April 28, 2014 2 Comments
These last few days I’ve been updating my FAQ page on body/ brain/ organ donation and I thought it’s perhaps time to also share my thoughts and observations based on the my conversations with prospective donors.
One thing I notice repeatedly is a significant communication gap between the person who wants to donate his/ her body and the family members who will actually have to do the required donation and sign the consent forms.
One example of a gap is when the prospective donor does not want the family to decide how to dispose the body after death. These donors believe that if they have signed up for donor programs, family members will be obliged to respect their wishes. Some such donors even consider a donation enrolment as equivalent of a “will.” Alas, they are mistaken. There is no legal obligation on the family members to donate a body just because the donor wanted this to be done. The next-of-kin decide how the body may be disposed; they select the way (cremation, burial, donation) and rituals depending on what they want (unless the death is “unnatural”, which then involves police and autopsies and stuff).
A couple of persons I talked to were not even on talking terms with immediate family members. They would not inform them of their travel plans or health problems or anything else, and had not told them about their desire to donate their bodies. They were so sure that their intention to donate was good enough to ensure donation happens that they hadn’t paused to think that it was this alienated family that would handle their body disposal after they died. The dead person does not exist any more, and cannot dispose off his own body.
Some donors tell the family what they want, but the family is not convinced. The topic is not discussed much, because everyone is uncomfortable talking about it. Even if the immediate family is almost convinced, the topic is not broached with the larger familial or social circle. Donors don’t realize that this is likely to result in a failure to donate, because once they die, their immediate family members will face social pressure and pressure from relatives, and may find it easier to just opt for traditional modes of body disposal.
One amazing thing I noticed is that in many families, the elderly person is keen to donate, but faces a lot of protest from the children, even children who are scientists and doctors and who theoretically accept that body donation is good. These children cannot imagine Appa or Amma’s body being donated; they see it as disrespect (students cutting a body of a loved one) or hurtful (imagine taking out the eyes), but have no problem with seeing the body being buried or being burned on a pyre. This emotional barrier to donation makes discussion difficult. In some cases, the prospective donors persist till family members come around and agree that they will donate. In other instances, when the children get emotional and agitated, the parents stop talking about the donation.
I recently attended a function organized by one hospital for its registered voluntary body donors. The hall was full of elderly persons who had signed up as donors, but I saw hardly any middle-aged children who would probably have to coordinate/ perform the actual donation. I wondered why these elders were not accompanied by the children if the commitment to donate was a family commitment. It was a Sunday, so attending should not have been a problem. Were these elders living away from their children (empty nests are common now), or were the children not involved enough to come along, or did the elders not even inform them about the function? Wouldn’t this affect the probability of the donation actually happening?
Another thing I have noticed when talking to many prospective donors is that they (and their families) have not spent much time figuring out the nitty-gritties that have to be done to actually donate the body. They remain unclear about who has to be contacted after death, how to get the required certificate from the doctor in time, etc. It’s a morbid topic, sure. Somehow they assume (or hope?) that getting a donor card means the donation will be easy to do and don’t figure out the procedure to be followed as soon as the death occurs (or as soon as the family realizes the person is dead). The confusion and distress that kicks in when someone dies is not factored into the planning. Most donors and their families assume that the hospitals or doctors will guide the family through the donation process when the time comes. They don’t realize that body donation is so rare that most doctors don’t have much experience in it and will not be able to help. It was realization of such information gaps that had led me to create the FAQ page last year (this is the page I have now updated to improve clarity).
Thinking about and planning for body donation takes effort and commitment, because in our current setting, it is far simpler to use the conventional modes of cremation or burial. So a prospective donor’s efforts cannot stop after registering as a donor. Much needs to be done to make sure that this intention converts into an actual donation after death occurs. This includes ensuring that family members are convinced about the donation, and so are persons in the relatives/ social circles. Family members will need to act promptly after the death to coordinate the body donation, which means they need to be very conversant with the procedure and also have the required information readily accessible. Their commitment to actually donate the body must be reinforced periodically, so that it is not forgotten when the need arises. And additionally, planning may require steps like involving the family doctor and securing their commitment, and so on.
Oh, and my updated FAQ page is here: FAQ on Organ/ Body/ Brain/ Eye Donation. It is rather long, but hopefully it covers all areas where people need information. Do let me know if you have any suggestions.
P.S.: In the post above, the discussion on post-death procedures is in the context of normal death (cardiac death). For the other form of death, brain death, the person is already under the care of the team of doctors who declare the person brain dead and will guide the family through the process of organ donation. In brain death cases, organs can be donated if the family is comfortable donating organs of a person who is still on some sort of life support; the procedure is not the challenge as the person is already being tended to in a hospital that is equipped for accepting organs for transplant.
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