The Irish Medical Times - Organ donation are you in or out
Let’s sit back, relax, be in the moment, and imagine you’re in a high speed high impact car accident. Your airbag decides to fart and drape it’s silky self around your dashboard like a pashmina. One minute you’re listening to the saccharine sounds of Sunshine FM the next thing you know your head is buried 5 inches into the dashboard as Simply Red bleeds into your ear.
Your passenger, let's be whimsical and call her Ophelia, is now pinned to the top of the car by some contorted metal. Your one eye (don’t even contemplate what air vent your other orb might be wedged in) is saccading from left to right looking for signs of life in Ophelia. You can see movement and you can hear her whimpering (or is that Mick Hucknall). You know you won’t last, probably not even until the end of the song (silver lining - you’re not a fan), but Ophelia has a fighting chance, maybe she’ll need an organ or two, maybe you could throw a kidney, a heart, even a pancreas her way, liver, lungs - take ‘em all.
However, you remember you are in Ireland where you don’t get to decide if you are an organ donor, your next-of-kin do - even if you carry a donor card and spend your days down laneways asking people if they need a gently used kidney, an unbroken heart, a slice of liver or a pancreas with bile on the side, ultimately the decision around your body parts will be made by your mad uncle Charlie.
Ireland currently has an express consent, opt-in, organ donation system. I’m not sure the general public is even aware of this. The government, to their credit, is trying to implement an opt-out consent system - organs will be offered for donation unless the dead person registered not to consent, while alive obviously. Politicians do like to play both sides of the fence so I believe there may be a caveat proposed where the next-of-kin is still consulted and if they object the donation does not go ahead. This is technically described as a ‘soft opt-out’ system or in more colloquial terms a cop out.
I think everyone is entitled to their own thoughts on donation and if they want to privately or publicly decline the chance to donate that is their decision and should be respected.
My concern is that due to Covid the movement to change the donation system from opt-in to opt-out has been sidelined. With everyone now laser focused on taking charge of their own health I believe this life changing policy should be a priority again. There are somewhere in the region of 650 people around Ireland waiting for an organ - heart, lung, kidney, pancreas- this change in law would save so many lives with immediate effect. Supply needs to meet demand or people die.
I’m not just a pontificator who reads an article, or listens to a podcast, and marches to the Dail, or the streets of Twitter, choking on recency bias, with my half baked outrage and moral intransigence. I do other things too. On this particular topic my experience is personal - my Mum received a kidney transplant, both of my aunts received a transplant, my uncle received two, my aunt donated her kidney, my brother gave my other brother a kidney, my cousin recently got a new kidney and I have two other relatives on the transplant list. My own kidneys are in good shape (not to rub my extended family's face in it) but my heart, lungs and pancreas have all seen better days. Even those of us in tip top shape could be mangled in an accident and end up on life support with their name on a list before the day is out.
Having the great idea to move to opt-out (soft or otherwise) is only step one, as the government is aware it would also mean the establishment of the healthcare infrastructure to cater for donations, such as - transplant co-ordinators, support staff, nurses, surgeons, counsellors, beds, training staff in A&E and ICU, establishing donor pathways which would need to be managed and audited, etc. There would have to be oversight, perhaps a dedicated donation body (no pun intended), without a governing board to organise transplants and deploy the policies we’d be back to long lists and the Mad Max Terrordome ‘every man for himself’ approach.
To be a due and fair process the public would have to be made aware of the change in organ donation policy through campaigns, may I suggest Paul McCartney and Guns n’ Roses singing Live and Let Die on the top of the GPO. I jape, death is as serious as it gets, but for donation to become the ‘norm’ the government would have to cultivate a positive attitude around organ donation, probably through popularizers, influencers and content creators (jobs that didn’t exist when my organs were born).
My parents came from big families, who came from big families, who believed in open caskets, so I have seen my fair share of dead bodies. I do think there is dignity and decorum that should be kept in death. Therefore I’m not suggesting we scavenge dead bodies leaving behind just fingernails and a toe ring. Organ removals would involve precise discreet incisions, the body, in my opinion, would not be desecrated. The soul, if one believes in such, would remain intact. Nothing would be mandatory, if a person or their kin felt strongly against any organ harvesting that choice would be respected. The potential donor's family would and should be treated with sensitivity and their loss and attachment be understood and allowed.
Of course there is the ethical argument that moving to an opt-out system implicitly gives the government ‘rights’ over your deceased body. People wage war and civil unrest over human rights, could there be people out there looking for the next great cause #deadlivesmatter
Organ donation impacts everybody. Personally, I’d give it all away, in the words of Paul McCartney “What does it matter to ya”.
If you are on the fence about switching from an opt-in donation system to an opt-out, perhaps you have to ask yourself the question - if your loved one needed a heart to survive, would you accept the donation?
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