Monday, February 11, 2008
In my local newspaper there was recently a letter to the editor, the gist of which was that people who indicate they'd be an organ donor (we have a place on our driver's license to do so) ought to go to the head of the waiting list were they ever to need one; and conversely, those that don't so indicate go to the back of the line. It would, he said, go a long way toward solving the shortage of available organs. And so it might.
It's been many years since I was involved in a very busy transplant program. Way back then, there were, in some localities, committees set up to decide the relative worthiness of potential recipients. Doctors, nurses, social workers, clergy, lay people met to hash it out, to prioritize recipients of those scarce bits of flesh based on highly subjective considerations of people's relative value. To someone. Far as I know, such deliberations no longer occur. The ideal, of course, is that one's place on the list is determined only by medical need and appropriateness, and the urgency thereof (Mickey Mantle and other celebrities notwithstanding.) The letter writer's suggestion, it seems to me, is a step backward. I've indicated that I'm a donor; if I were given an option, I wouldn't specify that it should only go to another person so inclined, nor would I want it to be legislated that way. And, I'm pretty sure, I wouldn't place a lesser value on the life of a person who, for reasons unknown to me, chose not to be a donor.
Such were my thoughts as I read the letter, and I was surprised to see that it came from a person who identified himself as executive director of an organization involved in promoting organ donation. Surely it's a worthy goal to increase organ donation among the population. (We're talking about post-mortem donation here; living donors are self-directed, as they should be.) As it now stands, there's no self-interest in checking that box -- other than feeling good about oneself, and, of course, the hope that it might cancel out a life of dissolution and get one a ticket to heaven.
I'm not certain about this. The letter writer is more involved than I am. Maybe it's a smart idea, especially as society becomes more self-centered and less generous. Maybe "what's in it for me?" ought to be the motivator, as it is in so much else. Could such a system be gamed? After all, most people who indicate their willingness don't end up being a donor. And, I wonder, how many cadaver donors come from that checked box, without input from family? Conversely, how many potential donors are "wasted" (if that's a proper term) because of a lack of advanced directive? In my experience the decision is generally made at the time of disaster, by the family, regardless of prior indications. These questions are part of why I'm uncertain. The rest, I guess, is philosophical. Tenuous territory for a surgeon.
For the time being, organ donation is a gift with no strings; an act of generosity and grace and, often, a way forward for the bereaved. (I refer the reader to a post of mine from a while ago.) The better part of me (that vanishingly small nut-like nubbin, ever more withered and battered) says it ought to stay that way. The pragmatist and cynical (ever growing, especially that last part) says, given what we are become, maybe the guy is onto something.