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I received a call. This was yest ...

Posted Nov 16 2009 10:03pm

I received a call. This was yesterday. Across the line, I hear a familiar voice tainted by her sobbing. Through those, I heard the message that made me shiver. ” My cousin, she is 20, had a fit and collapsed.” Being in the medical line herself, she continued,”She arrived to the hospital with a GCS(Glasgow Coma Scale) of 3, intubated her and done a CTscan which shows a huge bleed within the brain. The Neurosurgical doctor saw and said that they cannot salvage her.” Silence was my response. Then the advice came and she felt better. I informed my colleagues in that hospital to have a look on my behalf. Then, I realised, probably as being part of the Transplant Organ Procurement (TOP) team for Selayang, I had to impress upon this doctor of organ donation.

Lying there in the hospital is a 20 year old lady who is brain dead but otherwise healthy. She will not survive. Then the faces of those who are in need flashes across. The baby with biliary cirrhosis whose only hope is a healthy liver. Another young lady with young kids to care for but cannot because she will slowly succumb to her failed kidneys. Another man with a large dilated heart failing with every contractions. Nobody sees them, nobody talks about them. All the above will survive for long if they replace their dysfunctioning organs.

Lying there is a 20 year old lady, who for once in her life during her dying hours can make the biggest selfless contribution and save at least another. The commonly transplanted organs are kidneys, heart, liver, lungs and pancreas while the transplantable tissues are eyes, bones, skin and heart valves. Thus a single donor can save the lives of a number of people.

But even the doctors are hard to convince! Some are reluctant to talk or find it shamefull to talk about it. I myself occasionally have difficulties even after successfully convinced at least 2 families to proceed with donations. I am young at this, I agree but there is no awareness created and a sense of need to approach this issue more seriously. This is not a topic thought in medical school and during your early years as a doctor unless your superiors were keen for organ donation little is learned and far from understood.

Is it enough just to sympathize or sholuld you push for donations for your other patients in need when an opportunity comes in however painful it may be!!

Patient’s relative in the grief of the moment do not take to such topics well unless they have had friends or family who have encountered similar issue. Often, the doctor would be seen as unjust and uncaring. We are sorry for being so blunt some times. Communication therefore plays an important role. I am happy I managed to attend a course on this but does the other doctors get the same opportunity? The TOP team are thought on how to communicate, counsel and pick up the bad non verbal cues and cool down the situation quickly rather then get entangled.

Normally, once a patient has been identified, some test are done to confirm that there is irreversible brain death. The doctors involved in confirming brain death are not involved in the transplant procedure.

The issues that came about were initially of religious matter.
For the Buddhist
From the Buddhist point of view, the donation of organs after one�s death for the purpose of restoring the life of another human being clearly constitutes an act of charity - which forms the basis or foundation of a spiritual or religious way of life.

For the Muslims
The matter was discussed at the National Fatwa Committee meeting on June 23 and 24 in 1970. The committee, assisted by a panel of medical experts, made the decision to allow organ transplantation based on acceptable juridical principles.

For the Christians
The Christian Federation of Malaysia encourages all Christians to share Christ�s love with those who are in grave need of replacement for their dysfunctional organs. This should become an integral part of Christian education at home and in the church.

For the Hindus
a Hindu should do whatever is in his means, to eradicate sorrow and sufferings of others. To this end he may donate anything, including his organs, while living or at the time of death. If he can save the life of a patient by donating one of his organs.

The other is the ability of the family to say yes to their dying member of the family. For example, I have agreed for organ donation and sustain irreversible head injury, will my family members give consent on my behalf to proceed with the donation? Perhaps yes if I have clearly raised my views to them. What if I haven’t? Is holding a pledge card sufficient for family members to consent?

This is not a comfortable topic to talk about at home for most Asians. But talking about death should not be a taboo. Your wish once put forward makes it easier for beloved members of the family to act on your behalf. Is it fair to make others responsible for such a decision? So what would you do?

Some facts about over local scene:

Organ Transplant

The first organ transplant in Malaysia was a living related renal transplant that took place in Hospital Kuala Lumpur(HKL) on Dec 15th 1975. Since then a total of 1,005* renal transplants have been carried out in the country.
Heart transplant which is only carried out in Institut Jantung Negara(IJN) was first performed on Dec 18th 1997 and 15 heart transplantations have been done since then.
Liver transplant programme was started in 1995 at Subang Jaya Medical Centre(SJMC), and later in Selayang Hospital. To date, about 50 liver transplantations had been carried out with majority from living related donors to paediatric recipients.

*(Source:National Transplant Resource Centre, 30-11-2003)

Tissue Tansplant

Corneal transplants have been performed in Malaysia since the late sixties with a total of 1,231* reported cases.
Bone marrow transplant service was first started in University Hospital Kuala Lumpur for paediatric patients in 1987 and later for adults. This was followed by other centers in HKL (1994), Hospital University Kebangsaan Malaysia (HUKM) and SJMC. Up to November 2003, a total of 634* bone marrow transplantations had been performed, of which 372 were for paediatric and 262 for adult cases.
The first National Tissue Bank was set up in Hospital University Of Science Malaysia (HUSM), Kubang Kerian in 1991. The bank collects, processes, stores and provides tissues such as bone, skin, and amnion from both human and animal sources, to be used by surgeons nationwide as biomaterial or tissue grafts to replace diseased tissues. Total of 4,170 tissue grafts had been done until now. Bone banking services also started in HKL in 1993, a total of 483 grafts had been performed so far.

*(Source:National Transplant Resource Centre, 30-11-2003

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