Monday, 14 January 2008

Stop thief!!

The Daily Telegraph has an interesting headline today - "Organs to be taken without consent." The article looks at the concept of "presumed consent" which means we assume that everyone wants to donate their organs at death unless they specifically say otherwise. After all, 90% of people, when asked, say they'd be happy to donate. At present we assume that no one wants to donate organs unless they specifically say so, and 40-75% of relatives refuse to allow organs to be taken when a family member dies.

The article moves on with some more emotive language. Patients' groups, it says, claim the plan will "take away patients' rights over their own bodies." The article plays on people's fears that sinister doctors will be whipping livers out of people before they are actually dead in order to pass them on to people awaiting organs.

There are two issues here. One is the way in which newspaper editors choose to present a story. The Telegraph wasn't alone in having a screaming headline on this. The Mail also chose to present it as a story of organs being taken without consent. The leading article in today's Independent claims that 1,000 people die each year waiting for a transplant, so the headlines could just as easily have read "Government to save 1000s from death."

The other strand here is around the ethics of consent. Consent has its difficulties, ethics are a complex. Neither is helped by knee jerk reactions and emotive language.

Yesterday's Independent on Sunday ran an article claiming that huge increases in the call for donations are due to binge drinkers destroying their livers and kidneys of the obese being damaged through the complications of diabetes. George Best received a liver to replace one damaged by drink. Should he have been given that liver? Are some people more deserving of new organs than others?

If we don't have enough organs to go around, how can we find more? One option being looked at is xenotransplantation - using organs from animals, including pigs. There are health risks involved - perhaps some that will only come to light too late. There are more ethical questions - is it right to breed pigs as if they were spare part factories for people, rather than animals in their own right?

Then there are artificial organs, including artificial hearts. Surely no ethical problems here? Perhaps the question edges into philosophy. If I have "bionic" limbs, and several artificial organs, to what extent am I still a human being, to what extent some sort of machine or robot? How much of the physical entity of "me" can be removed before I stop being "me"?

Part of the question around organ donation is to do with the ways in which we view death and what, if anything, happens to us after death. Will the dead be raised incorruptible? Is a dead body still the person we love? I can imagine that if I lost someone close to me I might want to sit with them for a while, growing accustomed to the fact of my loss. Those are precious minutes, hours, during which harvestable organs are deteriorating. If they were still on a life support machine could I really bear to have the organs removed when their heart was still beating, their lungs still breathing. What exactly is death?

UK Transplant has questions and answers on organ donation. Student BMJ, the World Health Organisation and the Nuffield Council on Bioethics all provide starting points for thought and discussion on this difficult topic.

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