Cyprus Mail
Cyprus Health

Donor dilemma divides doctors

By Poly Pantelides

DOCTORS need better education when it comes to the complicated ethical issue of brain death and when organs can be removed for life-saving transplants, stakeholders said at a public consultation organised by the ministry of health yesterday.

The debate focused around the argument that many doctors refuse to accept brain death as legal death, especially as a mechanically supported vegetative state would allow vital organs to be kept functional making them ideal for transplantation.

Although some of the nearly thirty stakeholders at the meeting conceded that Cyprus has one of the lowest rates of registered organ donors in Europe, possibly due to a lack of awareness, doctors too were seen as obstacles to potential transplants due to a lack of education on the matter.

One trauma expert from Limassol said that at least seven other lives can be saved from a dead donor’s organs, while a lawyer present argued that the current law itself was so complicated that it raised more dilemmas than provided solutions.

Health minister Petros Petrides said the consultation was the first of a series in a government initiative to increase the public’s participation in policy-making.

Currently, there are 63 people in Cyprus waiting for an organ that can only come from a dead donor, while others are on waiting lists abroad, the health ministry said. So far this year, there have been nine post-mortem organ donors, compared with five last year and twelve in 2011.

A register of potential donors was set up after a law regulating organ donations and transplants was passed last year, but only 670 people have registered so far. Donors may be removed from the register whenever they want and their details will continue to be kept confidential. In any case, officials will still need the final consent from the dead person’s immediate family or legal representative in order to harness an organ. And relatives may also be approached for possible organ donation whether or not the potential donor is registered or not.

Surgeon Panayiotis Hadjicostas, who has represented Cyprus at EU-level discussions on organ donation and transplantations, said the most successful models were the ones focusing on training medical staff on organ donation procedures, but also how to approach relatives.

Spain, that has trained 11,000 people and placed them in all public and private hospitals, has double the organ donation rate than the UK, Hadjicostas said.

But although some people called for removing the need to get relatives’ consent in the case of registered donors, others were worried over the impact this would have on the mourners but also the negativity this would generate in Cyprus’ close-knit society.

Health minister Petrides, a public sector surgeon prior to taking up his cabinet position, shared an anecdote from three years’ ago when relatives of a brain dead patient in Nicosia general hospital were up in arms against the doctors who suggested their relative was a potential organ donor. They perceived the suggestion as an effort to take away their relative’s life, Petrides said.

Brain death occurs when a person no longer has any activity in their brain stem and there is no potential for consciousness, is kept alive through a ventilator, the UK’s national health service says. Once brain death occurs, it is possible to use organs for transplants, potentially saving several lives. But asking a grieving relative to make a choice at the intensive care unit, especially if they have never given thought to the issue before, is a harsh and difficult thing to do, many said yesterday.

Many doctors do not even accept the notion of brain death, the head of the hospital’s intensive care unit Theodoros Kyprianou said, a point echoed by others. Another stakeholder said there was a need for a survey among doctors and the general public to quantify people’s attitudes towards organ donation.

Participants at the discussion were asked to express an opinion on whether policy should shift towards the notion of “presumed consent”, whereby everyone is considered a potential donor unless they explicitly state otherwise, or whether people should be asked to declare if they want to be potential organ donors.

Most stakeholders, including doctors, academics, cancer patient carers and organ transplant recipients, rejected the notion of presumed consent. The chairman of the bioethics committee, Michalis Voniatis, added, “silence is not consent”.

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