A "culture of fear and horror" after death should not thwart the wishes of a deceased patient to become an organ donor, two University of Otago researchers say.

The researchers, master of bioethics and health-law student Jennifer Ngahooro and Prof Grant Gillett, of the university-based Otago Bioethics Centre, highlight organ-donation concerns in an article in the latest issue of the Journal of the New Zealand Medical Association .

The article, "Over My Dead Body: The Ethics of Organ Donation in New Zealand", said there was a global shortage of organs for transplantation. New Zealand had one of the lowest donor rates in the Western world, with 10.2 donors per million population. Nineteen people had died last year while on the country's 400-strong organ waiting list.

The Spanish donor rate was highest, at 39.6, the United States fourth, at 22.3, and the Polish rate among the lowest, at 1 per million.

The main method of identifying donors in New Zealand was a donor section in drivers' licences. A total of 1.1 million people (about 42% of licensed drivers) had registered as donors.

In most cases, the relevant legislation, the Human Tissue Act, did not require familial or informed consent for body parts to be lawfully removed for medical purposes, if the deceased had requested donation. However, hospital clinicians tended not to retrieve organs if family members of the deceased objected, despite the patient's earlier clear wishes to donate.

"One cannot ethically defend this practice, which, in effect, over-rules the individual's autonomous decision (when presumably in sound mind) and favours the emotionally fraught decision of a relative, made in a time of stress, and often with no or little background knowledge," the researchers said.

"Indeed, it seems clear that the culture of fear and horror, perhaps generated from an aura of scavenging and body-snatching, shouldn't be allowed to eclipse the clear wishes of everyday New Zealanders to help each other in mortal crises."

There was obviously a "clear-cut ethical and legal case" for a change of practice.

The public should be educated in a nationwide campaign, which should clearly state that when a decision had been made, relatives had no valid role in overturning it, except when there were very special considerations.

Clinicians should change their approach to the donor's relatives. Relatives were "shocked by their sudden loss, and even sometimes unsure about the way they should show their love and respect for the dead".

Clinicians could help by saying something like, "Your relative has indicated that he/she wanted to be an organ donor. Is there any reason why that should not go ahead?"

This approach would increase the donor rate and "take a lot of the feelings of guilt and responsibility away" from those concerned.

Monday, 20-September 2004