Musings on transfusion medicine: April 2016

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 blood. As 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

The number of tissues and organs that can be donated is large

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,

Organ, Tissue and Eye Donation (Most locales in the developed world have similar registries and opportunities to donate.)

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;

For some, religion plays a role:

Oliver M, Woywodt A, Ahmed A, Saif I. Organ Donation, Transplantation and Religion. Nephrol Dial Transplant 2010

Includes positions of many religions on organ donation and transplantation

Bramstedt KA. Transfusion contracts for Jehovah's Witnesses receiving organ transplants: ethical necessity or coercive pact? J Med Ethics. 2006 Apr; 32(4): 193-5.
Why don't more Muslims donate?

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:

10 body parts you can legally sell for big bucks (TheRichest.Com, 27 May 2015)

How much can you get for selling your body parts? (The Guardian, 31 Jan. 2014)

Some argue we should be able to sell organs, not just plasma, hair, etc.

Give a kidney, get a check. (The Atlantic, 27 Oct. 2015)

'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.

Illegal kidney trade booms as new organ is 'sold every hour' (The Guardian, 27 May 2012)

WHO estimates 10,000 black market operations involving human organs take place each year
Body organ 'medical tourism'

As well, there's another shady, hidden body organ market that seldom sees the light of day:

Human corpses harvested in multi-million dollar trade (Sydney Morning Herald, 17 July 2012)

A must read. Truly incredible!

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

Skin for burn victims; (2 min. video)
Corneas for blindness;
Lungs for cystic fibrosis (or idiopathic pulmonary fibrosis);
Kidneys for diabetes;
and many more conditions and diseases.

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.