Dawn Picken: Organ donation crucial to saving lives

COMMENT: You can save lives but need to let your own family know first. Photo / File

COMMENT:

"The worms crawl in, the worms crawl out, the worms play pinochle on your snout…"

The rhyme from childhood, dating to 1810 or earlier, may have been predictive -foretelling the role of pigs in our lives.

In the future, some of us could carry pig parts. Not a ham sandwich, but an internal porcine organ - say, a liver or kidney.

NZME reported earlier this month genetically-enhanced New Zealand pigs could be ideal sources of organ donors in the future. Scientists plan to use Auckland Island pigs as potential candidates for xenografts, or transplants for other species.

Though researchers worldwide have long trialled pigs as sources of cells, tissues and organs, problems arise from non-human donors: our immune systems naturally reject "xenoantigens" carried by pigs. Also, animals could pass along disease.

Then there's the ethical dilemma of breeding and killing pigs to save or enhance human lives.

Though non-genetically edited pigs have already been used to develop successful pig-to-human cell transplants to control diabetes and Parkinson's disease, we could still be many years from when Uncle Ed can stop thrice-weekly dialysis thanks to a pig kidney.

A researcher on the Auckland pig project highlighted the severe global shortage of transplantable items such as tissue and organs. Kidneys account for 66 per cent of all transplants and comprise more than 80 per cent of patients on waiting lists. Many of the 2700 Kiwis on dialysis never make it to a transplant list, because they get too sick, or die.

The true need for organ transplants is estimated at 10 times the waiting list. End-stage renal disease costs an estimated $1 trillion over a decade.

Only 183 kidneys were transplanted in New Zealand last year, while 589 new cases of end-stage renal disease were confirmed.

The number of live donor transplants accounts for just under half of all kidney transplants. New Zealand has a lower organ donation rate than the United States, United Kingdom and Australia.

According to Organ Donation New Zealand only 62 deceased organ donations happened last year.

The Organ Donors and Related Matters Bill, now before the health select committee, encourages and supports live organ donors. The bill would introduce new payments for some donors, like those taking time off work for surgery. It also seeks to make it easier for New Zealanders to make their deceased organ donation wishes known to family and whānau, and would establish a national organ donation agency tasked with increasing deceased organ donation and transplantation rates.

If, like me, your driver's license says DONOR, you still might not ever be one if your family vetoes your wishes. My own whanau is divided over the issue: My mum said she feared doctors wouldn't try to save her life if she had a catastrophic accident and had ticked the organ donor box. While I can't guarantee this would never happen in Western society, I've seen critical care in action - doctors and nurses working to restore health, not seeing how quickly they could pull the plug to harvest a heart or capture a cornea.

I'm rooted in the "can't take it with you" camp. My will says if the opportunity arises, grab what's usable after I die. I've told my family I'll haunt them if they don't comply.

My daughter, Miss 15, had a kidney removed two days after birth due to a benign mass. Our running gag is we had her younger brother for spare parts. She'll point at his midsection and say, "I've got dibs on that kidney!" Fact is, most people with one kidney live healthy, normal lives with no problem.

But for thousands of Kiwis who need a new kidney, liver, lung, heart… waiting for an organ is no joke, it's the difference between life and death.

According to an April article in The Listener, our deceased donation rate of fewer than 13 per million in 2018 is lower than the 21 in Australia, 23 in the UK, 32 in the US and 46 in Spain. Spain's consent process for organ donation is opt-out. It's time New Zealand adopt the same system. Anyone with a strong objection to organ donation after they died could make it known beforehand.

It's working for KiwiSaver: employees between ages 18 and 64 would have been enrolled into a KiwiSaver fund unless they opted out. The plan has been credited with allowing thousands of New Zealanders to buy a first home. Imagine what could happen if opt-out happened when the stakes were much higher? How many lives would be saved? What a waste to imagine serviceable organs awash in embalming fluid, which will eventually decompose in the grave, rather than save someone else's life.

We must work to overcome psychological barriers to organ donation including fear and mistrust of the medical system.

An op-ed recently in the Los Angeles Times marked the anniversary of the death of Nicholas Green. The seven-year-old was shot and killed after two masked gunmen ambushed the family in their car in southern Italy. Nicholas died 25 years ago on the first of October. His father, Reg Green, wrote the only solace the family has had in the wake of his son's death came from the decision they made to donate Nicholas' organs and corneas. His heart was transplanted into the chest of a 15-year-old boy, who lived with it for 23 years.

In the decade following Nicholas' death, the rate of organ donation in Italy tripled. No other country has touched that growth rate. The phenomenon was called "the Nicholas Effect". Because of the Greens, people around the world suddenly became aware if someone they loved died of a brain injury, they could save three or four families from devastation by choosing to give.

Reg Green, who has written a book called The Nicholas Effect and also advocates for organ donation, says the decision to donate offers benefits beyond saving lives, "Organ donation leaps the barriers between us: The hearts of black women beat inside white women — and vice versa. Muslims are breathing through Jewish lungs — and vice versa."

The laws of thermodynamics say energy cannot be created or destroyed, only converted from one form to another. You have the potential to convert the energy of your body after death into life-saving components. You might turn another family's tragedy to triumph - but you must tell your own family first.

Take your organs to the grave, if you like. I'd rather help a human than play pinochle with the worms.