Showing posts with label transplantation. Show all posts
Showing posts with label transplantation. Show all posts

Friday, April 22, 2016

Heart of Gold (Musings on donating the gift of life)

Updated: 24 April 2016
April's blog was stimulated by a flurry of news about organ and tissue donation in North America due to 
  • Canada: National Organ and Tissue Donation Awareness Week, April 22-28;
  • USA: April is National Donate Life Month;
  • Other nations have similar days, weeks, months throughout the year.
Recently, many news items have appeared on selling a body tissue, namely the introduction of paid plasma collection centres in Canada. Be aware that this is NOT another blog on that contentious issue. Rather it's about awareness of 
  • What we can donate;
  • Why we should donate;
  • How we can donate;
  • Why we don't donate. 
The blog's title derives from a 1972 ditty by Canada's Neil Young.

STATISTICS ON  DONATING BLOOD VS TISSUES AND ORGANS
The blog will mainly present Canadian statistics, which are not that different from statistics elsewhere in the world, except where noted. The focus will be on tissue and organ donation, not blood donation. OMG, statistics! Not to worry about being flooded with numbers. Statistics are great fun. 

About blood donation, ~4% of Canadians voluntarily donate bloodAs to tissue and organ donation, 80-90% of Canadians support organ and tissue donation but less than 20% make plans to donate.

Donating tissue and organs is in many ways different than donating blood, especially if the former applies to the future once you're dead, something you put in a Will or indicate on your driver's license. 

Organ donation is a complex process, which involves identifying potential donors, getting consent from families and procuring organs around the time of death. Donating tissues and organs after death is something that won't affect you personally as you're dead. 

But donating will affect your family at an emotional time, so it's essential that you frankly discuss your wishes with them. If your family objects, regardless of your wishes, your donation will not happen. 

Canadian STATS - Organ Donation (2014)
  • Over 4,500 people waited for organ transplants (77% needed a kidney); 
  • 2,356 organs were transplanted;
  • 278 people died waiting for a transplant (one-third needed a kidney).
TIDBITS
You can register to donate your organs and tissues and even donate certain organs while you're still alive: a kidney, part of the liver, and a lobe of the lung. See, for example,
An estimated two-thirds of deceased patients who are eligible to donate organs in Canada do not make it through the complex organ donation process. 

Only 2% of people who die meet the strict criteria for organ donation. But 90% can donate tissues, including corneas, heart valves, tendons and skin. 

Each deceased donor provides 3.4 organs on average.

Quebec had the highest deceased organ donor conversion rate in Canada, at 21% of eligible deaths, nearly double that of all the Prairie provinces.  

Transplant BC has 988,740 registered organ donors but only 422 organs were transplanted in 2015 due to strict medical requirements that rule out 99% of donors. Most deceased donors are declared brain-dead in intensive care but their hearts are kept beating until surgeries can be performed. 

Donation after Cardiac Death (DCD) is an emerging phenomenon in Canada that has forced the health care system to confront ethical issues on what constitutes death. Canada has adopted neurological criteria (“brain arrest”) to define death but some provinces do accept DCD.  

MUSINGS
Why don't more people donate?
So why don't more people take steps to give the gift of life after death? It's complex but here's why I think many good folks don't think about donating tissues and organs and plan for it:
  • Simply because it doesn't enter their consciousness;
  • Unless they know someone whose life depends on a transplant, they're unaware;
  • If they think about it, cutting up their bodies, even if dead, to remove parts may seem creepy;
Legal trade in tissues and organs
In many nations voluntarily donation is honoured but, depending on the body part, you may be able to sell it legally. For example:
Some argue we should be able to sell organs, not just plasma, hair, etc. 
 'A recent survey of Americans by researchers from Argentina, Canada, and the US. ...found that while barely half of respondents initially favored a system that would pay organ donors, the number rose significantly—to 71 percent—once those surveyed were given information about how the system would actually work.'
And some use arguments similar to those used to justify paid plasma. Paying helps the economy (the poor have more disposable money to spend) and recipient lives are saved. 

Black market in tissues and organs
We volunteer to donate body tissues and organs, we sell some legally, then there's the dark side, and it's very dark indeed.
As well, there's another shady, hidden body organ market that seldom sees the light of day:
You can search the Internet and find MANY similar - and even more gruesome - real-life, true reports.

LEARNING POINTS 
To me paid plasma is the thin edge of the wedge, the slippery slope that leads to hell, a hell where the poor sell their body parts in the open market to the highest bidder. Paid plasma and 'kidneys for sale' are on the same continuum.

My view is that voluntary tissue and organ donations are an incredible opportunity to make a real difference in the lives of fellow humans, whether 
Please take the time to indicate you want to donate tissues and organs, put it in your Will, and and explain your reasons to your family. Donating tissues and organs is a wonderful way to live after you die. 
  • In Canada, How to donate
  • In your country, search for 'organ donation' plus your nation, e.g., 
    • Organ donation UK, organ donation Australia, etc.
FOR FUN
Neil Young's song fits this blog:
FURTHER READING
A selection of resources used to develop this blog and ones well worth reading.

Monday, February 15, 2010

We are the world - Musings on how we can lessen the global trade in body parts

As Valentine's Day approached, I got to thinking about what it means to give of ourself to family, friends, and total strangers.

A Canadian Blood Services press release about a new initiative, "Improving organ and tissue donation and transplantation (OTDT) in Canada," made me wonder what motivates some to give so generously, whether by donating blood or by donating tissues and organs.

The blog's title comes from the Lionel Ritchie - Michael Jackson song of the same name. It's hard to realize that it was 25 years ago that 'United Support of Artists for Africa' (aka 'USA for Africa') recorded what has become the biggest selling single of all time:

The song has been in the news again recently as it was re-recorded just this month to help the people of Haiti:
Organ & Tissue Donation
This blog concentrates on organ donation and tissue donation (rather than blood) and focuses on organ donation in Australia, Canada, UK, and USA. Some random statistics:

Australia
In 2008, 259 Australians donated organs benefiting 846 transplant recipients [NSW Factsheet]

Around 1700 people are on Australian organ transplant waiting lists at any one time. In 2009, 247 organ donors gave 799 Australians a new chance in life. [AODAW]

Canada

In 2008 CBS was given a government mandate to develop a recommendation for a new national OTDT system in consultation with stakeholders, the public, and the medical community.

"Canada is one of the only countries in the western world without a national, coordinated system for organ and tissue donation and transplantation. [OTDT, 2010]
Statistics from Organ Donation & Transplant Association of Canada
  • 4330 people were on the waiting list for an organ transplant.
  • 215 people died while waiting for an organ transplant.
  • 303 people withdrew from the waiting list. (People are withdrawn from the waiting list when they become too sick to receive a transplant, opt out of the surgery, or their health improves.)
  • 2083 transplants took place.
  • 1541 of those transplants were made possible because of deceased donors.
Also see Organ donation & transplantation in Canada (Govt. of Canada):The organ donor rate in Canada continues to be mediocre despite efforts in recent years to increase it....

UK
  • Last year 3,237 organ transplants were carried out in the UK but the number needing a transplant is steadily increasing, with almost 8,000 people currently waiting for a transplant.
  • Around 1,000 die while waiting because of the shortage of donated organs. [NHSBT, 2008]
USA
From OrganDonor.Gov:
  • ~77 people receive organ transplants daily
  • 19 people die daily waiting for transplants (~7000/yr)
International Donation Rates
In 2007, the USA ranked 4th in organ donation, Canada 12th, and Australia 17th. (International Registry of Organ Donation & Transplantation, according to Transplant Australia)

Transplant Australia also notes
  • Spain, Belgium, France, Norway, and Italy have “presumed consent” laws, where everyone is considered a donor unless they specify otherwise.
  • USA and Finland have an ‘opt in’ consent law where citizens provide express and informed agreement to donate organs in the event of their death.
  • Many factors beside legislation affect donor rates, including hospital processes, public awareness, religion and culture, road death toll rates and others.
  • Donation is still discussed with the family and the objections of next of kin are not overruled in Australia and all comparable countries, whether a presumed or informed consent model is in place.
Related news items - Spain leads the way in organ donation

WHY NOT DONATE?
There are many reasons why more of us do not donate our organs and tissues:
CONSEQUENCES OF ORGAN SHORTAGES
Although not this simple, in most economies a shortage of organs will operate like shortages of other commodities and obey the laws of supply and demand, i,e, if demand increases while availability decreases or remains low, prices will rise.

Invariably, shortages mean that the rich will be able to obtain expensive goods and services unavailable to the poor. Globally we see this with HIV/AIDS and hemophilia:
Comparisons from World Federation of Hemophilia 2008 Global Survey on the use of FVIII concentrates (see p.27) show a striking trend:
FVIII use per capita* (% recombinant) * total IUs used divided used by total population
  • Australia: 6.21 (87%)
  • Canada: 4.64 (100%)
  • USA: 5.21 (81%)
  • Georgia: 0.39 (0%)
  • India: 0.005 (0%)
  • Nigeria: 0.0003 (19%)
To get a sense of life in the developing world, see the typical patient profiles in this paper:
BODY ORGANS
With body organs, we get the specter of the poor selling their body parts to rich 'medical tourists' of the industrialized West.
BOTTOM LINE
In effect, the low rate of organ donation by those of us in the privileged West has consequences.
  • Not only do our friends and loved ones die waiting for transplants.
  • We also unwittingly contribute to our fellow citizens prolonging their own lives by preying on the least fortunate on the planet, those so desperate that they will give up a kidney to feed their families.
Valentine's Day has just passed and many of us showed our love of others by giving a card, a gift, etc. Can we each do more? As the song goes.... (listen along by right clicking and opening in a new tab or window)
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving...
How to Become an Organ Donor
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