Reply to ‘Organ transplant: Are we on the right track?’ by FK-506

Letters
by Carpe Diem

I would like to comment on the letter by FK-506. However I will try to focus on rebutting factual inaccuracies in his letter, rather than comment on his insinuations and innuendos as my interpretations of his statements may be flawed.

Quote : “………..it isn’t quite right to place patients on VADs which have a limited life of their own into patients, not knowing if they are ever going to get a heart. This cannot be ethically correct.”

Whether this is ethically correct or not depends on the patient’s wishes, the facilities available and expert opinion. Unfortunately this is one area where opinions matter. An individual may consider it mental and physical torture to be hooked to a machine with no definite end in sight, but another may consider it a lifeline to a possibly better future. Is it more ethical to deny me this option, based on not knowing whether I will get a heart in time, if the expertise is available and I am more than willing?

Quote : “Merican howled that what SJMC and Tan did were improper as ignorant patients may “not have been briefed about complications”. Tan, who pioneered liver transplant techniques at King’s College, London, of course left, preferring to base himself in “less ethical” Singapore, leaving Merican to focus on traditional medicine back here in Malaysia.”

Well I have no love for traditional medicine, but I don’t see how this case affects the current scenario. Anyway, if I am not mistaken the issue against KC Tan then was on unrelated living donors. Please correct me if I am wrong.

Quote : “Many fail to realise that the most painful thing about losing a family member to a traffic accident is the suddenness.”

I can assure you most if not all doctors realise the emotional trauma of losing a loved one, more so when it is unexpected. That is why more often than not, medical professionals fail to bring up the issue of cadaveric organ donation to mourning family members. We are human too and often find handling strong emotions difficult. So to imply we are unfeeling to the deceased’s family members is a great insult. In fact the opposite commonly happens, where medical staff fail to bring up the option of organ donation as they fear it will distress the family.

Quote : “And if you define human death as brain death and give doctors the power to demand or request organs, a family member might have his heart or lung ripped out even before they have a chance to mourn.”

Human death IS brain death, and this scientific fact has been proven beyond all doubt internationally, and has been accepted medically and legally for many years. I repeat,brain death is death. Doctors do not have the power whatsoever to demand organ donations. We may mention the option to the deceased’s family and allow them to make the decision. We answer queries but we do not pressure. It is up to the family to make a decision. There is also no guilt in refusing. Ultimately, it is always the family’s choice. Unfortunately, there often is a narrow window of opportunity for cadaveric organ donation. Once a person is brain dead, ie dead, the organs start to shut down. Once deterioration is advanced, organ donation is no longer an option; exceptions are skin, bones, cornea, which are viable for longer periods. So it is true a decision is required while the family is still mourning and in shock. There is no way to sugarcoat it, a decision needs to be made within a few hours time for cadaveric organ donations to take place. But the final word is always the family’s.

Quote : “Add this to the current perception of widespread political corruption with a judiciary hopelessly entangled in a quagmire from which no one knows if they are ever going to extricate themselves, you will end up with a family or relative not wanting to believe anything the authorities tell you including the fact that their beloved is brain dead.”

I can’t disagree with FK-506 on the low regard many now hold for our current politicians and judges, but to stretch it to include healthcare providers is without basis, as far as I am concerned. If FK-506’s assumptions are correct, I am sorry, but I do not see any evidence of that at the moment. If a relative does not believe a person is brain dead, which may happen as a natural part of grief response, so be it. No one will touch the body without prior consent.

Quote : “And is brain death criteria in Malaysia strictly adhered to? Are our anesthetists, neurologists, neurosurgeons or critical care physicians well trained in ascertaining brain death? Will our brain death certifiers be singularly medically unbiased or will they lean towards to a lower criteria as the demand for the organ rises just as in Argentina, Brazil, Chile, China and India or if the VAD’s 3,000 hours ticks closer.”

Yes to all the above.

Quote : “Abuse of brain death criteria around the world is widespread and quite possibly in Malaysia if some cases highlighted in the media are anything to go by.”

Widespread? Can you provide some evidence? Especially for Malaysia since you say it is quite possible. Which cases were highlighted in the media, was it local or foreign? Making sweeping statements without basis is libelous / slanderous. Sorry I am not a legal eagle, I could never differentiate the two. Initially you criticized the media for being non-discerning and misleading, now you take other reports as the truth? We should not cherry pick what we want to believe.

Quote : “In Japan, the name Juro Wada is almost synonymous with how society can turn distrustful of organ donation. …….”

Another incidence of cherry-picking using anecdotal evidence. For every unethical/illegal example, there are hundreds of ethical counterparts. These bad hats taught us measures to prevent similar mistakes. Brain death in Malaysia is confirmed by 2 independent specialists through a number of set tests under specified conditions, at repeated at least 6 hours. These 2 doctors must be in no way associated with potential organ recipients. Please refer to Malaysia Medical Council’s website for details.

Quote : “Even within the medical fraternity no one knows the short, medium and long term results of mortality and morbidity rates of all organs transplanted in Malaysia.”

I am not sure about other organs, but the renal fraternity has an ongoing annual report since 1992.

Quote : “These transplants may be less glamorous but a long and gratifying track record in these areas may warm Malaysians eventually to actually accepting brain death.”

While I agree with FK-506 on the need for equal emphasis on living related transplants etc, how that helps Malaysians come to terms with the concept of brain death is a mystery to me. The two do not seem to be related.

Quote : “Hopefully someday we will have a primary healthcare system that will prevent the emergence of most diseases but until then we should avoid descending into the questionable achievement of killing people to save the dying.”

This final statement is the most shocking lie in the whole letter. Claiming Malaysian doctors are killing people to obtain their organs is an insult beyond my imagination. If FK-506 has any evidence on this, I implore him/her to make a police report immediately in order to bring the culprits to book. If not, he should apologize immediately for spreading falsehood.