| The Nasty Side of Organ Transplanting Second Edition Norm Barber Copyright Chapter 12 Avoiding Harvest Time Transplant Coordinators Won�t Accept A "Soft No" As stated above the hospital can legally remove organs and bones from a registered donor without next of kin consent. They won�t because societal consensus doesn�t hold that organ harvesting is wholly beneficial, or that the donors are completely dead, and harvesters don�t dare risk nasty reactions from next of kin. But medical technology increasingly requires more body parts and the industry players have become increasingly desperate to harvest and transplant more organs. Their representatives, such as Professor Geoffrey Dahlenburg of the South Australia Organ Donation Agency, say that a "soft no" by relatives isn't good enough. There has to be an undefined "strong objection" after some discussion between shocked relatives and desperate transplant coordinators in the hospital waiting room or wherever. Delivering The Hard Word The transplant coordinator or, intensive care staff, will sidle up to the relatives in the waiting room and begin the sales pitch by expressing sympathy and hinting that good may come out of this tragedy. If the patient isn�t dead the coordinator will leave and pressure hospital staff to get an apnoea and brain death test confirmation. If this happens preservation of organs may begin which may accelerate brain death. The coordinator will later return continuing with the stream of ideas saying the positive outcome of lives saved from donation can result from the terrible negative of impending death. If the dying or seriously injured patient registered as a donor the coordinator may mention the hospital isn�t legally required to obtain consent but are doing it from kindness. This ploy is to undermine the relatives� confidence in their legal status and position the coordinator as a benevolent and kind person. It is a bluff. Transplant Coordinators May Try To Position Themselves Between The Injured Patient and Relatives Transplant coordinating staff, especially when they are the intensive care staff, become the teller of the prospective donor�s condition so relatives depend on their messages and feel they must repay something for this kindness. The coordinator may imply a closer and more intimate access to the patient than that of the relatives. They may try to mentally inveigle themselves between you and your dying relative. They may imply the patients� dignity and comfort depends on you keeping them happy by agreeing to donation. If the patient wasn�t a registered donor they may attempt to extract a statement from you that the patient had expressed a favourable opinion of organ donation or at least didn�t express objections to it. This will give them a legal standpoint that the patient would not object to donating his or her organs and again, that seeking family approval is only a kindness on their part and not a legal requirement. The transplant coordinator will apply as much pressure as can be gotten away with. This will be disguised under the cover of caring emotions and kind thoughts, but the underlying motive is getting the organs and perhaps the whole body. It should be remembered that the coordinator and transplant staff are extremely desperate people. Relatives may experience their sales pitch as an unpleasant seduction attempt and subconsciously know there is an underlying motive. Nurses may become involved and tell the harvest promoter to go easy. One faction in hospitals follows the Hippocratic oath of protecting and nurturing all injured patients while the other faction wants to help one group of patients by cutting up those predicted to die and using them as spare parts. Harvesters Mistrust Other Hospital Staff The position of Transplant Coordinator was invented in the United States after industry promoters discovered Intensive Care Unit staff were reluctant to pressure relatives to consent to harvesting. Experts in the United States discovered the problem of low donation numbers due, not so much to public resistance, but with intensive care staff who wouldn�t ask relatives. It was even said some nurses and doctors disguised patient conditions from the harvesters. In Australia it is usually intensive care staff that seek consent to harvest. Repelling A Transplant Coordinator Anyone can repel harvester coordinators by threatening to hit them. A physically weak person can do this because the harvest coordinator wouldn�t dare be seen beating up a relative in the hospital waiting room while attempting to extract consent. Another tactic is by walking about the hospital telling patients and staff that the harvesters want to cut up your still breathing relative for spare parts. This desperate act would have a strong impact in making the transplant coordinators back off. A second defensive action is to keep moving about. One should move the body and limbs while sitting, even walking about the building, anything to avoid the hypnotic stare of the harvest coordinators. This will help protect you because your emotions and brain will be in shock and you may be vulnerable to the harvesters� mesmerising voice and presence. Sitting still is like being a hypnotic subject. A third defensive action is calling the media. Newspapers and television stations feed on Frankenstein stories and you will be in the middle of a national story. The least effective tactic is intellectual argument. Transplant coordinators are desperate for victory and won�t hear a word you say. They are immune to argument. Anecdotal evidence from the industry reports that cases of relatives refusing to allow harvesting are 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 2002; 28: 89-94, 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. Bruce Lindsay of Australians Donate reports a refusal rate of "nearly 50%�" This last figure was in a letter Bruce sent thanking me for my interest in becoming an organ donor. Actually, I had asked how to register as an organ keeper. Protecting The Patient Head injury patients may increase their recovery chances if their relatives insist, with witnesses present, that neither the apnoea test be applied or any treatment designed to preserve organs for harvest. Stating the patient won�t be a donor and had recently expressed distaste for donation will reduce interest from harvest staff and transplant coordinators. You could also suggest that hypothermia and use of brain cell protecting drugs, such as barbiturates, be used as treatment if applicable. You can also insist on visiting the patient in privacy without medical observation. If allowing the dangerous apnoea test you could still insist on observing the procedure. You may also insist it not be performed. The reflex test is shocking because the doctor inflicts pain to prompt response. You could also require that two flat EEGs be obtained and brain death not declared unless there is a blood pressure collapse. Death Vigil Elephants, hippopotami and other less evolved animals protect dying members of their species from predators until they are completely dead. Only when all life has left the animal and decomposition sets in do they abandon further vigil. We should also protect our next of kin and, sadly, it is from our own species. It is often the organ harvesters who control the registration system making it difficult and unreliable to effectively register an organkeeper or organ retainer decision. We are bombarded with appeals and means to register a decision to allow harvesting, but the mechanism to centrally register an organkeeper decision rarely exists. More sinister is the subtle propagation of the concept that our individual bodies are owned by the species as a whole and not by ourselves � an apparently benevolent concept until one investigates who control the medical industry and their motives for promoting this concept. Who Owns A Dead Body? A patient declared brain dead with a beating heart hasn�t any legal rights. This means most of the patient�s previous directives on treating their body are not legally binding. Some states have Power of Attorney or Advance Medical Directives where you can give advance medical treatment orders before death. This includes the point of deterioration where you no longer want medical treatment except pain reduction. The contrived brain death criteria erase these orders because you�re legally dead and Advance Medical Directives only cover a living person. The fact that part of your brain is alive and your body quite alive make no difference. At this point closest friends or relatives face difficulties in directing treatment because you are dead or, so the medical authorities will say. Certain conditions for treating the body can be left in a will but it will be days until this is read. Until then the brain dead patient in a hospital is quite at the mercy of staff who may want to harvest parts while the patient is still warm, pliable and with a strong blood circulation. Protecting Your Body The legal key to protecting yourself, and later your body from harvesting, is by ensuring that numerous people know you are an organ keeper. Once your legal advocates and donation agencies know you require an intact body for burial or cremation they are legally obliged to ensure it stays that way. This will legally protect you and your body, a fact that angers the donation agencies, who respond by making it very difficult to register the choice of "no harvesting, thanks". The Australian Organ Donor Register is the computer data base available nationally to medical and transplant promoters. It is designed to easier identify patients who acquiesce to organ and body parts removal. Medical and transplant staff around Australia can check patient names with the Register and record this detail on the patients� hospital record so staff can identify each patient as a donor or organkeeper right from the start. The startling feature of its on-line registration is that a person can register an organkeeper choice. While this is an encouraging development one cannot by all means be assured that the register won�t be changed before or on �harvest day�. The problem for organ keepers is that the on-line form is for donors. One must fill in the whole donor form, giving medicare card number and personal details as if one is an organ donor, then tick a tiny box that indicates organ retainer. This leaves it very easy for a harvest agent to change that single box to make you a registered harvest candidate. A much safer system would be having two separate databases with separate staff. An organ keeper would complete an organ keeper on-line form and a harvest candidate would fill out a separate donor form. The Australian Organ Donor Register�s paper application is even worse. To register an organ retainer decision staff insist the person complete a whole organ donation form agreeing to donate organs including ticking a specific box saying you want to an organ donor. Then, Register staff suggest without a trace of embarrassment, one lists on two tiny lines all the organs, body parts and substances you want to keep. Simple as that, providing you know all the body materials the harvesters want, and you want to keep, and can list them in tiny, tiny print on two tiny lines. Even donors could be deceived into thinking they were registering to donate their heart, liver and kidneys (called "mixed grill" in the industry), and perhaps say, "leave my eyes" but unwittingly signing over their remaining body. Quite probably many people would be signing up for a degree of harvesting while thinking they had protected themselves. Like on-line registration there should be a separate paper form for organ retainers and even donor registration forms should have a checklist of all harvestable organs, body parts and other materials. This would allow prospective donors an "informed consent". The Register avoids this because it would shock prospective donors, especially children, with the extent of body parts harvesting and expose the unpleasant fact that very little harvesting involves lifesaving surgery. But the Register, like all those the world over, won�t and can�t because a population informed on the subject would rush to cancel donation and become organ retainers. Such deceptive methods restricting an informed choice don't inspire trust. If governments do this at the propaganda and bureaucratic level, while we are alive, one can only imagine what happens to the brain-injured human, lying on the harvest table, and when relatives have been excluded. Organ Retainer and Organ Keeping Cards The Australian Organ Donor Register is one of the few databases in the world that will register an organkeeper decision. But computers crash and data can be manipulated. In the coercive environment of organ transplanting you may benefit by carrying an organ retainer or organ keeper card. Carrying a card signifying your intention to keep organs and body parts intact before and after death will generally be respected by hospitals. It will help to keep multiple cards, one in your wallet with Medicare or health insurance cards and others scattered throughout your worldly possessions. You can state your organ keeper intentions and, though this isn�t necessary, get a witness to sign your card. Homemade cards are valid or you can list your preferences using prepared cards from any country in the world. Your stated intention in writing is the significant factor rather than who prints the card. A card signifies your intentions so either a homemade card or any statement in writing is applicable in any country. Australian and World Organ Retainer Cards These simple cards are available from www.geocities.com/organdonate or www.geocities.com/organretainer. Files in Word will be emailed on request or you can print directly from the site. Japanese Organ Keeper and Organ Donor Cards The Japanese Organ Transplant Network distributes free cards in English or Japanese. Their unique card has three levels of intention, brain death donation, cardiac death (complete death) donation or �I do not want to donate�. Most Japanese find organ harvesting a repulsive and spiritually dangerous concept thus three choices was the most intrusive their transplant industry could pressure the government to legislate for. It is important to circle your choice with a scratch and then ink over the scratch. The other choices could be scratched out to avoid changes by pro-harvest medical staff. Their cards have only a section for a signature so scratching your name and inking it over seems preferable to depending solely on a signature. You can add more precise instructions by attaching a piece of card or paper to the official card. These free cards can be ordered by email from their website, www.jotnw.or.jp. Organ Keeper CardsTM50 Duane Horton, an engineer and entrepreneur, of Rhode Island, USA operates www.organkeeper.com, a website promoting increased organ transplanting through payments to donors and their families. Duane says organ donating would increase if the rights of organ donors were improved and encourages prospective donors to go on strike until governments improve conditions. Duane Horton is the western world�s leading donor rights activist. Duane publishes a detailed, absorbent surfaced, trade marked OrganKeeper card that signifies the holder wants to retain organs upon brain death and complete death. There are six tickable boxes each giving a reason why the signer is opposed to organ donation. These are: 1) Laws prohibit compensating surviving family of donors; 2) Those who register as donors should get preference if they need an organ; 3) Organs and body parts may go to people the donor dislikes. (the card has space to list the people. E.g. used car sellers, drug dealers, next door neighbours, etc.); 4) Harvesting violates religious or moral beliefs; 5) It is wrong that doctors, hospitals and pharmaceutical firms derive huge profits from donated organs and tissues. A last section is blank so you can add your own reasons. Duane may post the cards for free if you send him a self-addressed, stamped envelope or you can print cards from his website, www.organkeeper.com. The benefit of Organ keeper and Organ Retainer Cards is that the signer retains control of the printed information and may duplicate it for protection. Those who sign as organ retainers with an electronic register, such as the Australian Organ Donor Register, cede control of this statement to pro-transplant bureaucrats. Power of Attorney and Tattoos Giving Power of Attorney to a person chosen by yourself protects your body from transplant harvesters. Power of Attorney allows your representative to represent your interests as directed by yourself when you were conscious. You should have a note on your person naming your representative. Tattoos are a permanent form of registering your intention to be an organkeeper. A harvesting surgeon might be reluctant to slit up the torso of someone with Organ Keeper tattooed in big letters across his or her body. Just make sure you don�t change your mind. Organ Keeper Cards are an anti-dote to Donor Cards, the latter perhaps signed without thought, and in the midst of a promotional talk by harvest promoters. Dated organkeeper cards can also counteract your having signed a donor card or an electronic register then forgotten and later changed one�s mind. Donor Cards are often signed without too much thought but they are serious documents that have serious ramifications. Dr David Hill has observed, "People may well sign out of commendable altruism but in complete ignorance, but this Card [Donor Card] has legal force and the status of an advanced directive." |