An act of the organ donation is always perceived as an act of kindness and noble intentions. The word donation itself depicts no expectation in return. In Canada, there is the universal prioritised list of organ recipients. The prospective donors can document their intentions while registering for driver’s license or while setting up health insurance. If a person misses every opportunity to register, the question arises about living will and willingness of organ donation at the time of hospital admission. Finally if the health is worse enough and incapable of answering or making any decision, the substitute decision maker takes charge. The decision making is never spontaneous, under time constraints or involuntary at no level through the process of organ donation.
Recently, I stumbled upon a case of organ donation from India. 14 months old becomes a cadaver organ donor. The information and scarce clinical data, I gathered from stories published on Facebook, local newspapers and online stories published on www.donatelife.org.in. By constructing the information from sources; a 14 month-old boy fell down the stairs with skull fracture and subdural hematoma, was pronounced dead after one week of hospital stay because of “brain death” determined by either a neurologist or neurosurgeon based on CT scan. The information leading to withdrawal of life support may be missing or misleading; but it can easily point to suspicions to an educated brain.
Based on information we gathered and did primary research, upon calling local doctors to find out diagnostic facility available to investigate surrounding circumstances of brain death. There are series of tests and clinical examinations within low means of facility, which allow to declare death with high precision if properly conducted by a team of physicians and not only one doctor at different times over the span of a couple of days. There are established protocol to declare death in India. Practicing euthanasia is considered unethical conduct in Indian medicine but withdrawal of life support in case of brain death, if decided by a team of doctors, in accordance with transplantation of a human organ act, 1994, considered acceptable practice. There are few cases where withdrawal of life support and considering for organ donation even in pediatric patient population where mortal complications and obvious unfavorable recovery. Those cases are limited in numbers.
Grey Zone Between Harvesting vs. Donating
India is an economically emerging country. There is a large number of patients who need organs and can afford to pay for it. On the other extreme, there is a sizable patient population which cannot afford to pay for complex and expensive medical procedures and rather prefer to die. If these cases have any opportunity of compensation of any kind, for being cadaver organ donation, they will likely to agree than being a burden for their families. It is sad situation in particularly when government-funded hospitals provide inferior and less advanced critical care in the direction of survival.
These are two extremes of financial situations, and sparsely regulated medicine, chances of malpractice and unethical compensation rise. Wealthy prospective organ recipients jump lines by providing money to physician and luring poor people to sell organs. When a patient is critical but not dying, the physician can easily convince an uneducated, illiterate and poor patient about ending life to become an organ donor. Medical council of India, the controlling body for medicine has clearly depicted laws about declaring the death, but they hardly implement or audit.
There is down sloping trend in organ transplant in India. Awareness and education are very important for prospective donors starting from the living Will, withdrawing life support, and cadaver donation. There are many cadaver organ donations done with rightful intentions. There is a noble purpose in the entire process. Oftentimes those intentions are hindered by lack of diagnostic tools, failure to follow proper protocols and policies in withdrawing life support. Central controlling body like Medical Council of India should get actively involved in making prioritized recipients list, list of prospective donors, frequent auditing the entire organ-donation procedure, and procedures involving the withdrawal of life support.