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The Nasty Side of Organ Transplanting.

Chapter 17

Societal Consensus and the Slippery Slope

One could easily doubt the validity of criticising transplant coordinators who so considerately wait for next of kin consent before allowing surgeons to remove organs from registered donors. After all, it isn't legally required.

But the reason for their sensitivity is their acute awareness of what political scientists call societal consensus. This means promoters know many people are innately disgusted by transplanting and don’t want to upset them.

Parliaments and legislative assemblies easily passed harvest legislation with little organised objection because few understand the processes except the advertised idea of dead bodies being used to save beautiful peoples’ lives.

But the reality is slowly sinking in. It began when nurses and doctors, after observing the reduced care for donor candidates, began privately advising their friends to avoid signing donor cards. Then some high level surgeons and specialists withdrew in disgust from positions involving transplant procedures.

Legislators may pass unpopular laws with ease but it is the enforcement that prompts civil reaction. Before enforcing new laws a government needs a significant proportion of the population in favour otherwise it risks spontaneous and then organised resistance or civil unrest. There could be demonstrations and sabotage resulting in police beating citizens and courts clogged with objectors. Rival politicians might then exploit the confusion and pledge to repeal the law at the next election.

To avoid these reactions an astute government uses the “frog in boiling water” procedure. When a frog is thrown it into a pot of boiling water the sudden pain prompts it to jump out and escape. When dropped into warm water it swims around and relaxes. When the heat is slowly increased the rising water temperature lulls the frog into a pleasant lethargy. Then when the temperature begins to kill the frog it is too dazed and sleepy to jump out. It dies.

To avoid negative reaction to transplant legislation the astute government orders its bureaucracies to gradually promote and introduce organ donation laws as good and voluntary acts rather than being obligatory and enforceable with penalties. It runs “awareness” campaigns, like the Australian Organ Donor Register and “Australians Donate”^[105], who hired models, professional actors and a stand-up comedian to promote “awareness”. These paid actors pretended they loved being donors despite the fact that real donors are never able to return to say how they felt about the harvest experience. Media kits include photographs and video clips of smiling children with organ transplants and “donor” relatives saying how wonderful they feel about having donating the heart-beating bodies of their “dead” children. The Australian Government won't say if those who were paid to have their images appear on organ donation campaigns have registered as organ donors or not.^[106]

These promotion campaigns are run by government agencies with Pharmaceutical Corporation funding and are replacing medical staff with public relations experts to promote transplanting.

Ghost Organisations

Governments and pharmaceutical companies have another trick. They provide lavish funds to a few ambitious individuals in the industry who form a loose “association” giving themselves a name that suggests a mass movement. These small groups may produce car stickers, pencils, stationary, badges and T-shirts all promoting the government’s view. Once the items are printed and a media release issued the “association” may never meet again. The promotional material is distributed for years in government departments and non-government agencies. The aim is to lull the public into feeling there is a huge undercurrent of positive sentiment towards transplant medicine so it must be good. But it’s just a government advertising campaign.

When a societal consensus is formed with the majority or, at least a significant minority favouring the government view, the bureaucracies gradually enforce the harsher aspects of any law. Volunteer behaviour becomes compulsory behaviour where dissidents or resistors are branded as deviants or extremists.

But until this societal consensus is formed transplant coordinators will display consideration despite the law allowing hospitals to remove organs from most donor card signers without seeking next of kin consent. If this consensus is formed then even those wishing to die intact may find it rather difficult. This is because most countries don't operate donor registers that include the option of registering one’s objection to organ donation. It pays to carry an organ keeper card and have an advocate to represent your interests if you suffer brain injury.

Desperation in the Body Parts Industry

Medical technology allows surgeons to perform acts of incredible benevolence to patients but this technology has created an industry that manifests, metaphorically, as a “hungry animal” requiring ever increasing portions of dead and semi-dead human bodies.

Exponentially increasing technological advances keeps more and more sick people alive. Governments are no longer willing or able to pay the costs of drugs and medical equipment. Yet we can’t kill the sick or let them die when the life-saving technology is available.

Organ transplants, particularly kidney and cornea, are a stopgap answer. They are cheaper to insert than paying dialysis or home care. A government decision has increased demand for fresh organs.

On the supply side of the equation, raw materials aren’t keeping up with demand. Car smashes are producing less brain-injured bodies while the treatment of brain injuries, including strokes, is improving. Young men, in particular, have become less enthusiastic to beat each other around the head thus denying the transplanters another source of live organs.

Even prospective donors have become fussy and rarely say, “take all” but are limiting harvesters to the “mixed grill” (heart, kidney and liver) or just a single organ. Next of kin are also playing harder to get with harvest coordinators. Supply is not rising to meet demand so governments are pushing harder and harder to increase or simply maintain supplies of vital organs.

More Pressure on Relatives

So it shouldn’t be any surprise when the Australian and United Kingdom governments begin denying veto harvesting rights to next of kin. Relatives will be required to display “sincere objections", a definition of which these governments keep secret. Nor will they say who determines sincerity, how that person is qualified or whether an appeal process exists against a harvest decision.

But governments around the world face a problem. If transplant coordinators apply what could be seen as draconian laws then relatives will question the legislation and may form anti-donation organisations. Governments walk a tightrope between increasing supply and avoiding a backlash.

The Next Stage of “Consent"

The next increment of pressure to obtain your body is called the “opt out” system where governments legally assume ownership of everyone’s body unless each person registers an objection in writing. This is not law in the U.S.A., United Kingdom or Australia, but Greg Armstrong of the Australasian Transplant Coordinators Association euphemistically sums up the industry’s attitude with,

“We really need to consider presumed consent because if organ donation is legally sanctioned, theologically correct and ethically supported, why must people have to take action themselves to donate.”^[107]

There are two reasons why “opt-out” isn’t universally adopted. Many people have a sense of bodily self-ownership and distrust government claims of ownership. Secondly, governments that have adopted the “opt out” system have prompted a rush of citizens registering as organ keepers who normally wouldn’t consider it. Brazil chose presumed consent but it backfired when people rushed to register the preference to keep their organs. One Brazilian summed up his attitude,

“Now we are doubly afraid of being hit by a car. We were always afraid of crazy drivers. Now we have to worry about ambulance workers who may be paid on the side to declare us “dead” before our time is really up.”^[108]

Spain and United States have the highest per capita rates of organ donation. Spain has presumed consent though in practice they still seek consent from relatives. Most states in the United States have an opt-in system but consent is not always sought from relatives. ^[109] Other opt-in countries are New Zealand, Australia, Canada, the United Kingdom, Germany, Japan, Ireland and the Netherlands though consent is not always sought from next of kin of registered donors.

Organ Donation around the World

Japan has some of the strictest rules limiting organ harvesting. The prospective donor must be over fifteen years of age and express in writing a wish to donate organs either, after “brain death” or, after “cardiac death”. Relatives must also consent after the donor’s “death”. Kidneys may be removed without the donor expressing a wish for it if the family agrees, but only after the heart has stopped. This differs from most countries where kidneys from cardiac dead donors aren’t used though there is a trend to harvesting kidneys from these sources.

Portugal, Luxembourg, Italy and Greece have presumed consent or “opt-out” systems but, like Spain, seek next of kin consent.

Hungary, France, Finland, Denmark, Cyprus, Bulgaria, Belgium, Austria, Sweden and parts of Switzerland have harsher attitudes and apply presumed consent. They automatically remove organs and body parts from “brain dead” and cardiac dead donors without requesting consent or even advising next of kin. Harvest surgeons in France sought consent from the father when they cut off the right hand of his nineteen-year old “brain dead” son to sew onto Clint Hallam. They weren’t required to but with international media focused on the world’s first hand transplant they weren't taking any chances. It was insurance in case the father later became disillusioned.

Austria, Denmark, Poland, Latvia and part of Switzerland are the fastest countries to remove organs without consent or notice. International travellers with dual citizenship visiting these countries should carry organ keeper cards and advise relatives of their “no harvesting” decisions. It should be noted that countries often apply their laws to international tourists, but generally any organ keeper indication will protect that person.

“Softly, softly” Increases Harvesting

European countries that applied presumed consent suffered the Brazilian organ retainer reaction. They found their harvest rates lower than Spain and the United States that seek next of kin consent.

However, both “opt-in” or “opt-out” transplant programs are geared to increase supply through persuasion and compulsion rather than increased understanding. Harvest strategists know that informed citizens will resist registering as donors and refuse consent for harvesting of their next of kin. Resistance has already begun.

Anecdotal evidence from the industry indicates that refusal rates from relatives have been increasing. Nora Machado in her book, Using the Bodies of the Dead, reports a 40% refusal rate in Sweden and 30% in United States.

Kerridge, Saul, Lowe, McPhee and Williams report in their paper in the Journal of Medical Ethics, a “refusal rate” by families of potential donors of 82% in 1999 in the Australian State of New South Wales – up from 56% in 1995.^[110]

Bruce Lindsay of Australians Donate reported a refusal rate of “nearly 50%…” This was in a letter from Bruce thanking me for my interest in becoming an organ donor. Actually, I had written them asking how to register as an organ keeper.

An extreme approach to bypass citizen resistance to Give and Let Live is to target unpopular groups. The Chinese government makes prisoners “brain dead” by shooting them on demand to satisfy local and foreign “organ tourists”. It proved so popular the government has allegedly expanded the scheme to include Falun Gong practitioners. But for other Chinese the organ donor concept has proved unpopular. They don't understanding why anyone would voluntarily become a donor. Organ donation is for losers in China.

The United Kingdom government has dealt with the same problem with typical British subtlety. They lowered the requirement for “brain death” declaration by assuming that serious brain-stem failure is identical “brain death”. To avoid pesky debates over the medical definition of “brain death” these deviously clever British have re-labelled it “Certified Dead”. This means you're dead when the doctor says you're dead: end of debate. The government introduced this change when both lay-people and medical experts claimed the “brain death” condition merely predicted death.

Governments have responded to resistance by saying those who doubt the “brain death” concept and resist donation are uneducated and superstitious.

However, Nicholas Tonti-Filippini, himself a victim of renal failure, knocked this one on the head by saying, “Anecdotally, the wealthier, more educated communities in Spain have a relatively low compliance rate with organ donation”^[111]