Should people surrender their mortal remains?

[bilateralrope]

If society doesn't invest in maintaining those organs via socialized healthcare from start to finish, it has no claim at all to those organs once you die.

Do you think the government as a right to enforce traffic laws in jurisdictions where the roads are poorly maintained? Because that's the same logic you are using. The truth is, until such a time as organs can be mass produced out of a lab, medical science NEEDS these organs. As in, it isn't optional, it isn't a luxury, its a necessity. People's lives depend on it, often in a very immediate sense. I think you are glossing over this and treating it as if the government just wants a big warehouse of people's colons to auction off to the highest bidder.

The difference is that traffic laws are enforced by government. Under socialized healthcare, it's government taking the organs.

Without socialized healthcare it's private companies profiting from forcibly acquired organs. I do not like the idea of private companies being able to forcibly take anything from the public and then profit from it.

[PainRack]

The difference is that traffic laws are enforced by government. Under socialized healthcare, it's government taking the organs.

Without socialized healthcare it's private companies profiting from forcibly acquired organs. I do not like the idea of private companies being able to forcibly take anything from the public and then profit from it.

I......... huh?

Ok, the US ALREADY has organ donation protocols in place. Just how is it ethically wrong for a company to profit from the process of implanting the donated organ and preventing the person from dying? Unless they charge for supplying the ORGAN specifically......

Are blood banks thus ethically wrong for profiting from the fees involved in blood processing?(The blood donated in most countries is free. What isn't free is the processing, multiple countries allow the blood banks to have a small profit margin from the processing fees although for organisations like the Red Cross, they use the profits back into expanding operations since non profit.)



As for opt out opening the gates to a flood of dirty organs, that really depends on the medical system, doesn't it? In Singapore, the ammendent to HOTA as opt out actually didn't increase transplants made under HOTA, although organ transplants made under MTERA increased, resulting in a increase in organ transplants, presumably due to media publicity.
Granted, my data is more than 2 years old now so yeah.....

I'm more leery about salvaging the cadavers for any use afterwards........ Medical cadevars are short sure, but the taboo involved is just........

[Ziggy Stardust]

The difference is that traffic laws are enforced by government. Under socialized healthcare, it's government taking the organs.

I am going to be completely honest. I don't have the slightest idea what the point you are trying to make here is with reference to my analogy. What do these two sentences imply that refutes the point I had made? It feels like these two sentences were pulled from a completely unrelated discussion.

Without socialized healthcare it's private companies profiting from forcibly acquired organs. I do not like the idea of private companies being able to forcibly take anything from the public and then profit from it.

Where is all this forcibly acquired stuff coming from? We're not talking about people waking up in a bath-tub full of ice with a kidney shaped scar and a note saying, "Go fuck yourself. Love, Microsoft."

[Broomstick]

The "forcibly acquired" phrase is because, instead of what now happens where the family has ownership/responsibility of a corpse, the government will take said corpse and either strip it for parts and hand the remains back to the family, or else simply take the whole thing. Yes, there is some mention made of an "opt-out" but from the way it's worded it seems that's something you have to think of in advance, screw the family if it's, say, a young kid and they haven't gotten around to filing the paperwork yet. It was also phrased as a some sort of religious exemption but in reality a lot of people are seriously squicked due to cultural taboos, not religious ones.

The result is that, at least in some cultures and sub-cultures, you're going to generate an enormous amount of resentment and anger, and in some cases outright fear.

Once again we have someone proposing something entirely logical but neglecting the fact that most humans are highly emotional animals, not Vulcans.

[Oskuro]

We are emotional, but as the different burial rituals around the world indicate, we can get used to different/new ideas.

So the trick would be to apply such regulations gradually, and painting them in a positive light.

I'll agree here that privatizing the "corpse handling" industry would probably fail on both those accounts, as the private sector would push for quick profitability and not much care for public reaction beyond their immediate "customers".

We'd also probably get a Soylent Green remake, just cause.


As for birds eating corpses... Aren't "open sky" burials still being practised in Tibet or similar places? I think the rationale there was that the high mountains didn't really offer options for proper burial, so leaving the corpses to be consumed by the wildlife was more practical, and I'd bet the mythological significance grew from the practical considerations.

[Broomstick]

My familiarity with carrion-bird corpse disposal is mostly in India, where the corpses are put into "towers of silence" allowing the birds access but not other creatures.

Apparently, in the old days the birds used to consume the edible bits rapidly but since the diclofenac poisoning killed off something like 99%+ of the birds there aren't enough birds to eat all the dead. So the practice may end simply because there aren't enough healthy vultures left in India to do the job.

Other cultures have practiced "sky burial", but there's not the much information out there about it. The Tibetan exposure of the dead to birds and elements is usually called by that name as well in English. Like other cultures that practiced this method of disposal, though, the practice is disappearing. In no small part because surrounding cultures tend to favor burial or cremation rather than "feeding the birds", some variant of that phrase being a typical euphemism in the languages of those that practice it.

[PainRack]

I think these articles might be helpful regarding how public opinion would be shaped with an opt in procedure.

GRIEF-STRICKEN relatives of a brain-dead man on Tuesday begged that his organs not be taken - and then got into a tussle with hospital staff when their request was rejected.

They were praying for a miracle, hoping that Mr Sim Tee Hua, 43, would awake from his coma. But the crane operator was declared brain dead at 6.20pm on Monday - four days after he collapsed at work last Thursday. The cause of death a stroke, or brain haemorrhage.

When doctors at Singapore General Hospital (SGH) said on Monday that they were going to remove his organs, the family requested that they wait for 24 hours - and the doctors agreed.

After that time was up, the family asked for another 24 hours, but doctors felt that a delay would make the organs unusable for transplant and went ahead with the operation.

Under the Human Organ Transplant Act (Hota) amended in July 2004, kidneys, livers, hearts and corneas suitable for transplant can be removed from all Singaporeans and permanent residents upon their death - unless they have opted out. Muslims are exempted because of religious reasons.

Mr Sim had not opted out of the programme, so his family was powerless to stop his organs from being removed. But they tried their best.

Lianhe Wanbao reported that around 20 members of Mr Sim's family intervened when his body was being wheeled into the operating theatre at about 10.15pm on Tuesday. His mother and five other relatives went down on their knees to beg doctors to delay the operation for one more day.

But when their request was denied, emotions ran high and the police were called. An aunt tried to bite a police officer in the arm. Nine police officers and about 10 hospital security staff members were involved in the three-hour confrontation before the matter was resolved peacefully and doctors performed the operation.

Mr Sim's sister, Ms Shen Qiu Xia, 45, told Lianhe Wanbao 'We were actually prepared to accept that he was dead if his condition did not get better by Wednesday night. 'Although he was brain-dead, his body was still warm and my mother said that she felt he would awake from the coma.' She added that he had no previous major illnesses and that he had planned to marry a girlfriend in her 30s from China's Hainan island.

A Health Ministry spokesman told The Straits Times yesterday 'Where possible, doctors will accommodate a family's request for a grace period as death is usually a difficult time for them. However, the transplant team will have to balance this with the need to save the lives of organ failure patients.'

Brain death is defined as a complete and irreversible cessation of brain activity. When this happens, a person can be declared dead even if the heart continues to beat due to life support measures.

The kidneys taken from Mr Sim's body were given to two patients. One, a 55-year-old man, was on the transplant waiting list for about six years. The other is a 49-year-old man who had been waiting for almost eight years. Mr Sim's corneas will be transplanted in the next few days.

Largely due to the amendments to Hota, the number of patients awaiting a kidney transplant dropped from 673 in 2003 to 605 in mid-2006. In the two years to July 2006, at least 130 people have received transplants under the revised Act.

Anyone who does not want his organs to be taken after his death can register with the Ministry of Health. The opt-out form can be obtained from all public hospitals and polyclinics or from the Organ Donor Registry at SGH.

Tracy Sua
The Straits Times
8 Feb 2007

SGH could have handled removal of organs better


READING the article, 'Brain-dead man's kin in scuffle over op to remove organs' (ST, Feb , the Singapore General Hospital came across as rather unfeeling in its handling of the situation.

The man's mother and five relatives kneeled and begged the doctors not to remove his kidneys and corneas, to no avail. His family was not convinced that he was really dead as his body was still warm.

Yes, the hospital was carrying out the procedure under the Human Organ Transplant Act (Hota) but, surely, the matter could have been handled better.

On one hand there is this family reeling from shock over the death of a loved one and, on the other hand, there is the law, in the form of surgeons and nurses bent on removing all his useable parts. Where is the compassion and humanity that are so clearly lacking?

Many people are still unaware that their organs can be taken away from them unless they opt out. To avoid such heartrending confrontations. I suggest that the Ministry of Health educates Singaporeans and permanent residents that unless they opt out, under Hota their organs will be removed once they are considered brain dead.

The ministry should also make opt-out forms more readily available - and also available online - so that people do not have to go hunting for this vital form in clinics and hospitals.

Dr Lim Boon Hee
Straits Times Forum
10 Feb 2007

Tussle shows need to educate the public on Hota


THE report, 'Brain-dead man's kin in scuffle over op to remove organs' (ST, Feb , shows clearly that there is much to be done to educate the public on the Human Organ Transplant Act (Hota), as amended in July 2004.

The public must be made aware that kidneys, livers, hearts and corneas suitable for transplant can be removed from all Singaporeans and permanent residents upon their death as defined by the Act - unless they have opted out. Hospitals and polyclinics should be in the forefront, explaining to patients Hota whenever the opportunity to do so arises. The various community institutions can also help in educating the public at the grassroots level.

This will prevent the tussle the relatives of Mr Sim Tee Hua had with the hospital staff because they would have known that Hota will kick in in such circumstances and would also be aware of the window of time needed for transplants.

Alternatively, hospitals can, whenever they anticipate the possibility of enforcing Hota, pre-empt any outburst by making the patient's relatives aware that the organs will be removed upon confirmation of brain death. This must be done with the utmost sensitivity.

Harry Chia Kim Seng
Straits Times Forum
10 Feb 2007

What about a grace period to clarify whether a deceased person has opted out of Hota?


I refer to the report, 'Brain-dead man's kin in scuffle over op to remove organs' (ST, Feb . The Human Organ Transplant Act (Hota) empowers the health authorities to remove the organs if the deceased had not opted out.

While the Ministry of Health regularly reminds the public of Hota and the opt-out procedure, what happens when the person suddenly dies and it is not known by his family members if he had opted out of the programme? In this situation, who can confirm the intent of the deceased? Should not the family of the deceased have a say as well?

This incident is not a case of pitting the interests of the living potential beneficiaries against a dead person who no longer has any need for organs.

Instead, it raises the ethical issue of the potentially conflicting duties of the health authorities to one group of the living (potential beneficiaries of the deceased's organs) and another (the next-of-kin of the deceased).

Hota came about to meet the urgent needs of organ-failure patients so that they can have a chance to live. However, the health authorities also have a duty to the living who survive a person who has suddenly died.

Can there be a better balance in meeting the needs of the two groups through a stipulated grace period that allows clarification in the absence of clear intent?

Harry Chia Kim Seng
Straits Times Forum
10 Feb 2007

Compromises needed in organ-trading dilemma


THE on-going debate on organ trading appears to be a tussle between those like Prof Lee Wei Ling who espouse the utilitarian view and those whose arguments dwell more on the emotional aspects.

While we think that our views on right or wrong are rational, more often than not they are based on emotional responses. The decisions we make will be coloured by shades of both cold rationality and raw emotions; different decisions are made based on where we as individuals lie on the continuum between these two extremes.

The tug-of-war between utilitarianism and emotions can be illustrated in a hypothetical case study: Suppose a trolley is rolling down a track towards five people who will die unless you pull a lever that diverts it onto another track - where, unfortunately, lies one person who will die instead. The choice would be easy in this case: utilitarianism - minimising loss of life - is the right thing to do. But, what if the person standing on the other track is a loved one, like your husband or wife? We would be faced with a great dilemma as emotional aspects cloud the picture.

Our behavioural impulses have been shaped by millennia of evolution, beginning with our origins in hostile, 'survival-of -the-fittest' hunter-gatherer environments where our genes have evolved to predispose us to favour our kith and kin in order to ensure our survival. Should we therefore continue to obey the moral impulses that evolved to serve what zoologist Richard Dawkins calls the 'selfish gene'?

Say, if you were given a sum of money to spend on either keeping your 90-year-old father on life support or saving 10 starving African babies, which would you choose?

Or, in our local context, the family of the brain-dead Sim Tee Hua ('Brain-dead man's kin in scuffle over op to remove organs'; ST, Feb resisted the harvesting of his organs even though they could benefit many strangers.

In the emotionally-charged debate on organ trading, we will always have dissenters and supporters who are motivated by the opposing forces of utilitarianism and visceral emotion. To come to a decision accepted by both sides will entail compromises in the weighing of the costs and benefits of the eventual decision.

Maria Loh Mun Foong
Straits Times Forum
10 Feb 2007


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Organ donation: Treat family members with sensitivity


I COULD NOT agree more with Mr Anthony Yeo in his letter 'Knowing how to handle trauma is important' (ST Forum, Feb 14). In his letter, he rightly stressed the need for medical staff to be better trained in handling procedures leading to the removal of organs from the dead as prescribed by law.

I was one of the unfortunate kin on the other side and I thought this letter can help hospital authorities understand people like us better, although it is very painful reopening our emotional wounds.

I lost my youngest son, aged 16, seven years ago in Perth. It was sudden due to complications arising from bleeding in his brain. When he was declared brain dead, the hospital assigned an Asian social worker to help us cope emotionally. Way before the reality sunk in, we were asked for consent to donate his organs as there was no such law in Australia.

While the ventilator was keeping my son's body alive, there were repeated requests but I turned them all down.

I am not the selfish type. What hindered my decision was the way one of the doctors treated my son (after he was declared dead) - he was treated like a slab of meat!

Even the interns gave me sympathetic looks over that doctor's shoulder. It was much later that I realised this doctor was handling the matter like a normal routine, hoping to get us to face the reality and just let go.

But by the way it was articulated, I almost threw a punch at the doctor's nose.

We never agreed to donate but authorised the hospital to shut down the apparatus and let my son go peacefully three days later. It was done only after repeated question and answer sessions were conducted (with subsequent test reports) between my family and the medical staff. I felt this procedure should have been necessary from the time of prognosis and not later.

While still grieving weeks later, my eldest son and I regretted not having donated our beloved brother and son's organs that would have saved lives. We concluded that had the doctor been more polite and empathetic, we would have consented under the circumstances. But I am not implying that all medical staff behave in the same manner.

While death is a common phenomenon in a hospital and medical staff may be emotionally better prepared, having seen so many lives go in their job, it is something that does not happen as often to us, the lay people.

By the way, the nurse who looked after my son in the intensive care unit broke down and was sent home - she had a brother of the same age as my son.

I hope that while the hospital authorities may think that they have a right to remove organs under the law, they should observe the simple courtesy of asking politely and in the most sensitive manner. It is a difficult task, but it has to be done humanely.

Hwang Liang Keng
Straits Times Forum
22 Feb 2007

Reply from MOH and SGH
Medical team maintained constant contact with kin


WE REFER to all the Forum letters and reports in The Straits Times on the late Mr Sim Tee Hua's organ donation.

We would like to express our regret at the unfortunate incident and the trauma the family went through.

To our nurses, surgeons, anaesthetists and intensivists who have chosen the difficult and challenging career of saving lives, every life is precious. To all patients and their families, they give the same level of commitment and compassion.

Families on the verge of losing a loved one go through emotions of deep grief, a sense of desperation and yet hope for a miracle. This is especially so when the death is untimely and the patient young and seemingly healthy.

Naturally, effort is made to extend counselling and comfort to the family. We understand that the consolation of being able to save other lives through organ donation does not assuage the loss for these families.

We fully sympathise with the shock and pain the family of Mr Sim went through. Our medical team had maintained constant communication with his family from the time his condition worsened on Feb 3, two days after he was hospitalised for the sudden illness.

The team also informed the family about his poor prognosis, and pending the results of tests for brain death, the possibility of organ donation under the Human Organ Transplant Act (Hota).

When his condition deteriorated further, the transplant coordinators from the Ministry of Health's National Organ Transplant Unit (Notu) met the family and explained again the implications of brain death and the organ donation process. The family acknowledged and accepted the information.

In every organ donation situation, the process is extremely time-sensitive. Beyond a certain period, after brain death, organs may no longer be suitable, and the opportunity to save patients with organ failure lost.

In Mr Sim's case, the Notu transplant coordinators readily acceded to the first request to postpone the procedure for 24 hours, after brain death. However, subsequent postponement would have jeopardised the organ recipients' chances.

The Notu transplant coordinators and hospital staff who were directly involved with caring for Mr Sim were deeply affected by this unfortunate incident as they had been torn between empathising with the emotions of his inconsolable family and the need to save organ-failure patients.

Nonetheless, both MOH and SGH will continue to find practical solutions to minimise the emotional distress of families and staff in such situations.

Dr Arthur Chern
Director (Integrated Health Services)
Ministry of Health

Professor Ng Han Seong
Chairman, Medical Board
Singapore General Hospital

Strait Times Forum
23 Feb 2007


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http://www.geraldtan.com/medaffairs/hota.html

Postponement killed dreams of liver transplant patients
The price of delay


LIVER patients, awaiting a transplant, had been put on stand-by when crane operator Sim Tee Hua was pronounced brain-dead by Singapore General Hospital (SGH) staff on Feb 5.

Hoping against hope that he would recover, his family asked hospital staff to postpone harvesting his organs for 24 hours. The doctors agreed, but the delay came at a price, Health Minister Khaw Boon Wan told Parliament yesterday.

By the time the doctors looked at harvesting Mr Sim's organs on Feb 6 — in spite of a ruckus created by his family members — his liver had become unsuitable for transplant. The Health Ministry had to turn away expectant recipients. His kidneys and corneas however, could still be used. Mr Sim's organs were removed under the Human Organ Transplant Act (Hota).

While Mr Khaw empathised with what the man's family members were going through, he stressed that the wishes of the dead should also be respected.

Mr Khaw said: "The donor was around 21 or 22 when Hota was introduced in this House. I remember there was widespread public debate. He was an educated man. I'm sure he was fully aware of Hota and the fact that if he did not opt out, that would mean he wanted to save lives in the event of a sudden death. So we should respect his wishes."

Enacted in 1987, Hota allows for the mandatory removal of kidneys if a person dies in an accident — unless the person has specifically opted out. The scheme covers all Singaporeans and Permanent Residents who are not Muslims.

The Act was revised in 2004 to include the harvesting of livers, hearts and corneas and expanded to cover non-accidental deaths. From 1987 till mid-2004, there were some 13 patients a year receiving kidney donations — compared to five a year before that. Since Hota's amendment in 2004, some 41 kidney patients a year benefited from cadaveric transplants. In addition, 94 have received corneas, 11 got livers and 10 have benefited from heart transplants.

Despite this, there is a shortage of organs. At the beginning of last month, there were 541 patients on the waiting list for kidney, 10 for liver, two for lung and one for heart.

"Each year, some patients die while waiting for an organ," said Mr Khaw. While most families are understanding about organ donation, some become abusive.

"We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," he said.

"People have a choice to opt out and if they don't, we assume that they must have no objections that upon sudden death, the organs can be used to save lives."

If everybody opted out, it would become harder to save lives, he added. And if someone is firm on opting out of Hota, the Health Ministry would respect that decision.

He urges Singaporeans to look on organ donation upon death in a positive way. "Upon death, the whole body is useless but you can still perform a useful role to save a few lives," he added.

Asked by MP Lim Wee Kiak if more could be done to educate the public about Hota, Mr Khaw said: "You have to explain it in a recurring manner, almost like a Celebrate Organ Donation day per year… Yes, we'll do so. But our communication experts advise us that this is not the time to start. Let the emotions calm down a little bit but definitely we have to do it regularly."

Tan Hui Leng
TODAYonline
01 Mar 2007

Singapore's compulsory organ transplants


As Sim Tee Hua lay on life support in a Singapore hospital, seven of his relatives knelt crying on the floor before the doctors, begging them not to remove his organs and give him a chance for a miracle recovery.

Their desperate pleas were to no avail and after police and hospital security staff were called in to restrain them, Mr Sim, 43, was rolled away to the operating theatre to expire.

"The hospital staff were running as they wheeled him out of the back door of the room," said Sim Chew Hiah, one of his sisters. "They were behaving like robbers."

The previously healthy lorry driver was already brain-dead after suffering a stroke at work, followed by a cerebral haemorrhage in Singapore General Hospital. The harvesting surgeons had waited for 24 hours, but although his family still clung to hopes that he could recover, Singaporean law assumes all citizens except Muslims are willing organ donors unless they have explicitly opted out.

As a way to tackle the perennial shortage of organs that all developed societies face it has proved effective - kidney transplant rates have tripled since the measure was brought in - but it is also a policy that exemplifies the authorities' paternalistic attitude towards the people.

Nonetheless the spectacle of a distraught family abasing themselves in a futile attempt to win an extra day's grace for their son and brother has triggered a rare debate in the city-state, with the letters pages of its newspapers filled with comments for and against.

"Tears would roll down from his eyes when we spoke to him, telling him not to give up," Mr Sim's brother Tee Yong, 49, told the New Paper. "We know that medically a brain-dead person cannot wake up. But we did not want to give up hope. All we asked for is just one more day for a miracle to happen."

Justine Burley, a bio-ethicist at the National University of Singapore, said the opt-out policy on donation was "fundamentally a good idea" but allowances had to be made on a case-by-case basis and relatives' mental trauma taken into consideration. "The spectre of family members down on their knees begging the doctors is almost too much to bear from a human standpoint," she said.

Singapore's media generally follow the government line, and the Today newspaper yesterday implicitly rebuked the relatives, referring to the harvest taking place "in spite of a ruckus created by his family members".

In an article headlined: "Postponement killed dreams of liver transplant patients" it quoted the health minister Khaw Boon Wan telling parliament that the single 24-hour delay they had been granted rendered Mr Sim's liver unusable, although his kidneys and corneas had been transplanted.

"We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," he said. "People have a choice to opt out and if they don't, we assume that they must have no objections."

Economically Singapore is a huge success, and Lee Wei Ling, a doctor and the daughter of the country's founding father Lee Kuan Yew, called for the buying and selling of organs to be legalised.

"Organ trading is frowned upon and usually not allowed in countries where political correctness reigns," she wrote. "If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?" Her suggestion was described as "wrong" by Alastair Campbell, the Chen Su Lan professor of medical ethics at the National University of Singapore, because of the "inevitable exploitation that would be involved".

"The sellers are always going to be the desperate poor," he said, adding that "to trade the human body as some sort of material possession like a car or house" was crossing an unacceptable line.

Mr Sim's parents have been offered reduced hospital fees for five years, and the family have been sent a letter thanking them for their "generous organ donation".

Sebastien Berger
telegraph.co.uk
3 Mar 07

I always wondererd whether the above incident prompted the modification to HOTA, which allowed for monetary benefits for donees, albeit, targeted mostly at living donees rather than cadaveric.

[Oskuro]

I wonder... Did the man not opt-out due to ignorance, or because he wanted to have his organs harvested? I'll assume the later for my following musings.

As has been debated on the thread about whether the baby of a brain-dead pregnant woman should be saved despite the woman's pre-death wishes.... This is a somewhat complex subject.

On one hand, the dead person is no longer there so its wishes shouldn't really take that much precedence... On the other hand, in this particular case this person has, in essence, given his corpse to the government for harvesting before death, so the body no longer "belongs" to the family, so to speak.

I understand the grief the family is feeling, though, and how they were holding out hope for a miraculous recovery. Not an easy place to be.

[PainRack]

Realistically? We don't know. The man probably didn't have any firm opinion on it either way.
There's actually a blog report that the relative insisted that the man wouldn't have wanted to donate his organs but due to the failure to opt out, implied consent kicked in. *Shrugs*.... A blog, reporting on a distraught relative input isn't credible and honestly wouldn't change any legal considerations anyway.

I can't recall whether its the same patient, but there is also a similar blog report on how one oversea relative wasn't able to arrive in time to pay their last respect before termination of life support............ Something that's honestly really kicks you in the gut.

The idea of the loss of control is significant to any family whenever the topic of cadeveric organ donation is brought up, its not just about wasting your organs, its also about the prospect of not controlling the time of your death and any closure that's required.

Note: We haven't even talked about Lazarasus sign. There's a reason why donors are sedated in the OT when the organs are harvested. Ignoring the complex movement above, the bodies do react to pain during harvesting.

Its kinda scary when you think about it.