INDIAN EXPERIENCE WITH SOCIAL, MORAL AND ETHICAL ISSUE

Starting with this issue, we present the first of the series of case study of real life situations. These case studies were discussed at the two workshops on” intensive care of brain death multi-organ donor” held at Chennai and organised by MOHAN Foundation. The discussion following the case studies is the summary of what the panel of doctors and the audience felt and their precept of the situations.

CASE STUDY- MONEY OR ORGAN EXCHANGE

A 40 year on two wheeler was brought to hospital with un protected head injury. On the spot GCS 12/15 rapidly progressed to 4/15 on arrival to casualty. Then emergency craniotomy failed to improve patient’s condition. On day 3, GCS was 2/15 with total absence of brainstem function on 2 examination 6 hours apart.

 Patient had a young wife; and son who was 8 years old. Wife was told about brain death. After some hesitation, grief counsellor talked to wife about possible organ donation. She first refused and subsequently agreed on her own accord. Preparations were made for retrieval surgery. However, 30 minutes before surgery wife demanded money in exchange of organs!

1. Is she justified in her demands?

1. Is this permissible under the THO act?

1. If she were persuaded that it is not right for her to take money, would you still proceed with retrieval surgery?

Summary of Discussion

Organ donation and money is a topic that has always evoked strong reactions and intense debates. Faced with the possibility that the potential organ donor’s young wife and family could be put to financial hardship, a section of the panellists felt that the wife’s demand was probably justified. Indirect incentives in the form of jobs for family members, free education by the government, tax breaks could be included in the THO act, it was suggested. However it was necessary to ensure that whatever incentive was offered did not lower the dignity of organ donation. Apparently, discussions are underway in UNOS, to include incentives for families of organ donors in the U S A, but they are still in the initial stages. But, it was made clear on all fronts that they should be no exchange of money. The THO act strictly prohibits any commercial dealings in organs.

A number of panellists, however felt that if a clause on indirect incentives was included in the THO act, it would defeat the primary purpose of the act and create a grey area. And creating this grey zone of rewarding a donor would amount to coercion of some kind since there would exist the lure of a reward. Donation has to be voluntary, free without any expectation of reward and should come with no strings attached. If, on the other hand, society decides to honour the donor and his family, that would be acceptable.

                                The panellists reiterated that if the THO act was modified to include a clause on rewarding organ donors, there would be a potential for misuse. As Dr Ram E Rajagopalan put it, “One does not have to prove a bias. It is enough to indicate the possibility of a bias”.

                                   It was firmly agreed upon that if a potential organ donor‘s family made a demand for money and even they retracted the demand at the later stage, organ retrieval should not be carried out. The cadaveric transplant programme is in its nascent stage in India and nothing should be done to jeopardise it. Organ donation should remain an absolutely altruistic act for that is what a donation is all about.

Editors Note

(Clinicians are invited to share their thoughts and experience with Indian problems in tackling with brain death situations in their institutions. This series of experiences are unique to India and will become a regular feature of Indian Transplant News Letter. You are invited to send your point of view to ITN Desk)

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