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Human tissue transplant bill to pave way for families to donate organs of deceased relatives

by Emmanuel Joseph
6 min read
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By Emmanuel Joseph

Barbados is preparing to introduce a major piece of legislation that would allow medical doctors to end “futile care” for brain-dead patients.  

Dr Margaret O’Shea, who has had input in the drafting of the Human Tissue Transplant Bill disclosed recently that the proposed law would also pave the way for the donation of the deceased’s organs. This move, she said, could potentially benefit hundreds of dialysis patients for whom kidney donation could offer a better alternative.

“When you are brain-dead there is no hope or chance of recovery and you are technically deceased. However, your body can be maintained on a ventilator. So rather than continue what one would call ‘futile care’, you can remove the patient from the ventilator. However, when you are brain-dead your heart is still beating and the law in Barbados does not allow a patient to be declared dead and taken off the ventilator as long as their heart is still beating,” Dr O’Shea explained during an interview with Barbados TODAY.

“Patients can be brain-dead on a ventilator for a prolonged period, and in those situations, the relatives may prefer to end the artificial life support because with brain death there is no chance of recovery. Also, maintaining a brain-dead patient on a ventilator still requires significant resources to keep the body viable. These resources may be re-directed to other patients who have a chance at survival,” the transplant surgeon explained.

“The legislation allowing for the declaration of death for brain-dead patients creates a significant opportunity for organ transplantation as you can approach relatives to offer them the opportunity to donate the organs of their loved ones to help someone who is still alive. Deceased donation in the setting of brain death is the best type of deceased donation as these organs are in the best shape. There is another type of deceased donation after the heart has stopped beating but these organs are not as ideal,” Dr O’Shea pointed out.

“There are two systems which may be adopted in the law. There is the ‘opt-in’ system where the relatives are approached for consent and the ‘opt-out’ where organ donation automatically occurs unless there is a request not to be a donor. This is known as presumed consent. 

“In the ‘opt-in’ system persons can also register to be organ donors before death or create a living will. The stakeholders are proposing the ‘opt-in’ system for Barbados. The recognition of registration to be a donor and living wills are not currently legal in Barbados but are also needed. Right now, you can will property, but you cannot direct what happens to your body,” the medical specialist noted.

She said that in some other jurisdictions, there is a provision called an advanced directive where a person could say ‘if I die I want to donate my organs’, or other such direction.  

This, the medical doctor added, needs to be put into law in Barbados.

“We are proposing the opt-in system for Barbados as we prefer to obtain the consent of the family vs presumed consent,” Dr. O’Shea contended.

“Towards the end of 2021 early 2022, we had stakeholder meetings with specialists at QEH, members of BAMP, the Ministry of Health and the Chief Parliamentary Counsel’s Office and a draft bill was developed. There are a few areas still to be clarified, and once that is completed, the proposed legislation should be put through the legal process for implementation,” the surgeon noted.

“Once the law is passed, there should be public sensitization to the benefits of the law, including that it forms a part of the Government’s healthcare plan and to encourage people to start having conversations with their relatives about whether they would wish to donate their organs in the event that they are diagnosed as brain-dead,” she advised.

Dr O’Shea said there is always a need for organ transplants in Barbados, particularly kidneys and corneas. 

“We have a huge dialysis population and this would give those people the ability to come off dialysis. There are about 400 dialysis patients in Barbados and it takes up 12 per cent of the hospital’s budget amounting to millions of dollars per year. Transplantation is not only good for the quality of life improvement, but it is also cost-effective,” the medical specialist explained.

She said the proposed law governs living donor transplantation and all other legal issues surrounding organ transplantation, such as prohibiting potential donors from being pressured or coerced, penalties for organ trafficking, and maintaining patient/donor confidentiality. 

The legislation contains a definition of brain death, how it is to be determined, and who is qualified to make that determination. 

Former Dean of the Faculty of Medicine at the Cave Hill Campus of the University of the West Indies (UWI) Professor Emeritus Sir Errol “Mickey” Walrond said efforts over the years to introduce legislation to deal with brain-dead matters, appeared to have been held back by certain members of the legal profession.

“That legislation has been presented over and over again. Again it is being presented and there seems to be always some legal hesitation. One of the most egregious hesitations is not putting in phrases where you or I could say ‘before I die, look, ‘I am happy to donate such and such or I am not happy’,’” Sir Errol told Barbados TODAY.

The retired surgeon, who was one of the medical experts invited by the government to comment on the proposed law, confirmed that the legislation also provides for minors’ protection from exploitation by their parents.

“It provides for many of the safeguards that are needed if you are going to get into any extensive programmes of transplantation. There are doctors that have gone to jail in places like the United Kingdom and in some states because they pirated organs for transplantation. But I think one essential part that is missing, in my opinion, is that you or I cannot say before we die, ‘I would like this organ, if it is suitable, transplanted’,” the pioneer in medical science stressed. emmanueljoseph@barbadostoday.bb

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