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Grappling with donation hesitancy: Is organ transplantation instilling fear or hope?

Traditionally, organ availability has relied on altruism expressed through organ donation as a “gift of life.”

With the advent of organ transplantation in the 1950s, surgeons were able to push the limits of life preservation, especially in patients with otherwise terminal illnesses. However, while organ transplantation has saved the lives of countless patients, it also faces a variety of issues.

To start, there are grave inequities surrounding organ transplantation rooted in wealth inequality and access to organs, which are often sourced from poor donors in developing countries like the Philippines for wealthy recipients in developed countries. Furthermore, a team of American surgeons was recently able to transplant a genetically modified pig kidney into a brain dead woman with no complications. The procedure, which has piqued the interest of many, raises important questions about how far we can take such an operation.

The gift of life 

As organ transplantation remains the most effective treatment method for end-stage organ disease, our modern healthcare system heavily relies on organ transplantation programs. However, despite the programs’ growth and achievements, the demand for transplantable organs often exceeds their availability.

Traditionally, organ availability has relied on altruism expressed through organ donation as a “gift of life.” Reliance on charity, however, has not improved organ shortages where the personal decision to donate may be influenced by doubt, mistrust, or lack of appropriate knowledge.

Resolving this issue requires a change in perspective on the human body after death. While prior knowledge regarding transplantation processes has been shown to increase willingness to donate, its portrayal in media and its association with human trafficking stories have discouraged many. 

With a life of its own

Within popular culture, the portrayal of medical procedures is often more sensational than accurate. For example, Mary Shelley’s Frankenstein introduces a discussion about organ donation and transplantation that reveals the darker aspects of modern medicine.  Similarly, there is a recurring narrative in popular fiction that persons are forced or deceived into giving up their organs for commerce.

Dr. Enrique Ona, former Department of Health (DOH) secretary, remarks that “the history of transplantation is full of fantastic stories.” These often began with cross-species organ transplantation which utilized the viscera of pigs and dogs in the hope of prolonging human life. 

But as the success of transplantation grew and as it became the best therapy for irreversible organ failure, the gap between organ demand and supply widened. It is this disparity that raises ethical considerations about the difference between organs sourced from donors that made conscientious, pressure-free decisions to save a loved one versus individuals who are offered large sums of money for their organs.

What’s in the way?

For Filipinos, the push to increase organ donations brings altruism at odds with the need to incentivize donation and to compensate for lost wages, job security, and mounting donor expenses. In fact, while the Philippines was listed as one of the top organ-exporting countries in 2007 by the World Health Organization, growing concerns over human trafficking and exploitation have led DOH to implement laws that combat these issues. 

Ona explains, “Our authorities reacted to certain abuses in the past…There were patients from other countries who came over and got a transplant from a poor donor. That was considered unacceptable and that’s really why a Department of Health order was passed.” He adds that, unfortunately, the public now associates organ transplantation with exploitation. “Stories spread as though this were a subject that was so horrible. And so, like [in] the Philippines, very few of our what we call brain dead or deceased donors donate their kidneys,” he furthers.

If we are to move forward from this problem, we should first understand the ethical concepts surrounding the said operation. Ona notes that there is very little understanding of the distinction between using human organs as “objects of commerce” and using payment as a token of gratitude when one is a recipient. 

Beyond ethics, however, organ transplantation’s biggest hurdle is organ rejection. Organs that need regular blood flow such as the kidneys, liver, heart, and lungs tend to have higher rates of rejection compared to the cornea in corneal transplants. “As a human being, you are unique. You have your own genetic makeup, and the challenge always is to prevent the body from rejecting what is not yours,” Ona clarifies.

Reinforcing the truth 

While popular notions surrounding organ replacement may leave the public engaged, they leave people misinformed and bring them to hesitate when faced with the option to engage in the operation. As audiences consume entertainment centered on dystopian worlds, the waitlist for organ transplant candidates grows.

While critiquing sensationalized depictions does not help in addressing organ scarcity, it serves as a starting point for people to respond to complex medical issues. Responding to mismatched realities of this practice with education may be the first step toward converting awareness on donating with consent. 

By Tiffany Blanquera

By Ysabel Dinsay

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