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Giving the gift of life

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Archives / 2007 / May

 

 

Giving the gift of life

David A. Becker
David A. Becker, M.Div., served most recently as a hospital chaplain in Fort Worth, Texas, United States. He is currently living in Pueblo, Colorado, United States.

 

Organ and tissue donors give genuine hope to people in their time of greatest need. As a hospital chaplain, I witnessed how human life hinges on the stewardship of the heart. Most religious organizations encourage organ and tissue donation and transplantation. Seventh-day Adventists, for example, support the best transplant research facilities, including Loma Linda University Children’s Hospital in California, that specialize in pediatric heart transplantation and cutting-edge technology in xenotransplantation (animal-to-human organ transplants).1

The demand for usable organs for transplantation always exceeds the supply. During 2006, for example, 22,000 people in the United States received transplanted organs, and 11,200 individuals were organ donors. Near the start of 2007, more than 94,800 people remained on the waiting list for organ transplants in the United States. Most of those people died before an organ became available. You can get the up-to-the-minute count of people waiting for transplants at http://www.unos.org. 2

Whether transplant surgeons procure organs from matching living donors or the donation of human organs arrives from a healthy human being who died, donation is an act of grace. The decision to give without reward—for the health and well-being of another person—is the essence of the Christian faith. It expresses our Christian calling to love one another.

The United States is one of the few nations in the world that legislates and funds a network to identify potential organs upon the death of an individual. The National Organ Transplant Act requires that, immediately upon death of any patient, a member of the hospital staff must call the area organ procurement organization (OPO). Within ten minutes the OPO representative calls back and notifies the hospital which organs or tissues may be eligible for transplant.3 If the deceased gave informed consent or explicit written instructions (“opting-in”), the hospital harvests the deceased’s organs or tissues immediately.

Often, however, family members override the decision of the deceased. Fewer than two families in ten choose to donate loved-ones’ organs and tissue. Many people sign the back of their driver’s licenses, preprinted in most states as organ donor cards. However, few of these people actually donate because medical personnel do not receive consent documents at the time of death.

Therefore, it is incumbent upon the donor to inform family members of their explicit wishes to donate tissue and organs. Give family members written copies of wishes because first responders in hospitals very often request organ donation directions from the next of kin. According to the Mayo Foundation for Medical Education and Research, “If your family doesn’t know you want to be a donor, [the family] may not allow the donation, even if your driver’s license identifies you as a donor.”4

In 2000, when a raging tornado sliced through downtown Fort Worth, Texas, falling debris killed a healthy nineteen-year-old man. His family agreed to donate whatever organs and tissues that the area OPO needed. The OPO determined that he was healthy enough to donate lungs, corneas, skin, pancreas, bones, and veins.

Within 36 hours of his death, doctors transplanted his lungs into the chest of a young woman suffering from cystic fibrosis. His corneas immediately allowed two youngsters to see for the very first time. Surgeons transplanted his pancreas into a diabetic and his veins into the legs of an elderly man who needed restorative blood fl ow for circulation. Hospital technicians carefully preserved and stored the valuable bone marrow. Within weeks, it extended the life of a young father with leukemia. Plastic surgeons in a hospital across the state made skin allografts on burn patients and then stored bones, tendons, and cartilage for use in reconstructive surgery. This young man’s death created an abundance of life for many others.

Decisions concerning organ and tissue transplants force people of diverse cultures, traditions, beliefs, and religions to discuss and codify standards for regulating transplant decisions. This requires making ethical and legal choices about the procurement and distribution of human organs and tissues long before a medical crisis occurs.

The sheer number of people seeking these medical procedures increases each year. Every hospital establishes litmus tests for surgery. Societal ethicists guide congregants about good judgment and common sense concerning decisions regarding transplant programs.

Every person has the same opportunity to have a transplant, regardless of age, sex, wealth, or any other factor. Medical bioethics and international felony law prohibit and penalize anyone who traffics in human organs. It is illegal to donate an organ for profit and illegal for a healthcare worker to knowingly participate in the transplant of an organ procured through a commercial transaction.5

The National Organ Transplant Act provides a network of medical schools and screened suppliers who furnish organs for transplant. An independent Internet broker (http://www.matchingdonor.com) brings together willing donors with desperate recipients. This upsets the establishment. Dr. Douglas W. Hanto, head of the ethics committee of the American Society of Transplant Surgeons, said that the practice of “brokering” undermines the trust in the procurement system set up by established hospitals.6 The possibility exists that a person desperate for a transplant might select a diseased organ over impending death.

Most donors matched with a recipient through matchingdonor.com desire no compensation, but there are exceptions. An inmate in a Kentucky prison offered a kidney for $900,000. The inmate estimated that her only risk in offering an organ for sale in violation of the law was felony arrest and a prison sentence.7

The second part of the ethics litmus test concerns the care of living transplant donors. In 2001, the number of living donors outnumbered deceased donors in the United States for the first time.8 No longer did people have to wait for someone to die to obtain a transplant.

Bioethicists believe that donations from living people must be accomplished using a routine to “minimize the physical, psychological and social risk to the donor and not undermine the confidence and credibility of the transplant program.” Decisions should be “autonomous but informed” because the risks are “small but not inconsiderable.”9

Third, and the most important piece of the ethics foundation in organ and tissue transplants, is security and traceability. Every transplant alliance requires a quality control program that includes “registration, identification, monitoring, coding and biosurveillance” of every step of the process from the donor to the recipient. 10

Pastors encourage congregants to think about organ and tissue donations as part of a healing ministry. Planting the seeds for discussion as a component of Christian education or in sermons gives people permission to discuss the topic openly rather than when they are under duress.

Pastors draw from Scriptures lessons on death, faith, justice, proclamation, charity, self-sacrificing service, and compassion. Some pastors talk about organ donations at the funerals of a donor or during Easter when we celebrate new life through Christ.

Most decisions on transplants come at the last moment. When a person dies, it is often too late. There is such a narrow window of opportunity to successfully harvest an organ, prepare a recipient for surgery, and complete the transplant. In the case of corneas that will assist blind children to regain sight, the transplant teams take them immediately from the donor on the hospital bed or emergency room gurney. When congregants call the pastor at the last minute to help them make an important decision, little time remains to discuss the issue. Pastors have time to pray and ask for God’s guidance but must think ahead so they anticipate the congregant’s queries about whether or not it is appropriate to donate.11

Saying “no” to a request for a donor organ is always an acceptable answer when someone in the hospital asks the next of kin to donate an organ or body tissue from the deceased. No additional explanation becomes necessary.

Requests for organs and tissue come as a difficult choice for a grieving family. The next of kin often cannot donate the organs from their loved ones after just facing the trauma of death. During times of grief, family dysfunction peaks with some families. Perhaps some members of the family favor organ donation while others oppose it. Most transplant surgeons prefer a consensus before they harvest organs.

Appropriate pastoral intervention works wonders to calm this issue in a time of high stress. Grief fills the hearts of staff members when a patient dies. They remove a heart or liver, for example, with respect for that dead human being. They take great care to treat the organs gently so as not to damage them. In turn, families can hold open casket funerals with no fear of scars where the hospital staff removed organs.

As a chaplain in a children’s hospital, I witnessed both death and the glory of new life. A little after midnight, I lifted a young baby into his mother’s arms as doctors prepared to remove him from life support. The grief that filled that room was overwhelming. Human initiative could not heal the catastrophic physical injuries this child sustained. The baby’s parents agreed to donate his organs and tissues to help another child live.

About four-thirty in the morning, the intensive care nursing supervisor summoned me to talk with a family whose ten-month-old girl was about to receive a donor heart. I found a single mother in her late teens who spoke no English. Her language was Spanish, and I speak only English.

This mom was not alone. A Spanish-speaking aide came from the operating room to stay with the family until the baby went into surgery, so he translated my queries to the mother.

“Do you want the chaplain to pray for the baby?” asked the aide.

The frightened mother saw the medical technicians searching for a place to place the intravenous tube. I asked the mother if it would help to pray the Lord’s Prayer. The translator spoke to her and she nodded.

“Our Father in heaven,” I began.

I could do little more as chaplain. An entourage of people entered the operating room. As the door shut, the mom turned and wept on my shoulder.

My time serving as a chaplain for that day ended and I went home to sleep. I read the obituary of the child who died in the weekend paper. In some ways, the dead child lived on.

The child who received the heart is doing fine with checkups three times a week to monitor for any signs of rejection. Improving immunosuppressive drugs and divine intervention gave this child many more days to live.

I witnessed the “resurrection” of the baby who received the new heart. Her life was close to being snuffed out by disease until another baby gave new life.

That’s why I believe in organ donations.

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