| The Nasty Side of Organ Transplanting Second Edition Norm Barber Copyright Chapter 11 Australian Transplant Legislation The South Australian Transplantation and Anatomy Act of 1983 is fairly typical of other Australian State legislation. It allows a government bureaucrat to order removal of the organs, bones and tendons of donor card signers regardless of next of kin wishes. Even if the patient hasn�t signed a donor card or registered an objection to donation then the bureaucrat can still order harvesting if the relatives aren't objecting or can't be contacted within a "reasonable period". Bones, skin and body parts can be used for scientific and medical purposes, non-coronial post-mortems (which in some states has been a time to secretly remove organs) and for the study and teaching of anatomy if the person hadn�t registered an objection nor do next of kin object. Harvesters may legally seek and obtain next of kin consent not only when the injured patient is brain stem or brain dead, but merely unconscious and uncommunicable, prior to an expected brain death. Obtaining an early consent signals to transplant and other hospital staff that it is safer to declare brain death, as there won�t be objections from relatives. The sooner brain death is diagnosed the sooner the brain damaging organ stabilisation process can begin. (If it hasn�t already begun). Next of kin means the patient�s closest relative. Wife, husband or partner are closest. Next closest are adult children who are classed as closer kin than parents. A cynic could say children are classed closer than parents as older people are more reluctant to consent to harvesting of their children. Registering as a donor allows the transplant coordinator to order harvesting despite objections from relatives though for political reasons this isn�t applied in Australia and harvesting still depends on consent from next of kin. The worst nightmare of harvesters isn�t making a surgical error. It is an angry relative going to the media with a ghoulish story. Who Is Chosen To Obtain The Brain Death Determination? Either the legislation or hospital protocols (their internal rules) will require brain death diagnosis to be made twice by two doctors not involved in harvesting or transplanting of that person�s body parts. This safeguards against a harvester wrongly diagnosing brain death just to grab some organs for his patient. Dr Juro Wada was accused of this in Japan and charged with double murder, once for harvesting the patient�s heart and, secondly, for the recipient who got a heart he didn�t need and died. Transplant surgeons know how to get around the problem of getting a declaration of brain death. Getting Around �The Problem� Dr David Hill, the English anaesthetist mentioned elsewhere in this book, says the United Kingdom pattern is that doctors reluctant to make quick brain death diagnosis won�t be asked to conduct the tests, "�doctors who are sympathetic to this form of death are required and consequently others, such as myself, who would not certify death on the basis of such tests, are not asked. It is doubtful whether this situation would pass any serious scrutiny for being truly independent of the transplant team." 49 The ease of getting a declaration of brain death depends on the integrity and desperation of the hospital. The transplant faction will want a quick brain death certification while the other faction will hesitate, even covertly delay the determination. Another Implication of Being An Intending Donor Registering as a donor has implications determining how your body is used for other purposes. As stated above most legislation gives a medical bureaucrat the right to order harvesting if there isn�t a record of your objection and next of kin can�t be contacted. This applies also to medical testing and anatomy classes. Few people ever make a point of saying they won�t allow their body to be used for these purposes because who actually gives it any thought. A wary bureaucrat may be reluctant to order a non-donor�s cardiac dead body for such purposes but being a registered organ donor makes it easier to assume the person wouldn�t have objected. They may also say to your relatives that you wouldn�t object to the hospital or medical school using your completely dead body for teaching dedicated students life-saving techniques for later use on living people. They may also throw in their standard script, "Let us make the best of this tragic occurrence. Your son/daughter would have wanted it this way." What they won�t say is that it may involve practising cosmetic surgery or that parts of your body may be covertly stored in jars for decades. The research institution may take over the burial of your remains not out of kindness but so they keep control of the body and stop you seeing the mess they made. Though to be realistic, the human body quickly becomes a decomposing mess regardless. |