“When it comes to organ donation, there is an urgent need to address the gap between supply and demand,” said Dr. Huang Shu-chien July 29. A pediatric cardiologist based at Taipei’s National Taiwan University Hospital, Huang said organ donation and transplants raise controversial questions with respect to medicine, morality, ethics and religion.
At present, the law in Taiwan does not allow organ donors to indicate their donor status on health cards. Irrespective, the Bureau of National Health Insurance enters organ donor intent on the cards of those who have already completed donation forms. But if the Legislature passes the proposed revisions, organ donors will now be able to legally express their wishes on health insurance cards.
According to the bureau, nearly 69,905 people have designated their organ donor status on the health cards since July 1994. But this pales in comparison to the 540,000 who completed organ donation forms issued by the Organ Procurement Association—Taiwan’s leading non-profit organization dedicated to promoting organ donation.
Liu Chia-chi, vice-president of Taiwan’s Organ Registry and Sharing Center, said there is still room for the government to take more effective measures to increase organ donation.
“Considering the health card’s portability, the new proposal should make it easier for frontline medical staff to get instant confirmation of a patient’s preference for organ donation,” Liu said. “It is essential that as many people as possible consider donating organs as a way of increasing the chances of those on transplant waiting lists.”
Taiwan is a leader in organ transplants and boasts top-notch medical experts and advanced facilities. It was the first country to carry out organ transplants in Asia, with successful kidney and heart transplant operations performed at NTUH in 1968 and 1987 respectively.
Moreover, a recent survey released by the Transplant Society of Taiwan indicated that the survival rate for patients 10 years after kidney transplant operations in Taiwan is 91 percent—a figure that exceeds those in the United States and other advanced countries. According to bureau statistics, more than 623 heart and 2,054 kidney transplants have been performed on the island over the past 11 years, and post-operative patients can now look forward to active and healthy lives.
But Despite being a world leader in organ transplants, Huang believes a shortage of donors remains a serious problem. Taiwan’s organ donation rate has always been low and presently stands at about 7.2 donors for every million people. In comparison, the rate in Britain is 14, the United States 24, and Spain a remarkable 34.
“It is good news that there was a record number of organ donation on the island last year, but attempts to further increase this number have met with limited success,” Huang said. TORSC statistics reveal that there were 728 organ recipients benefiting from 195 organ donors in 2008, which is the best record since 1995.
But the medical expert cautions that the need for donations has “never been greater,” with nearly 7,000 people waiting for transplants each day. “Nearly 90 percent of these patients die before an organ becomes available,” Huang said.
Given the fact that the demand for organs outstrips supply, Huang said that many patients have to go abroad on expensive trips for operations. “Countries such as mainland China, the Philippines and even India are increasingly being considered as possible destinations,” he added.
The option of organ donation in Taiwan is most often offered after brain death is declared, Huang explained. “A brain-dead patient, generally speaking, is a candidate for donating their heart, lung, kidney, liver, pancreas, skin, bone, eyes and other major organs,” he said, adding that on average, one brain-dead individual can give a life to nine other people.
However, Huang said Taiwan’s donor coordinator system lacks flexibility, especially when compared to the U.S. system. “American doctors can provide detailed explanations to a brain-dead patient’s family if the individual does not have a donor card. Moreover, they can offer options on whether to discontinue treatment, continue until the heart fails, or agree to donate organs.”
“In Taiwan, a brain-dead patient is able to donate organs only after their condition has been officially declared. Even so, most families of patients fear that doctors may end treatment for the sake of an organ donation even though there may be a way to save the patient,” Huang said, adding it is disappointing that there is such mistrust between doctors and patients’ families.
The revisions to the act do little to improve this situation, as they stipulate that doctors who have been involved in declaring a patient’s death are barred from performing organ harvest and transplant surgery. Violators face fines of NT$200,000 (US$6,050) to NT$1 million, up from the previous NT$90,000 to NT$450,000.
Huang believes the revisions have their place though. “Bias such as interest and ethical conflicts might occur if a doctor engages in both the processes of declaring a patient dead and conducting organ removal and transplant operations.”
As a leading pediatric cardiologist, Huang is of the opinion that the issue of organ donations for children and young adults is the most important challenge facing the medical industry today.
“Patients in this age category seem to be in a comparatively vulnerable situation when it comes to organ donation and transplants,” he said. “The number of donors weighing less than 30 kilograms in Taiwan has been almost zero over the past 10 years as children rarely die in circumstances that would make them medically acceptable sources of organs.”
Besides, Huang believes it is a difficult and emotionally challenging process for parents to decide to give the gift of life through organ or tissue donation. “It is a sad fact that sick children can only receive organs appropriate to their size.”
For Huang, increasing the public’s awareness of the need for organ donation is an issue that the government and medical industry need to urgently tackle together if more lives are to be saved. “An untold number of people in need of organs could have benefited if the wishes of potential donors could have been known,” he said. “I hope that he greater public awareness of the national organ shortage will lead to more donations in future.” (JSM)
—This feature is dedicated to the memory of my beloved nephew, a brave angel who suffered from hypertrophic cardiomyopathy from March 2, 2008 to Aug. 31, 2008. Your strong will to battle against the disease proved the greatest miracle of all. We hope that some day a way will be found to help infants like you with congenital heart defects. The celebration of your life will continue in our memory and always bring us peace.
Write to Chiayi Ho at chiayi@mail.gio.gov.tw