Recycle thyself

 

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Jemima Layzell

 

BBC: “Jemima Layzell, a 13-year-old girl who died from a brain aneurysm has helped…eight different people, including five children, through organ donation…no other donor had helped as many people. Jemima collapsed during preparations for her mum’s 38th birthday party and died four days later… Her heart, small bowel, and pancreas were transplanted into three different people while two people received her kidneys. Her liver was split and transplanted into a further two people, and both of her lungs were transplanted into one patient. Normally, a donation results in 2.6 transplants.”

As I got older, I stopped worrying about looking good – it never worked anyhow. Now it’s too late.  I started thinking more about my spare parts. They aren’t pretty, and they don’t smell good, (I learned that in Surgery,) but they keep me alive. My kidneys relieve me of my half-gallon of morning coffee, my liver lets me enjoy a glass of wine (or two), and thanks to my corneas and my many reading glasses, I can read, write, and look forward to “Game of Thrones.”

Like the matching gears of a well-oiled machine, your organs are essential to your life. Except for two: Your gallbladder – her life-goal is to make you crave French Fries and donuts, then shrink your clothes when you aren’t watching. And your appendix. He was invented to wake up grumpy surgeons and get you irradiated with CTs. But I digress.

Your organs let you enjoy life. Thanks to their good behavior, you can breathe well enough to make it to your grandkids’ soccer game, you can have a beer without drowning your lungs and you can enjoy a burger without turning yellow.

Some are not so lucky.

My patient L., a woman in her thirties, died slowly. She came back week after week, so I can drain the fluid from her abdomen to help her breathe, after alcohol had killed her liver.

After his heart attack, G.’s heart started failing. He was 58. His heart didn’t have the strength to pump the blood out of his soggy lungs. They filled with fluid. His breathing suffered. He barely walked to the bathroom. He couldn’t lay flat, so he slept in a recliner on the good days when he was home. Those days got fewer and fewer.

M, a beautiful woman in her twenties, was pregnant. Her kidneys had been iffy for a while. Her pregnancy didn’t help. A second pregnancy put her on the transplant list. There were no matches but her mother. She got rejected because her tests weren’t good enough. M. waited and waited on the transplant list, wondering what would happen to her kids.

Let’s talk transplant. That’s getting refurbished with other people’s spare parts. Like fixing a car, except we’re talking new lungs instead of new breaks. Taking parts from the dead to fix the live ones? No brainer! Well, it’s a brainer. Transplants are difficult. Transplants are expensive. Transplants are restrictive.

Organs are scarce. As per UNOS, on March 9th2019, there were 113710 people waiting for an organ. Mostly kidneys, followed by livers and hearts. The waiting times vary widely. The average wait for an eight-year-old needing a kidney was 920 days. Every day, twenty people die waiting. Every 10 minutes, another person is added to the waiting list. Still, people take their organs with them, when they die.

Does God need your organs? Apparently not. As per organdonor.gov, most religions allow organ donation “Organ, eye, and tissue donation is considered an act of charity and love, and transplants are morally and ethically acceptable to the Vatican. (Pope John Paul II, Evangelium Vitae, no. 86)”.

In the US, you need the donor’s consent to use their organs, no matter how dead they are. Even though God may need their soul, but probably doesn’t need their heart.

In Europe, twenty-four countries operate under presumed consent. Unless you opt out, your organs are available for somebody who needs them more. Spain is #1, with 35.1 donors per million population, compared to 26 per million in the US.

In China, the organs of executed prisoners are available for transplant. Since their consent is questionable, this practice is widely condemned. I’m a pragmatist. A dead person does not need a liver. Consent? Have they consented to be executed? If you don’t need consent to kill people, do you need consent to take their liver? Is the societal good enough to compensate for the harm of the individual? Is there harm done by removing a dead person’s liver? What if that person’s liver results in cash for the Chinese government? Some say that death row prisoners get executed on command, to provide an organ for an approved match. This is a can of worms I’m not competent to handle. Others have. Ethicists, philosophers, politicians.

Selling human organs is illegal in most of the world. Not so in Iran and the Philippines. Forbes: Selling Your Organs: Should it be Legal? Do You Own Yourself? “there is evidence that the financial incentive works. Organ sales are permitted in the Philippines as long as the donor recipients are natives. A Filipina organ recipient says: “Nobody would donate a kidney without getting paid.” Iran uses a hybrid system… vendors sell their organs to the government, which acts as an intermediary. It pays them and gives them free health insurance for one year. Donor recipients must be Iranian and they are required to work to pay for the cost of their organs. The system has virtually wiped out the waiting lists.”

This opens the door to organ trafficking. People whose kids are starving may sell parts of themselves in order to feed them, supplying the black market.

How does one find human organs though? How much do they cost? I googled “Human organs for sale.” eBay responded: “Organs For Sale Sold Direct – eBay – Fantastic Prices on Organs for Sale.” I clicked. “Nord C2 Organ Keyboard synthesizer in excellent condition.” No good. I tried again. I came up with: “Kidney for Sale by Owner: Human Organs, Transplant. Preowned.” $4.48. Cheap, I thought, but it was just a paperback.

According to Havocscope.com, Global Black-Market information, the asking price for a lung in Europe is $312.650 (you’d think they’d quote it in Euros and round a bit.) The average price paid for a kidney is $150K. Out of that, $5K goes to the kidney provider. The rest is shared between the middlemen.

Aljazeera: “The illicit kidney trade… has exploded as brokers use social media to find donors. This gaping hole between demand and the legal supply of kidneys is being filled by …the world’s biggest black market for organs, which crisscrosses India, Nepal, Bangladesh, Pakistan, Sri Lanka, and Iran.”

 The black market is, by definition, unregulated. Many donors found themselves penniless, without a kidney and without recourse. As always, the poor, the uninformed, the vulnerable.

In our society, you can’t pay for organs. You can pay for insurance, for hospitalization, for cancer treatment. You pay for food. Not for organ donation. That’s done for love. How many people do you love enough to give them a kidney? The lack of a legal market leads to functional organs being discarded, to sick people dying while waiting for them, and to a thriving black market praying on the vulnerable.

Legalizing organ markets would actually save money in healthcare. ABS-CBN news“Kidney transplant patients… enjoy a better quality of life… It is also cheaper…The cost of kidney dialysis in the US averages about $44,000 per year per patient…Separate studies conducted by the UMMC and the Washington University School of Medicine in St. Louis indicate that the “break-even” cost of kidney transplants is shrinking. The Washington University School of Medicine study stated that, given reduced transplantation and post-transplantation costs, society could pay each donor $90,000 and easily break even.”

No can do.  Selling organs is not ethical. Is selling antibiotics, vaccines, epinephrine, ethical? It’s legal! How is selling organs different? It’s legal to bury – or cremate – your heart, liver, corneas, after you crushed your brain in a motorcycle accident or overdosed on Fentanyl. Is it ethical?  What if there’s a mother watching her kid die, in need of a heart? How about the husband hoping a kidney for the mother of his two kids? How about the parents waiting for a match for their toddler? What if this was your kid?…your mom?… your wife?

How about recycling myself, I thought. I looked it up. My chances are mixed – kidneys and lungs look good, but my heart’s too old. Thankfully, she doesn’t know it.  If I want to recycle, I’d better die soon, and die healthy.

In a world where we recycle beer bottles, we make old clothes into quilts and remake the same movies, how about ultimate recycling? How about recycling yourself? I don’t know about you, but I love looking at houses for sale. I’m obsessed with traveling. I dream of alternative lives. Who would I be if I was born in Peru, petting llamas? In Portugal, fishing for octopus in clay pots? In Egypt, drinking mint tea instead of wine?

What if my heart got to live again, beating inside the bony chest of a teenager for his first kiss? Inside a mother holding her child? Inside a bride? Would it add to the joy of the universe? Would my spirit soar? Maybe not.

But even if I won’t be there to enjoy it, the recipient would. So would her family, her friends, her dog. So would my husband and my son. They’d know that somewhere in the world, my heart still beats, and loves them still. They may feel less alone.

Are you in? If so, what should you do?

  1. Tell your family. They need to hear it from you, not from some stranger asking them for your heart before it even got to stop.
  2. Start here. They’ll redirect you to your state site. Like fish, guests and French baguettes, organs go stale in a hurry. The closer the recipient, the better the results.
  3. Live well. Be happy. Be generous and kind. Live as if death can’t touch you.

But if the day comes…If that car comes too fast…if that floor is too slippery…if tomorrow never comes…Won’t it be good to have your heart love again in somebody’s chest? See the world through somebody’s eyes? Piss somebody else’s beer?

Rada Jones, MD is an Emergency Doc in Upstate NY, where she lives with her husband Steve and his deaf black cat Paxil. Her ER thriller, OVERDOSE, is now on Amazon.