ then I’d be much more cautious.

    Even then I might err on the side of the gift. Because even under riskier circumstances my organs are more useful to someone living than to me dead.