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Implications of an organ bank for Jamaica

"This intriguing possibility of an organ bank in Jamaica has medical, moral, ethical, religious, cultural as well as legal considerations, in Jamaica's cultural context."

"Establishing a databank of organ and tissue donors and potential recipients, as well as a regulatory framework for this, is complex. In cultures where transplantation is commonplace, organs such as kidneys, hearts, livers and pancreases are regularly transplanted. Tissues such as corneas, bone marrow, bone and skin grafts, tendons, ligaments, heart valves, veins, cartilage, fascia, and pericardium (the covering of the heart) are also being transplanted.

Organ and tissue donations save lives or improve the quality of a person's life. The organ or tissue may be obtained from a recently deceased person and either transplanted directly into another person or medically stored for a period of time where its tissue viability is maintained until it is needed. At present, organs cannot be stored beyond, say an 18-hour period.

Issues such as the compatibility of the organ or tissue with the body of the recipient and the non-transmission of infection (for example, the hepatitis B virus) are important considerations in the process. In addition, a major social and moral difficulty of transplant surgery is that it is extremely expensive, and the shortage of donor organs has sometimes led to the commoditisation and sale of body parts.

Concept of death

In Jamaica, transplantation may prove challenging for many who consider death a simple and final event. But, to the health professional who harvests the organs, death is considered a process in which the brain dies before the tissues of the body.

This definition allows for the removal of vital organs while they are still viable, with the tissue still having the oxygen supply to sustain it until it is placed in another body. Terms such as brain death, cardio-respiratory or heart death, and persistent vegetative state, will, therefore, need to be discussed for the nation to understand the intricacies of establishing a sustainable organ-transplant system in Jamaica.

The concept of death has a long history that has been coloured by religious as well as metaphysical considerations. The traditional definition of death has been that of the non-beating heart. However, Jamaicans should be aware that it is now possible for a person to be brain dead and not be heart dead at the same time, due to the current existence of life-support machinery.

[Yet] [s]ome have argued (...) that the brain should not be considered the central integrative unit of the human being, and so a human being's death ought not to be identified with brain death.

The context in which the term is used becomes very relevant. Upper-brain death, whole-brain death, and cardiac death are not the same thing. In which of these stages, therefore, are we allowed to explant an organ from a person? The simple answer is that the so-called explantable window occurs during the period after one of the above events has occurred, but before death at the tissue or organ level occurs.

Access, justice and organ donation

The issue of fairness in the allocation of organs and the process to achieve this will be very important. Another issue is whether scarce medical resources, such as a liver transplant, should be denied an alcoholic who damages his or her liver, or a diabetic or hypertensive patient who does not take his medication. While this discussion will be particularly vexing, the issue should turn on whether the person's conduct was sufficiently voluntary.

Kidney transplantation was started at the Kingston Public Hospital during the 1970s, but an inadequacy of kidney donations eventually led to its discontinuation.

Tissue transplantation, such as corneas for the eye and bone for grafting, are currently being done in Jamaica, but these tissues are imported from tissue banks in North America.

Organs and tissue are precious and are potential life-savers, but their donation should occur because of altruism and benevolence and never with a profit motive. Therefore, public-awareness programmes about the potential life-saving benefits of organ transplantation, the need for organ donation, the concept of brain death and religious teachings related to these issues would all be essential if donations to an organ-transplantation programme are to be successful at this time.

The programme would need altruistic persons to consider donating their organs at the time of death to possibly save the life of a fellow Jamaican or give a person another try at a better quality of life. They would do so by way of a living will.

Would organs and tissue donated in Jamaica only be made available to persons residing here? Would persons be allowed to dictate the terms and conditions under which their organs would be used?

The exploratory work should begin in earnest."

Derrick Aaron, MD, PhD - Consultant Bioethicist/palliative care and family physician. Convenor and president of the Bioethics Society of the English-speaking Caribbean and a member of the International Advisory Board for Bioethics, Pan American Health Organization.
Derrick Aaron, Contributor


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