By Dayanti Karunaratne
Imagine knowing one of your vital organs is infected or weak, not able to meet the demands of daily life. This probably means you are in a hospital bed, hooked up to machines that act in place of a healthy heart, kidney, or pancreas.
Now imagine a neighbour down the hall in the critical care unit, loosening his or her grip on life, and willing to donate a part of their body so that you can get out of this dire condition.
And now, imagine that deal is denied — not even offered to that patient or the patient’s family — because medical professionals are splitting hairs about exactly the type of death that has occurred.
The transplant surgery situation in this country is grim. Canada currently lags behind other countries in the field of organ donation, and is failing to meet the demands of the aging population.
In 2004, the Canadian Institute for Health Information reported a stagnant donor rate of 13.5 per million, compared with 124 per million who are waiting for surgery.
More than 3,700 people are currently waiting for transplant surgery, and about 150 die waiting every year.
Canada’s situation exists partly because hospitals do not perform transplant surgery unless the donor has been declared brain dead.
Brain death usually occurs from severe trauma to the head or neck; about two per cent of patients who die in Canadian hospitals can be pronounced brain dead. This means only about two per cent of accidental deaths are available as transplants.
But now the medical community has the power to shorten wait lists and improve the state of affairs for donation and transplantation.
Dr. Cameron Guest is the chief medical officer with the Trillium Gift of Life Foundation, Ontario’s organizing body for organ donation and transplantation. He explains that when a patient has been pronounced brain dead, there is no room for conflict of interest. Once brain activity has ceased, organ donor cards can be reviewed and the issue brought up with the family of the deceased.
If a patient has died from heart failure, however, he or she can often be kept alive on life support. The family is now faced with a number of tough choices.
“The donation decision doesn’t come up until a consensual decision (to remove life support) has been made with the family,” says Dr. Sam Shemie, chair of the donation committee with the Canadian Council for Donation and Transplantation (CCDT).
Rabbi Reuven Bulka sits on the CCDT as a representative from the religious community. “Everyone on the council is committed to saving lives,” says Bulka. Bulka, who also chairs an organ donation committee with the Kidney Foundation of Canada, emphasizes the CCDT discusses issues to ensure practices are morally, ethically, and medically sound.
Approached by an intensive-care doctor, the family must accept the status of their loved one as “vegetative.” The question to “pull the plug” is never easy. But Guest says in his experience as an intensive care doctor, once the decision has been made, “families are often motivated, they ask ‘is donation possible?’”
But for now, the answer is no.
Shemie agrees many families are interested in donating. It can be uncomfortable, he admits, because action must be taken quickly to obtain and maintain the vital organs.
“If you only have a short amount of time, will that compromise the grieving process?” Shemie asks, adding there are sometimes religious issues. His answer: “that’s the family’s decision.” Shemie says it is important family members know all the information, that donation could be possible.
The Netherlands and some U.S. hospitals allow organs to be donated after a patient has died from cardiac arrest. It was a risk at first. Guest says the first DCD transplant surgery was impromptu — the family was interested, the transplant and critical care teams were open to it, and it saved the life of a human in need.
After literally years of discussions, last December the CCDT announced its support of organ donation after cardiac death (DCD).
Dr. Shemie explains there is controlled DCD, in which a patient dies because life support has been removed (and it was therefore anticipated), and uncontrolled DCD, when cardiac arrest is unexpected and occurs outside of the hospital. The council does not yet support uncontrolled DCD.
With wait lists growing every year, and this new type of donation supported by experts across the country, health care workers must now put expertise into action, and begin to offer DCD to families who have experienced the loss of a loved one.
Guest says all groups — transplant teams, critical care workers, and provincial procurement agencies like Trillium Gift of Life Network — have agreed in kind to DCD, but the working guidelines still have to be established. Pilot projects are meant to begin in Ontario hospitals this year.
“There are a number of very cold things we have to talk about as health care workers,” Dr. Shemie says, “such as burial and autopsy requests . . . and it’s our discomfort, really, as health care workers that’s getting in the way.”
No one wants to imagine themselves in a hospital bed, for any reason, let alone suffering heart failure or life-threatening illness.
But these people are out there, and the thought of waiting among 3,700 others in a medical limbo seems like hell on earth.
It’s time to open the door to DCD, shorten the wait lists and bring life-saving organs to more people in need.monitoring, it forces people to get used to composting organic waste.
Another option is reducing garbage pickup, as was debated in November and tried successfully with volunteers. With a smaller garbage allowance, residents will be forced to reduce waste by putting organics in the green box.
Various municipalities have adopted a “pay as you throw” system, where the amount of garbage collected is limited and excess bags must be paid for.
A 2004 discussion paper on waste reduction was produced by the Ontario Ministry of the Environment. It shows that this system has increased waste diversion by 10 to 15 per cent alone.
Most importantly, throwing organic waste into the trash can no longer be socially acceptable, just as trashing a stack of newspapers now seems ridiculously short-sighted.
Ottawa will need to find incentives to encourage people to compost, but negative reinforcement cannot be ruled out. Stubborn and lazy critics should not be permitted to fill our landfills with the valuable resource of compost.
Susan Antler, the executive director of the Compost Council of Canada, puts composting into its proper perspective. She asks people to imagine how stupid trashing compost will look in the civilization museums of tomorrow.
“The writing is on the wall,” she says. Composting has been proven as the most effective waste reduction method. “People want to be given the tools to do the right thing.”
Unfortunately, it looks like they might also need a push.