The Nasty Side of Organ Transplanting
Second Edition
Norm Barber
Copyright
Chapter 13
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 harvest organs from registered donors. After all, they aren�t legally required to.
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 understood the processes except the advertised idea of dead bodies being used to save beautiful peoples� lives.
Then came the reality. 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 then dies.
To avoid negative reaction to transplant legislation the astute government orders its bureaucracies to gradually promote and introduce harvesting 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�, who hired models, professional actors and a stand-up comedian to promote �awareness�. These paid actors pretend they love being donors despite the fact that real donors are never able to return to say how good it was. Media kits include photographs and video clips of smiling children with organ transplants and "donor" relatives saying how wonderful they feel about donating the heart-beating bodies of their �dead� children.
*The Australians Donate organisation got a little surprise when they hired the actors for what they thought was a single payment for a series of sessions. They later discovered a small clause in the contract requiring them to pay each actor per media exposure meaning they have an ongoing financial commitment. The actors are laughing.
These promotion campaigns are run by advertising promoters who are increasingly replacing medical staff to promote harvesting and transplanting. These promoters are hired to visit schools to increase "awareness" and are trained as advertisers to carefully avoid telling children the negative aspects of being a donor.
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. This small group produces 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. Their aim is to lull the public into feeling there is a huge undercurrent of sentiment thinking favourably of transplant medicine so it must be good, but it is just a government and drug company 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 the 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 a law that allows hospitals to harvest donor card signers without seeking next of kin consent. If this consensus is formed then even those wishing to die intact, but who haven�t registered the difficult "no" choice, may be legally harvested if they don�t have an organkeeper card or advocate to indicate otherwise.
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 beings.
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. We can�t kill the sick or let them die when the medical 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 to promote transplantation has increased demand for fresh organs.
On the supply side of the equation, raw materials, in this case body parts, aren�t keeping up with demand. Car smashes are producing less brain-injured bodies while the treatment of brain injuries, including strokes, are improving. Young men, in particular, have become less enthusiastic to beat each other around the head thus denying the harvesters 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 the harvest coordinators. Supply is not rising to meet demand so governments are pushing harder and harder to increase or just maintain supplies of vital organs.
More Pressure on Relatives
So it shouldn�t be any surprise when Professor Geoffrey Dahlenburg of the South Australian Organ Donation Agency says transplant coordinators will no longer be accepting a "soft no" from relatives. The new requirement will be "strong objection" after some discussion. He says transplant coordinators "need to know" the reason why next of kin won�t consent to harvesting of their children or parents. Professor Dahlenburg faces a problem here. If coordinators pressure too hard then relatives will begin asking under what legislative or administrative rules the �requesting� is being done. The Professor walks a tightrope.
Geoffrey Dahlenburg (not to be confused with Jeffrey Dahmer, the American who murdered young men, chopped them up, put the parts in his freezer and later thawed them out to eat), is under pressure from the government to increase the supply of body parts. He must pressure transplant coordinators and other �requesting� staff to demand from shocked and dazed relatives to what in any culture must be a barbarous request.
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 every person�s body unless they register 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."51
There are two reasons why �opt-out� isn�t universally adopted. The first is that Anglo-Saxon dominated countries 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 to register organkeeper decisions by their citizens who normally wouldn�t consider it. Brazil chose "opt-out" but it backfired when people rushed to register the preference to keep their organs. One Brazilian summed up their 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."52
Spain and United States have the highest per capita rates of organ donation. Spain has presumed consent where the government legally assumes the right to remove body parts unless a citizen registers an organkeeper decision. In practice they still use the soft touch and seek consent from relatives. The United States, like most Anglo-Saxon and Celtic dominated countries, has an opt-in system where consent is sought from relatives and, usually, only if the terminally injured patients are registered organ donors. Other opt-in countries are New Zealand, Australia, Canada and the United Kingdom. Germany, Japan, Ireland and The Netherlands also seek consent from relatives.
Organ Donation Around The World
Japan has, perhaps more than any other technologically advanced country, 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 complete or 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 complete death when the heart has stopped. This differs from most countries where kidneys from cardiac dead donors aren�t used.
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, it was a public relations gesture and insurance policy if the father later became disillusioned.
Austria, Denmark, Poland, part of Switzerland and Latvia are the fastest countries to remove organs without consent or notice. International travellers with dual citizenship visiting these countries should carry organkeeper cards, advise relatives and write �organkeeper, no body harvesting� onto all their documents. It should also be noted that countries often apply their harvesting laws to international tourists, but generally one could say that any indication of an organ keeper choice will stop them from removing organs prior to complete brain/heart death.
"Softly, softly" Increases Harvesting
European countries that adopted and applied presumed consent found their harvest rates lower than Spain and the United States that seek next of kin consent. Governments presuming ownership of citizens� bodies triggered a response similar to the Brazilian organ retainer reaction.
However, both "opt-in" or "opt-out" organ transplant programs are geared to increase supply through indoctrination and compulsion rather than increased understanding. Harvesting strategists know that many donors and relatives would avoid donation if they knew what it involved.
Except for China where prisoners are made �brain dead� by being shot on demand to satisfy rich, �hungry customers� with their organs, the United Kingdom is perhaps the quickest to declare brain death. The clever British have increased harvest production by lowering the requirement of brain injury to declare brain death. They assume that serious brain-stem malfunction is brain death. To avoid debating the meaning of brain death these deviously clever people have re-labelled it as "Certified Dead". Certified dead means the doctor says so. This change arose when they found that both lay-people and medical experts were convinced that many donors weren�t brain dead or brain stem dead, but still alive and in a state that merely predicted death. |