Organ transplantation…brain death and financial implications (3)

by FK-506

In reply to Carpe Diem’s cherry picked quotes to the letter, ‘Organ transplant: Are we on the right track?’, the writer’s attempts to endorse this country’s nascent transplant program by trying to downplay key issues in any transplant program — financial implications and controversies surrounding brain death is reprehensible.

Quote : “… … … isn’t quite right to place patients on VADs which have a limited life of their own into patients, not knowing if they are ever going to get a heart. This cannot be ethically correct.”

“Is it more ethical to deny me this option, based on not knowing whether I will get a heart in time, if the expertise is available and I am more than willing?”

For how long and at whose cost? Is Carpe going to pay this out from his or her own pocket? Clearly this person doesn’t realize the economic costs of such programs on government expenditure, unless of course, Carpe thinks that it is the state’s moral duty to transplant everyone with end-stage heart failure, liver failure, renal failure, etc. Chua Soi Lek moaned only last year that the MOH couldn’t afford to pay the RM900 million pharmaceutical bill for patients being treated by the Ministry. But miraculously he today is quoted to have said that the Cabinet, which has never shown respect for tax-payers money, is willing to provide even up to a billion ringgit for a transplant program. Incredible. Where is the set of priorities? Why don’t the cabinet approve the billion ringgit so that patients get better care, better follow-ups, better education programs, home nursing and of course better medicines, so that less patients end up in heart failure, renal or liver failures.

The age old idiom “prevention is better then cure” must hold true for this country based on the economy that we have unless Carpe is advocating American style healthcare, in which case, I would like to suggest that the technology be kept going but all transplants be borne by private funds. And I do hope Carpe fathoms the economic consequences of transplant programs. I hope he/she realized what happened to Barnard’s pioneering transplant work at Groote-Schur in South Africa. Transplant programs were immediately shut down by incoming President Nelson Mandela in 1994 when he realized that precious and limited health resources that could be used for Soweto’s populace suffering from cholera, typhoid, malaria and an AIDs incidence of almost 14% in some provinces, were being channeled to a glamorous transplant program. Are we in Malaysia any different if the startling statistics provided by our own MOH are anything to go by? In Sabah alone, even decades after independence, we have still not eradicated malaria and TB.

Quote: “Merican howled that what SJMC and Tan did were improper as ignorant patients may “not have been briefed about complications”. Tan, who pioneered liver transplant techniques at King’s College, London, of course left, preferring to base himself in “less ethical” Singapore, leaving Merican to focus on traditional medicine back here in Malaysia.”

That Merican howled is a fact. It is also a fact that K.C. Tan announced in the media that he was not willing to work in the ethical environment imposed on him. But the end result of this entire episode was clear. Malaysia’s liver transplant program in the private sector, supported quite earnestly by the media even then, was dead in the water. No RM30 million, 100 million or 1 billion ringgit boost to this program, although it was led by a Malaysian surgeon and the incidence of patients requiring liver transplants were equally a concern. Even private donations collected to help patients in this program were ultimately taken over by the Ministry. Why the double standards? Was it because K.C.Tan was a private surgeon working at a private hospital? Or was it due to something else? Yes the insinuation is direct. I am sure readers can make their own conclusions.

Quote: “Many fail to realise that the most painful thing about losing a family member to a traffic accident is the suddenness.”

In dealing with the emotions of doctors in trying to convince patients to donate their organs, I have to assume Carpe is unaware of Singapore’s HOTA where despite the objections of the family, the state still has the right to the patient’s organs and doctors are duty bound to remove them either by gentle persuasion or by force as in the case of Sim Tee Hua in February of this year. Chua Soi Lek, well known now for his medico-legal bungling, during the euphoria of the recent heart transplant, actually announced that the laws of this nation would be changed so that families of patients who had pledged their organs previously will not be able to object.

Can we implement this in culturally and religiously sensitive Malaysia? A doctor’s feelings will become irrelevant if this Act comes through just as in the HOTA. He/she will just have to carry out his duty irrespective of the suddenness of the death so that organs harvested remain fresh and viable. Culture, religion, family objections including doctor’s feelings will have to take a back seat.

Quote: “And if you define human death as brain death and give doctors the power to demand or request organs, a family member might have his heart or lung ripped out even before they have a chance to mourn.”

Human death IS brain death? Really! By whose standards? Perhaps Carpe has forgotten that human death was always defined as cessation of the beating heart before Barnard did his transplant. The issue of brain death only arose when Barnard did his transplant. The following year an adhoc committee at Harvard Medical School rejected the notion that death was when the heart stopped. Rather they claimed a person was dead when higher neurological functions ceased. They came out with a list of criteria and quickly established brain death laws which were challenged half-heartedly in US courts. (Report of Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death: A definition of irreversible coma. JAMA 1968; 205:337). These criteria subsequently became law in the United States. As all things done in a hurry no one knew the implications it would have in the future. An ever-trusting American public believed the medical fraternity who were largely responsible for coming up with these criteria.

If Carpe thinks Malaysians, with their cultural and religious attachments, would be as gullible as the American public to believe that “human death is brain death”, then surely Carpe has not worked in a Pusat Kesihatan Kecil or on the outbacks of Kelantan, Trengganu or Kedah. It is certainly not going to be the same here and brain death regulations may have to mirror those in Japan rather than Singapore. The 1968 committee that endorsed brain-death syndrome in the United States consisted largely of physicians. But when Japan established its own brain-death committee in 1989, it included human rights activists, social scientists, a Buddhist lawyer, a Catholic novelist, a newspaper editor, an environmentalist, and a labor leader. Whereas the American committee reached consensus quickly, the Japanese committee debated for three years.

On June 16, 1997, brain death became a legal definition of death in Japan, but not the legal definition of death. Under the amended law, only people who sign up in advance to be donors can be pronounced legally dead upon meeting brain-death criteria. For citizens uncomfortable with brain death, the age-old stopped-heart criterion remains the standard.

Carpe’s repeated pronouncement that human death is brain death is not only grossly misplaced but reveals a disturbing impudence in the absolute definition of brain death when this science is still being debated although the rushed Harvard’s consensus and its modified versions are currently accepted as necessary for possible euthanasia and transplant programs.

Quote : “Add this to the current perception of widespread political corruption with a judiciary hopelessly entangled in a quagmire from which no one knows if they are ever going to extricate themselves, you will end up with a family or relative not wanting to believe anything the authorities tell you including the fact that their beloved is brain dead.”

Clearly Carpe doesn’t appear quite current in the often reported medical blunders in the media these last few years. Perhaps in Carpe’s eyes, all of them including failing ambulances, undiagnosed dengue deaths, lost arms, etc are anectodal. They may be. But there is a trend, a trend dangerously associated with the quality of medical schools and students in and out of the country. As theses anectodes appear common place, missing or confirming a person brain dead and thereby removing his vital organs consequentially killing him or her is not a remote possibility.

Quote: “And is brain death criteria in Malaysia strictly adhered to? Are our anesthetists, neurologists, neurosurgeons or critical care physicians well trained in ascertaining brain death? Will our brain death certifiers be singularly medically unbiased or will they lean towards to a lower criteria as the demand for the organ rises just as in Argentina, Brazil, Chile, China and India or if the VAD’s 3,000 hours ticks closer.”

Yes to all the above? This is a travesty. The anesthetists in our unit who claim that although they were taught about brain death, admit that they have had little exposure or experience in actually confirming someone brain dead. They seem unfamiliar with the criteria and at times quarrel which criteria should be followed and which one should be given any particular importance. Perhaps they do this to avoid having to make a decision or maybe they are just ethically shy. But ratcheting brain death criteria downwards is a problem in the United States where organs are in high demand.

China has been repeatedly been in the news and was the focus of a BBC documentary this year where prisoners’ organs were booked prior to them being executed. In India, kidnapping for the removal of kidneys is not uncommon. The CEO of a large corporate hospital in India in fact even campaigned that the sale of organs be legalized to reduce the black market trade of organs in India.

Can Carpe really be oblivious to organ trafficking which is an established massive problem globally? A kidney fetches US$2700 in Turkey. An Indian or Iraqi kidney is a mere US$1000. Wealthy clients later pay for a rare organ up to US$150,000. Organs are even auctioned on e-Bay and can fetch between US100,000 to US 1million depending on the organ and demand. Organ harvesting operations flourish in Turkey, central Europe, mainly in the Czech Republic, the Caucasus, mainly in Georgia. They operate in Turkey, Moldavia, Russia, Ukraine, Belarusia, Romania, Bosnia, Kosovo, Macedonia and Albania. They remove kidneys, lungs, pieces of liver, even corneas, bones, tendons, heart valves, skin and other sellable human bits. The organs are kept in cold storage and air lifted to illegal distribution centers in the United States, Germany, Scandinavia, the United Kingdom, Israel, South Africa, and other rich, industrialized locales. It gives “brain drain” a new, spine chilling, meaning.

Organ trafficking is an international trade. It involves Indian, Thai, Philippine, Brazilian, Turkish and Israeli doctors who scour the Balkan and other destitute regions for tissues. There have been reports that Moldavia and Romania stopped the practice of baby adoption by desperate foreign couples for fear that babies were being sliced open for their organs. That the abuse of brain death criteria here is not in question, but more importantly how do we monitor and halt this errant practice? Yes, you need to be a legal eagle if you are going to spot a problem in establishing brain death.

As for the local scene, only two reports have been reported so widely as to raise eyebrows. The first is the double lung transplant on an Indian patient whose donor was from a private hospital across town. The NST reported that despite valiant attempts the recipient died on the table. But the lungs came from a hospital where the operating surgeon had a friendly anesthetist with whom he had worked previously with at that hospital. Whether brain death was confirmed by the friendly anesthetist or by a team independent of the operating team was questionable.

However, the recent double transplant was just filled with too many coincidences for comfort. A patient on a VAD, without a heart for a year. Then a media blitz. A heart is found in Ipoh where presumably brain death was certified independently. Then the transplanted heart sustains “hyperacute rejection”. A second heart “comes by” after another patient is certified brain dead, with the same blood type, size etc and also hopefully certified brain dead by anesthetists/neurologists/neurosurgeons independent of the harvesting team with the usual 6 hour repeat tests or the isoelectric EEG 24 hours apart all within the space of a day. It may have been a miracle, but it does sound too close for comfort. Readers, I am certain can draw their own conclusions.

Splitting hairs, storm in a tea cup? No. Brain death is a serious matter as it involves taking away a person’s life if vital organs are harvested. And no doctor in his right mind will do it unless he is very certain that this patient has absolutely no chance of waking-up. The views of Dr. Yusho Muranaka, parliamentarian Takashi Yamamoto, Dr David Wainwright Evans, Dr David Hill, Michael Potts, the Hastings Centre Report (1993) and cardiologist Yoshio Watanabe, all of whom have expressed dissenting views regarding brain death cannot just be wished away. There are anesthetists even in Britain who don’t carry a donor card because they know what actually transpires when determining brain death. Even Islamic views on brain death are mixed. The strongest proponents, understandably, for the establishment of brain death criteria have almost always been the transplant industry. Brain death is a scientific definition but it doesn’t mean this definition is accepted globally let alone Malaysia.

Quote: “In Japan, the name Juro Wada is almost synonymous with how society can turn distrustful of organ donation. … … .”

Another incidence of cherry-picking using anecdotal evidence? There isn’t any need to. There are enough Juro Wadas from Brazil, right across to China, India and East European countries. Malaysia probably does not have one because we don’t have an active transplant program. The danger is always there when there is little or no surveillance.
Quote: “Even within the medical fraternity no one knows the short, medium and long term results of mortality and morbidity rates of all organs transplanted in Malaysia.”

Excellent. The renal guys have done good. Now if only we can have some data for the corneas, bones, livers, lungs, hearts, etc. I am sure the public will glow with confidence.

Quote: “These transplants may be less glamorous but a long and gratifying track record in these areas may warm Malaysians eventually to actually accepting brain death.”

Do we have an active transplant program for organs that don’t involve brain death? Corneas, kidneys, living related livers, bones, etc. We don’t. Why don’t you show the public that you can do these operations well with little complications and establish properly your organ procurement programs for these organs before you rush into taking out hearts or lungs that causes another person to die. The public cannot be rushed into accepting brain death, especially a society as diverse as Malaysia. But an active transplant program in areas that does not involve brain death will certainly encourage and educate the public about the pros of transplants. One brain death diagnosed wrongly, will see a backlash so bad that the public may not want transplant programs at all.

Quote: “Hopefully someday we will have a primary healthcare system that will prevent the emergence of most diseases but until then we should avoid descending into the questionable achievement of killing people to save the dying.”

Either the writer is hopelessly immature or downright ignorant for taking this phrase out of context. A first class, well funded primary health care system will reduce the emergence of most of these diseases which require transplantation. And yes, if you take the heart or lung out of a person, you do kill him unless you want to paraphrase it differently. And you do put the donor organ into generally a sick or dying patient or at least we hope that’s the way it’s done in Malaysia. Transplant technology entails killing people to save the dying. Hard facts are sometimes difficult to swallow. Carpe Diem is welcome to rephrase this any other way he/she chooses if it helps him/her sleep better at night.

  1. #1 by mycroft on Saturday, 13 October 2007 - 12:24 pm

    Sometimes I wonder if the opposition to organ transplantation espoused by some commentators on this blog based on politically partisan behaviour rather than any real ethical value.

  2. #2 by k1980 on Saturday, 13 October 2007 - 2:35 pm

    Which is better: spending USD60 million on heart transplants to save lives or spending USD60 million to send 2 idiotnauts to enjoy the view from space?

  3. #3 by mycroft on Saturday, 13 October 2007 - 2:58 pm

    I think the comment above betrays the immaturity of the poster. To call them idiotnauts is completely uncalled for.

  4. #4 by Jeffrey on Saturday, 13 October 2007 - 5:12 pm

    About this FK-506 versus Carpe Diem debate, I agree with FK-506 that brain death, as the definition of death is at best contentious and ought not to be criteria and justification for harvesting the brain dead’s organs. (Haven’t they heard of recorded NDEs or so called “near death experiences’ where the person certifed medically dead subsequently sprang back to life relating their out of body experiences?)

    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….

  5. #5 by Jeffrey on Saturday, 13 October 2007 - 6:23 pm

    Bottom line, most of us hold on to the important twin principle of one’s right to life and right to freedom to choose.

    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.

  6. #6 by undergrad2 on Saturday, 13 October 2007 - 11:44 pm

    “Transplant technology entails killing people …”

    Sheeesh!!! Motherf*@#ng biaaatch!

  7. #7 by Jeffrey on Sunday, 14 October 2007 - 7:26 am

    “Transplant technology entails killing people …” – FK-506 that attracted this unsavory response – “Sheeesh!!! Motherf*@#ng biaaatch!” – Undergrad2. :)

    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.

  8. #8 by Jeffrey on Sunday, 14 October 2007 - 7:54 am

    Of course one can say what’s point of pledging our’s organs as donor that one, whilst still conscious, before going brain dead, can revoke, so that a pledge is not a pledge? The simple answer is that if there is no moral and legal reason to require a person to be a donor, in the first instance, then the fact that he has voluntarily become one out of an impulse to do the world some good – and not because he has got something else in exchange like money – should not preclude him from reneging on the pledge and turning back the position. For what Caesar gave he could take back!

    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.

  9. #9 by k1980 on Sunday, 14 October 2007 - 9:47 am

    I betcha if an in-depth survey were to be made on all the Cabinet Ministers, including the PM-cum-Finance-Minister-cum-Internal-Security Minister ( Mr 3-in-1) and their wives/kids, it will reveal that not a single one of them has walked the talk of donating their precious organs for transplant. A1 for talk-kok BUT F9 for action

  10. #10 by Cinapek on Sunday, 14 October 2007 - 11:09 am

    Whilst on this subject of transplants, I would like to propose brain transplants for the entire Cabinet and several members of the BN MPs and, last but not least, several of the UMNOputras who fancies that playing the racial card will further their political ambitions.

    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.

  11. #11 by Jeffrey on Sunday, 14 October 2007 - 11:49 am

    MCA President Datuk Seri Ong Ka Ting described as an “incredible Malaysian story” that broke a taboo on organ donation – that of Tee Hui Yi, 14, the case a Malaysian Chinese girl who underwent two heart transplants including one from a Muslim boy.
    However the gauntlet that k1980 throws – whether our grandstanding high and mighty politicians will also walk the talk, and by example to rakyat, donate ‘their precious organs’ is also valid.

    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.

  12. #12 by Jeffrey on Sunday, 14 October 2007 - 11:53 am

    TYPO – “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 NOTgruesome!”

  13. #13 by douglaskk on Sunday, 14 October 2007 - 3:54 pm

    I’ve heard about hospital staff stealing organs from “brain dead” patients. The family members of the poor guy only realised this when the body was taken home.

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

  14. #14 by undergrad2 on Sunday, 14 October 2007 - 9:54 pm

    I don’t know about you guys think but I’d like to be able to stealthily tip toe in the dark of night into the many mansions and palaces owned by UMNO Ministers and their sidekicks and harvest their organs while they sleep. I’d not bother asking for their consent.

    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.

  15. #15 by Jong on Monday, 15 October 2007 - 2:02 am


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