As for the brains I may keep them as they fetch a good price in the used brain market. Why not?? These brains are hadly used.

What is the implications? Or rather, can the family members take legal actions?

But will they?

After all, religious teachings generally do not proscribe organ donation or transplant. It was reported that Islamic authorities here emphasised that donation was not against the tenets of the religion. “In Islam, donating one’s organs is considered a noble act, and how much more in the month of Ramadan,” Department of Islamic development chief Wan Mohamad Sheikh Abdul Aziz reportedly said. This means that there is no iobjection for even a muslim to receive an infidel’s heart…….

For it is said that donating one’s organs is an unselfish act of caring and sharing, of charity and giving ourselves of promoting life not derogating it.

But selfish politicians whom all their lives have been taking from and making money out of the Rakyat – will such people donate their precious organs? That is the question!

They, however, preach that we do.

Now whether the politicians donate or not, there is no problem on the part of common rakyat if the prime consideration is utilitarian ie, besides the charity bit, as time progresses, civilization too must keep abreast, and as far as technology can keep pace, the development of new approaches like organ transplantation to prolong life and increase its quality is good. It reflects a species taking care of its perpetuation amid the prospects of mutual annihilation by wars and nuclear weapons.

But if one takes the level of debate from utilitarian to more abstract ethical or even religious level, there are immediately several problems to overcome.

Firstly, for those who believe in life after death, especially that they are going to heaven, they’ll be wondering, whether having some of their organs taken off – whether heart, kidney, pancreas or even genitals – they will still be themselves at the portals and gates of Heaven. Like it or not there are some (say) the suicide bombers who believe that as a reward for martyrdom, scores of virgins are waiting for them in Heaven, so what’s the point of being martyr, if they are going to Heaven without their organs, heart, kidneys, eyes and that between their legs? Some people are vain, they don’t want to meet their Maker, let alone virgins, in a mutilated state! Even if they don’t expect to go to Heaven and by reasons of their sins expect to return as pontianak, keong si (chinese dracula?), they want to look pretty and gruesome!

Admittedly suicide bombers or the Vain may not constitute the Average Joe Public and Religious teachers may advise body parts should not be mistaken for the person themselves…but the question, as always, is who are religious teachers to know – are they God? If they could, as history has shown, mislead multitudes of believers in all kinds of rituals and sometimes galvanise them for war or vitimisation of people of other faiths, can they be trusted that their word of what God intends is really God’s intent???

After all, if it were believed that every life on earth is predetermined by the Almighty – including premature death by accident or disease – so why allow a mutilation of one’s physical body at death for prolonging another’s life, threatened by disease that is the design and handiwork of the Almighty Himself? In short, why then must we or the physicians disturb God’s plan for us whether it is a long and healthy or a short and diseased life? The bodies that we have on this world belong to God and he is calling us back to Himself, and “us back” means the integral bodily self…..

Also, if religion tells people it’s okay for us to donate our organs when we are “dead” for the good, is it really “good” if, in a society governed by influence of power, that our organ is eventually transplanted, in a case of two competing priorities of a needy poor nobody and a powerful corrupt politician who has financial means to buy judges and doctors alike, to the latter to prolong his life to rake in more riches, continue the stealing and plundering?

Even if one believes Darwin’s evolution theory of survival of the fittest, is it good to donate one’s organ, without concomitant control over the allocation of benefit of such donation ending up in the body of the corrupt, selfish politicians who retard civilization’s progress to a higher level and in Darwin’s evolution ladder should not even be allowed to survive as the Almighty probably intends?
Is that what the Almighty intends – charitable act and the ultimate gift of love even to our corrupt politicians?

These are some of the questions.

Of course the question of available donor brains arises. Not a problem. With the high fatal rates of the Mat Rempits on any Sat. nights, there are many underutilised brains available. With a little effort from the PDRM, there is also a readily available source from the many frequent snatch thieves who could easily be rendered donors by ramming into their motor cycles when they commit their criminal acts.

One has to be fair to the donor. He must know what he is going into by the pedge of his organs and after making it the right to revoke as well. Though saving the lives of organ recepients are important so are the rights of the organs donor : from ethical standpoint one cannot serve only cause of the former category by neglecting the second.

Now if the cabinet and Chua Soi Lek would support transplant, all the cabinet ministers should set an example for the rakyat by officially pledging their organs (minus the brains) for transplant first.

Ok, lets look at this matter further.

A short while, maybe 15 minutes, after heartbeat and breathing stop, organs are irreparably damaged and cannot be used for transplants, so for transplants to be viable for the transplant industry , advocates and beneficiaries, and yet carried out by physicians without violation of the Hippocratic Oath, the criteria of death has to be based on “brain dead” i.e. human life ends with the brain being certified irretrievably dead though patient is still having heat beat and drawing breath, albeit very faint one. This means the definition of brain death as real death is key to legislation to pave the way for the transplant programme.

However for many of us death comes when we draw the last breath and stop the last heartbeat – and not when we go ‘brain dead’ – for if our brain is certified dead by physicians even under the most stringent medical criteria (eg absence of brain-stem reflex, no strong evidence of breathing and a total lack of consciousness), what is that thing then that continues to make us breathe, albeit faintly, and our heart to beat, albeit weakly (never mind, that we are now a vegetable and our useful life has ended) if, paradoxically, it is not the last spark of “life” itself?

The big ethical and religious argument is over the termination of such spark of life in interest of organs transplant, when organs are still intact, for the utilitarian benefit of the many patients, who have not reached such a terminal stage yet and need organ transplants, who are holding both their ventricular assist device and their hopes alive that they may be lucky enough to count to be the few amongst many who will not die whilst waiting for the organs?

For the benefit of those who have a chance to continue useful life, the transplant advocates have redefined death to draw a line against donors whose chances of continuing to live meaningful and productive life is, by virtue of brain dead, medically and clinically certified as zero.

That may be utilitarian approach – take and defend it then – but why pretend that there is cessation of life when the brain ceases to work but the organs still work and serve the requirement of transplant? What makes the organs work if not that something we call life? Doesn’t life exist not only in one’s mind, but also in one’s body?

Hey it’s the Hippocratic Oath – not Hypocrisy Oath!

The physicians’ Hippocratic Oath is to save lives not take lives so they cannot reconcile this and hence cannot openly embrace the utilitarian approach (especially when in extremely rare inexplicable cases, people “brain dead” in deep coma have revived, not to mention what is called NDEs or ‘Near Death Experiences’ recorded cases when they sprang back to life after both mind and body evince cessation of activity).

Ethical and religious considerations that no one should play God to end a life as long as the spark of it is there, are harder and as often the case impossible to reconcile with utilitarian approach.

But lets get realistic about the latter: it is always there whether admitted or not. That is why killing per se is wrong if its unjustified as in murder but OK in other cases when it is on private level a case of self defence or justifiable abortion and at state level where it’s a state sanctioned execution for grave crimes attracting capital punishment or in war, killing the nation’s enemies…

The utilitarian approach is get a donor to carry a donor’s card and in the donor’s card carries the donor prior declaration that in principle, he will allow doctors to take his organs when he is brain dead according to established clinical criteria, that he is aware that such clinical criteria may not be perfect, that there is always a miniscule possibility that he could revive – but never mind that and never mind his next of kin may otherwise object : the declaration should be treated as his last will and testament that no one could thwart. However such a law that paves the way for brain death criteria and transplant must state that donor’s position and declaration is not final but revocable by him any time.

Sheeesh!!! Motherf*@#ng biaaatch!

On that principle alone, (i) the patient, provided he knows the full implications and practical limitations, has right to opt for VAD as what Carpe Diem argued; (ii) the brain dead person should not be determined dead and have his organs harvested, unless he has prior agreed to donate upon these conditions.

FK-506 would probably have no quarrel with the general statement above except that in practical terms, balancing advantages against cost, he likely thinks that here, if the cabinet and Chua Soi Lek would allocate a billion ringgit for a transplant program, it probably camouflages a subterranean political agenda having no regard to reality and will lead to more costs and disadvantages than advantages – esp in our cultural and societal milieu steeped in corruption and lack of willingness and mechanism to counter conflicts of interest in all areas and not just a medical field, where for money, patients looking for VAD will have their money fleeced for one without being aware of its cost and limitations, other patients diagnosed brain dead by unscrupulous medical personnel, will have their organs harvested without consent, that laws establishing criteria for transplant procedures will be promulgated nicely by cut and paste but never followed (just like the Anti Corruption Act where the legal net is tight but all big fish get through), and crime being rampant and on the rise now will also extend from snatch thief and robbery to kidnapping and killing for organs…And if credible allegations of impropriety could be made against a hallowed institution like judiciary, will the medical profession be spared from the blandishment of glory and money triumphing over and overriding, in due course, individual and patient’s right? All the concerns raised by FK-506 are not without force and truth when he argues that the billion ringgit is better spent on more practical and achievable things like transplants of “corneas, bones, much needed kidneys as well as living related liver transplants”…..

Implicit in FK-506’s argument is that one cannot introduce the billion ringgit transplant programme in the name of respecting the right to life or hope for life on the part of the patient seeking a VAD and yet not inevitably lose and sacrifice in the eventual process, the other principle respecting life as applied to the donor patient diagnosed brain dead where in due course something like Singapore HOTA will be introduced to make his and family’s objection and right to say no to donation superfluous, and that in due course some patients will be killed (for the glory and properity of those who play God) to save the dying.

All these may be valid prognosis of what could and indeed would likely happen in a society like ours without honest and capable people all around and importing ambitious programmes from other societies where institutional safeguards against abuses and conflicts of interest are better entrenched but be that as it may, these concerns and related considerations, though real, are strictly extraneous – and should be kept such and addressed separately through other means – to the principal issue of what are the props and cons within the strict 4 corners of such a programme organ transplantation and whether it should be put in place to avail to those who could afford and risk it at the same time as part of right to life, without bringing in wider societal issues of corruption, NEP and the like to muddy the debate.

On top of that I am inclined to agree with FK-506 that a programme of ventricular assist device (“VAD”) to be supported by organ transplantation faces severe limitations of the VAD having a limited 3000 hour life of its own, a dearth of donors in Malaysia whether due to cultural or religious reasons, costliness to maintain such a programme which raises valid questions whether scare resources should be better concentrated on “prevention better than cure” programmes involving lesser and less drastic transplants of “corneas, bones, much needed kidneys as well as living related liver transplants”…..

I also agree that the dangers pointed out by FK-506 – incompetence or conflict of interest within medical profession where the section on organ transplantation has a stake in pushing for its agenda based on brain dead criteria, Singapore’s HOTA and co-relation between abuses and crimes linked to organs harvesting with that of organ transplant in India, Turkey, Central Europe etc – are real but in spite of all that, and subject to the caveat that no law should be pushed for to make brain death the criteria to allow the State or doctors to harvest a brain dead person’s organs without his/her family consent freely given, I agree with Carpe Diem’s basic position that every patient has the fundamental right to have a VAD provided that the following safeguards are fully in place, ie that : -

1. the patent/his family are made aware of the full facts about the costliness and limited life of VAD as against limited opportunities of getting donor’s organs; and

2. no donor or family members have been coerced, to have their organs harvested, donated and transplanted by law or a system like Singapore’s HOTA or any other means which such donor/his family haven’t or wouldn’t otherwise have freely agreed to.

This is because where technology and professional skills support the availability of VAD that gives hopes to life, even against all odds, who are we to deny the patient (who is given the full facts and odds against and yet voluntarily opts for it) that right?

Yes, it is true there are always dangers of illegal organ harvesting trade, cases of Juro Wada and possibility of unethical collusion between nuero and organ transplant surgeons and unethical anesthetists etc but these dangers should be separately addressed, and guarded against and by their possibility of occurring here or there, should not by themselves alone constitute the barrier to stop the country and the medical profession from progressing and going forward in this area, subject always, as I earlier said, to the overarching qualifications in 1. and 2. above being observed….