Paging Dr. Frischer - Organ Donor

Every one of us has the opportunity have our organs donated upon our death. How do we make that decision? What factors should we consider? There is a clear need, but bioethical concerns cloud the issue. Interestingly, organized religion poses few obstacles. Let's explore together.Organ transplants save lives every day. If a transplant is not possible due to organ condition or match failure, the organ can still be used forresearch or education. Researchers use normal as well as diseased organs and tissues for study, and vast numbers of people benefit from the resulting medical advancements. The world's major religions accept the concept of organ donation in at least some form. Most religions, including the Catholic Church, support organ donation on the grounds that it constitutes an act of charity and provides a means of saving a life. Some religions impose restrictions on the types of organs that may be donated, or on the means by which organs are to be harvested or transplanted. For example, due to their prohibition of blood transfusions, Jehovah's Witnesses require that organ be drained of blood prior to transplant. Muslims require that the donor provide written consent in advance. Orthodox Judaism considers organ donation obligatory if it will save a life, as long as the donor is considered dead as defined by Jewish law. A few groups do oppose organ transplantation or donation, including many who follow Shinto practices, and Gypsies. There is an enormous shortage of donor organs.This could not be truer than with the increasing need for kidneys. Kidney failure is brought on by rising age, diabetes and hypertension, and all three of these categories are growing in size. Spain boasts the highest organ donation rate in the world, with 35.1 donors per million people. This rate compares to 24.8 donors per million in Austria, and 22.2 donors per million in France. The Spanish transplant system is one of the most successful in the world, but it still can't meet the demand, and 10% of those needing a transplant die while still on the transplant list. Under Spanish law, every death can provide organs unless the donor expressly specified otherwise (while still living!). Organ donation is becoming an important bioethical issue. For example, prisoners here in the United States are not discriminated against as organ recipients and are equally eligible for organ transplant as the general population. In 1976, the Supreme Court ruled that withholding health care from prisoners constituted "cruel and unusual punishment." Of course, many are uncomfortable that an organ transplant and follow-up care can cost the prison system up to $1 million, and that an organ transplant to a prisoner may well deprive another citizen of that organ and a possibly life-saving surgery. Another ethical issue involves whether to give liver transplants to alcoholics who may be in danger of relapse. Should organ transplants be allowed for drug abusers, those with reckless lifestyles, older patients, etc.? With a limited supply of organs to transplant, these become complicated and difficult bioethical social issues. Because demand for organs far outpaces supply, a black market, often referred to as transplant tourism, exists. Black markets are, by their nature, unregulated, and not surprisingly the rich take advantage of the poor. Those who support a black market argue that the poor are in desperate need of the money. Follow-up studies have actually been conducted on those donors who sold a kidney in countries where organ sales are legal. These studies show that a majority of donors have extreme regret, and if given the chance to repeat the procedure, they would not. In addition, many study participants reported an actual decline in economic status following the procedure, despite income from the donated organ. Even more frightening black market cases have involved suspected cases of organ theft, including murder. Supporters of a legal organ market claim that the black-market system encourages such tragedies, and that regulation could prevent them. Opponents claim that such a market could encourage criminals by making it easier to claim that a stolen organ was legal. Needless to say, this issue is far from resolved. In 1999, eBay was involved in an organ scandal. An auction for "one functional human kidney" reached a bid of $5.7 million before it was blocked by eBay. In the United States, the sale of human organs is punishable by up to five years in prison and a $50,000 fine. An exciting but hugely controversial new field has arisen with great potential for providing organ supplies: cloning. A cloned organ would run no risk of rejection, since it would be a perfect match. However, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own. Consider the ethics of cloning an entire person for the express purpose of being destroyed for organ procurement! Currently, stem cell research is investigating using cloned stem cells to grow only a new organ. This research shows enormous promise, despite the bioethical and religious issues still unresolved. There is simply no replacement for having available a real human body when it comes to teaching and research. I would urge all of us to give organ or full body donation serious consideration. It will truly help in the discovery of cures for many debilitating conditions such as cancer and Alzheimer's disease, in the development of new medicines, in the study of human anatomy, and in perfecting new surgical procedures. As a medical student, one of my most important classes was Human Anatomy and Dissection, and I clearly recall that each donation was highly valued, and treated with the utmost humanity, compassion and respect. Many years have passed, and my oldest daughter just finished the very same human anatomy course in her own medical school. She describes a ceremony held before the course began, attended by both medical students and donor families, where the donor families were personally thanked for their amazing and precious gift. Here are some steps you can take to become an organ donor: •Register with your state donor registry: www.DonateLifeCalifornia.org/register/ •Sign a donor card and carry it with you until you renew your driver's license, at which time your decision can be designated on your driver's license. •Talk to your family now about your decision to donate. Help them to understand your wish to be an organ and tissue donor, before a crisis occurs. I wish you and future generations the gift of a long and healthy life! Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

********** Published: January 13, 2011 - Volume 9 - Issue 39