UNDER THE MICROSCOPE
Recently, I attended an HLA (Human Leucocyte Antigens) conference in connection with organ transplantation, both solid organ and stem cell. The common lament was that in the Philippines, very few deceased-donor organ donations are made.
In fact, it is declining and “dismally low,” according to NKTI Executive Director Dr. Rosemarie Liquete. From 227 in 2012, it plunged to 12 in 2020. Majority of transplanted solid organs, mainly kidneys, are from living donors. There is a thriving black market for paid organ donations, due again to prevailing poverty. The poor have to sell parts of their bodies (including blood, which is considered an organ, even if in a liquid state) to keep the rest of the body and soul together. Our laws prohibit such paid “donations,” but when a desperate patient with end-stage kidney failure is made to choose, he’d rather pay than face certain death or be miserable on dialysis for the rest of his life.
Every year, thousands of Filipinos develop kidney failure (21,000 in 2017 per the Philippine Renal Disease Registry). The numbers are increasing due to the prevalence of hypertension and diabetes.
The cost of dialysis is staggering for most. Some don’t respond well to this treatment and must have a transplant to survive. Quality of life and median survival (years of life after diagnosis) are better for transplant patients than for those on dialysis.
The problem is that family members of transplant patients can’t or won’t donate their own organs because of either a pre-existing disease or mainly their own fear of surgery; and so they would rather buy from others willing to part with their organs. The only solution is to procure organs from deceased donors.
Deceased-donor organ donation is being practiced worldwide. When patients suffer traumatic head injury, stroke, or brain aneurysm and are declared brain-dead, they become candidates as organ donors. The patient will be on mechanical life support to continuously supply oxygen to the organs. It is during this time that talk of organ donation can be initiated.
I myself have signified on my driver’s license application my intention to donate whatever organs are needed in case of my death. There are many organs that can be donated: kidneys (two), liver, lungs (two), heart, pancreas, intestines, eyes (corneas), bone, skin, other tissues, and recently hands and faces. Locally, only kidneys, liver, pancreas, and corneas are allowed by law. These are harvested after the patient is declared brain-dead although the other organs are still functioning and being maintained on life support.
The provision for organ donation on a driver’s license is legal and should be honored as the living will of the patient. However, families frequently oppose the donations, thus leading to wastage of the organs. Hospitals would rather bow to the will of the family than be engaged in legal battles if they harvest the organs on the strength of the donation provision on the driver’s license.
The reasons for rejecting the request for organ donations are many. Some say the patient has suffered enough and should be allowed to rest or be buried intact for their future resurrection. Others are not familiar with the concept of brain death. Many still hope that their patient will somehow be brought back to good health miraculously even in that irreversible state. But even if there is that remote possibility, how long should a brain-dead patient be on life support? And who pays for it?
Is religion really a reason not to donate? The Vatican has long encouraged organ donation as an act of charity, but majority of Filipinos still cling to outmoded beliefs about the body literally rising from the dead.
Today, many families are opting for cremation of their deceased rather than traditional burials. In cremation, the body is reduced to ashes in a short span of time. Traditional burials only prolong the process but eventually, the body decomposes and returns to dust.
It is, in fact, selfish of the family of the deceased not to donate the organs, especially if the person has indicated their intention to donate. It disrespects the will and the memory of the deceased to oppose the donation. What better way to remember your beloved than to know that parts of the person you love still live on in others, who will forever remember and appreciate the generosity of the donor.
REGALO (REnal Gift Allowing Life for Others) is a multi-stakeholder alliance advocating for organ donation and kidney transplantation. There are other organizations with similar advocacies, and there is a need to urgently band together and give organ donation a boost in the Philippines.
Truly, “from dust thou art, to dust thou shalt return” is a reality. Let’s save many from their suffering by not wasting precious organs. Donate them. Don’t bury or burn them!