Corona Daily 299: Life After Life

Mr R, a neighbour, ran two businesses, raised a family of five children and swam every morning, even at 91. I think he was 94, when he decided he had had enough. He went to Sion hospital, one of Bombay’s leading municipal hospitals and booked a room for himself. He told the doctor he planned to fast unto death. Once he dies, the hospital should take over his body. He wished to donate it.

The horrified doctor said this was illegal. Mr R should fill the necessary forms, go home and die, and arrange (in advance) to send his body. Mr R., a meticulous man, signed the forms, made his family sign them, and started fasting. On the seventh day, he died. The son took him to the same place he had visited a week before.

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India has more than 10 million blind people. In casual conversations, I have heard many Indians say they would like to donate their eyes after death. In reality, when death occurs, the relatives are not in any frame of mind to arrange organ donations. Obviously, the donor can’t act, either.

If conditions are right, eight vital organs can be donated: heart, two kidneys, pancreas, two lungs, liver and intestines. Add to that cornea, skin, blood vessels. Cornea donation by a single person can gift vision to two or three blind people. If all organs and tissues are functional, transplantable and donated timely, one donor can enhance the quality of life of up to 75 people.

Generally, this requires dying in a hospital and being on artificial support before death. Once a person is brain dead, the organs can be kept alive for some time on a mechanical ventilator. Organ donation is time sensitive. Now computers can quickly match local residents in need of a transplant.

Body donation, the type Mr R did, is comparatively simple. The relatives should bring the body within six hours. If the person is registered for eye donation as well, eyes (cornea) are donated first, and then the body. The body is essential for medical students. It is used for anatomical exams, research or training. Surgeons need bodies for practice, before operating on a live person.

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Some countries require an explicit consent (opt-in), meaning a person must confirm his wish to donate organs in writing. Other countries have presumed consent (opt-out), where the default is every citizen giving consent. Germany uses opt-in. About 12% of Germans give consent. Austria has presumed consent. The Austrian state has a right to take organs from nearly 99% of Austrians. (Only 1% has declined consent).

The world has a huge shortage of organs. The USA has more than 100,000 people waiting for organ transplants with no donors.

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Yesterday, I wrote about a will (testament). A living will is different. It tells the medical staff what the person wishes if he were to be in coma or a vegetative state. Modern medicine is aggressive and usually tries to keep a person alive without bothering about the quality of life. Patients with terminal or incurable illnesses can spend months if not years in agony or as a vegetable. The expense can kill the surviving family. (Not only cost of living, but cost of dying is also going up).

A living will allows a person to refuse such interventions in advance. Alternatively, a medical power of attorney (e.g. spouse) can be issued. That person is given an authority to take decisions about the treatment to an incapacitated person. Two years ago, the Indian Supreme Court confirmed the right to die with dignity. Netherlands allows euthanasia.  

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A pandemic is an excellent time to create a will and a living will. And if someone wishes to posthumously donate organs or body, forms must be filled and explained to the family.

Organ donation offers a singular opportunity to be useful to humanity beyond our lifetime.

Ravi