Maltese doctors wary of making organ donation mandatory

This emerges from a study published in the Malta Medical Journal by psychologist Mary Anne Lauri and Prof. Joseph Zarb Adami on doctors’ attitudes towards organ donation.

At present organs can only be retrieved from a dead body only if permission from the family of the deceased is given. Even the presence of a donor card signed by the deceased does not give doctors an automatic right to remove organs from the body.

But countries like Spain, Italy and Belgium have introduced an “opt-out” system through which the only way to prevent the donation of organs is through a declaration made by the deceased when alive, stating his or her wish not to donate organs.

The law in these countries requires doctors to take organs from the dead body if they can be used for transplantation purposes even if they do not have the permission of the family. 

Spain, which has a mandatory organ donation system, also has the highest rate of donated organs in Europe, followed by Belgium and France who have similar legislation.

But despite the clear advantages of this system in increasing the supply of organs, the five Maltese doctors cited in the study are wary of the implications of introducing a similar system in Malta.

Although they favour an opt-out policy, they feel it could create problems and that it should be postponed to a later date when people are in a better position to understand such a system.

Doctors interviewed in the study explained the difficult context in which family members are asked to donate organs. When brain death is confirmed, the family of the person is approached and told their family member is dead. Some families do not understand the notion of brain death and that a family member, who is apparently still alive and with his or her heart beating, is in fact dead. This could lead some relatives to refuse to donate organs.

One of the doctors referred to the case of a nun, who was the dead man’s niece, objecting to the donation of his organs. “She entered the room and said, he is still alive, look at him, feel him, he’s still warm. I explained what it is. But these problems can and do arise.”

The doctors argued that if opting-out is in place, it would be very difficult for most of the doctors to remove organs without informing the relatives and to some extent getting their cooperation. If the relatives object, a very uncomfortable situation would arise.

“When I attended meetings with Spanish and Italian colleagues, who have the opt-out system, they claim that it is still socially necessary to inform relatives and ask for consent,” one of the doctors participating in the study said.

Although many families refuse to donate organs when asked, refusals are likely to be higher when the potential donor is a child.

The doctors also pointed out that introducing the opt-out system would remove the element of altruism from the act of donating organs.

“If we wish to keep having high standards, then we need to accept altruism as part of our health care…We need to be ready to help others. And donating kidneys is one such way.”

High donor rate

Another reason why doctors do not feel the urgency to change the law in Malta to make organ donation mandatory is that they report a low rate of refusal by relatives of deceased persons.

But since doctors are not requested to record the number of refusals, there is no way of knowing how many families refuse to donate. In an earlier study, doctors and medical professionals concurred that the number of families who refuse to donate is low. According to the study the rate of organ donation in Malta is higher than the EU average of 17.8 per million population.

But in spite of the fact that the number of transplants has steadily increased over the years, the problem of organ shortage is still present. In fact 75 patients were on the waiting list for kidney transplants in 2009.

According to the research carried out by the European Commission,the Maltese are more likely to have discussed organ donation with their families when still alive than other European. While 42% of Europeans have discussed this issue, 44% of the Maltese have done so.

“Doctors find that a number of potential donors had, during their life-time, signed a consent form for donation and whilst doing this they had informed their family of their strong views in favour of donation. A signed donor card helps families reach a favourable decision”, another doctor said.

The doctors interviewed in the study disagreed on whether the donors and the recipients should remain anonymous.  Some doctors believe that it can be therapeutic for both the donor family and the recipient to get to know each other.  But others think that anonymity is better.

“If a transplant goes wrong, there is a tendency for the family of the recipient or the recipient himself or herself, to blame the donor for possibly leading a risky life.”