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She’s been called both crazy and amazing for donating an organ to a stranger, but Annemieke Vanneste may be what scientists call a ‘super altruist.’ In the wake of Eugene Melnyk’s high-profile transplant plea, Elizabeth Payne tracks at the rise of the ‘live donor’ and the ethical quandaries they raise.
Annemieke Vanneste spent last Christmas in a hospital bed trying not to roll on her side and dealing with some nasty side effects from painkillers.
The Ottawa woman wasn’t there because of an accident or a disease, or even a mental illness — although there was a time when some thought people like Vanneste must be crazy.
Why else would anyone eagerly choose to give one of her kidneys to a complete stranger?
The title of a 2003 scientific research paper captured the skepticism of the time: “The living anonymous kidney donor: lunatic or saint?” it asked.
Times have changed. Living organ donors like Vanneste are now responsible for a significant number of organs transplanted each year. Living donors even slightly outnumber deceased donors in Canada when it comes to kidney transplants. In 2013, there were 588 living organ donations in Canada, compared to 553 deceased organ donations.
Two high-profile cases this year — the Ottawa Senators’ extraordinary plea for a liver donor to save team owner Eugene Melnyk’s life, and a Kingston family’s plea for a liver to save one of their twin Vietnamese toddlers — have put living organ donation in the spotlight.
Most living donors are family members or close friends. Anonymous donors, like Vanneste, are still relatively rare, but are increasingly important to transplant programs.
Sisters Caroline and Annemieke Vanneste are both living organ donors: Caroline, left, gave her kidney to a friend and Annemieke gave hers to a stranger.
Vanneste is no saint, she insists, although the facts aren’t entirely convincing.
The 54-year-old agreed to undergo surgery to have her kidney removed on Dec. 24, meaning she would spend Christmas at Toronto General Hospital instead of at home in Ottawa with family and friends. She was given the option of changing the date, but declined.
“They offered me Dec. 24 and I said that would be the coolest Secret Santa gig ever. I think the symbolism is pretty cool.”
Vanneste is naturally altruistic and may even be part of a rarer group of extreme altruists whose unusually empathetic brains have been the subject of recent research. They are so unusual that they are sometimes treated with suspicion. Researchers note that anonymous donors they studied were often reluctant to talk about their stories because of the negative reaction they sometimes get.
Vanneste works with disabled children at Crystal Bay Centre for Special Education in Ottawa’s west end and has a second job working in a group home with developmentally disabled adults. She is also a frequent blood donor and a regular volunteer (she and her rescue dog Rory visit the dementia wing of an Ottawa nursing home every second Sunday).
She has witnessed the benefits of organ donation within her own family — her sister Caroline also donated a kidney last year, to a friend. Vanneste’s brother-in-law, Dr. Aubrey Goldstein, who is president of the Canadian Transplant Association, received a liver from a deceased donor in 1998.
The desperate need for donated organs is something members of the family understand well. Caroline Vanneste said she donated to a friend after getting to know so many people who had benefitted from organ transplants through her husband’s involvement with the Canadian Transplant Association. “I met a lot of people who had benefitted from transplant. I felt that I had this advantage and thought I should share some of my health somehow,” said Caroline.
For her sister Annemieke, becoming an anonymous donor made perfect sense.
Vanneste, who is petite and fit, has been called crazy. More frequently, though, she is called amazing. She says she is just someone who appreciates the difference an organ can make to a person in need, at relatively little cost to a healthy donor.
“Most people’s reaction is ‘Oh my god, you are amazing,’” she says. “No, I don’t see myself as being all that amazing. Yes, it is amazing for the recipient. But I am not amazing.”
Just 11 years after the first living anonymous donor kidney transplant was performed in Canada — in Vancouver in 2004, — people like Vanneste, while still the exception, are becoming better understood and increasingly relied on to save lives.
Dr. David Landsberg, medical lead of the kidney transplant program at St. Paul’s Hospital in Vancouver, and the chairman of Canadian Blood Services’ Living Donor Advisory Committee, was an author of the paper that asked whether anonymous donors are “lunatics or saints”. He admits he had to be convinced. His initial reaction was “We can only do surgery on people who are sane and by definition giving a kidney to a stranger is an act of insanity. I didn’t think it was the right thing to do and people challenged me.”
His research to study the question proved his concerns unfounded. Most anonymous donors, it found, were psychologically intact and very altruistic.
“For years we have treated these people like they are nuts,” says Linda Wright, director of bioethics at the University Health Network in Toronto, which includes North America’s largest living liver donor program. “They are not.”
Many observers were surprised at the overwhelming response to the plea on behalf of Eugene Melnyk. Within a week, hundreds of people had answered the call, many of whom had no idea you could even donate part of your liver until they heard about Melnyk’s desperate plight. A donor who volunteered to have up to 70 per cent of his or her liver removed and transplanted into the critically ill businessman was selected. The surgery was a success and both donor and recipient are recovering. The donor remains anonymous, both to the public and to Melnyk, at least for now.
The case raised awareness about the chronic shortage of organs — something the Senators are vowing to make the focus of a public campaign — as well as the growing trend of transplants from living organ donors.
It also raised numerous ethical questions.
For one, performing surgery on a healthy patient is a violation of the hippocratic oath’s pledge to do no harm.
Careful attention to donor screening and informed consent, in addition to advances in medical technology, help balance the risk donors face by undergoing surgery. “In general, you will find there is an enormous amount of work done to make sure the donation is as safe as possible for the donor,” said Dr. Katherine Tinckham, who is medical adviser on transplantation for the Canadian Blood Services, which runs a program to match kidney donors with recipients. In Canada, more than 97 per cent of living donor kidney transplants are successful, she said.
That does not mean there are not risks.
Liver donation, especially to an adult recipient, which requires that a larger portion of the donor liver be removed than with a donation to a child, comes with more risks than kidney donation. One study put the risk of death for living liver donors at one in 500, while the risk of death for living kidney donors is about one in 3,200, according to a study published in the Journal of the American Medical Association in 2010.
In the United States, five living liver donors have died.
Toronto General Hospital, part of University Health Networks, which is home of the biggest living liver transplant program in North America, has had no deaths among nearly 700 donors since the program began more than a decade ago. But Dr. Gary Levy, who now leads the living donor liver program there, says that does not mean there are not risks. About 40 per cent of donors experience complications, ranging from pain to infection, pneumonia and other symptoms.
The information package given by the hospital to prospective liver donors has this to say about risk: “It is worth noting that the risk of death is higher after live donation than the risk of death after routine bypass surgery.”
Kidney donations are not as risky. They can be done laparoscopically or, as with Vanneste, with a micro-incision. Donating a liver is a much longer procedure and requires more recovery time, although livers grow back to full size within a matter of months and donors go on to lead normal lives. Still, donating a kidney is no picnic, notes Arthur Caplan, head of the division of medical ethics at New York University. “Most transplant surgeons have two kidneys; if it was so easy, they wouldn’t.”
Balancing potential risks with benefits makes sense for family members or close friends who have a strong incentive to want to help their loved one survive and become healthy again. It is also slightly safer for the recipient to receive an organ from a living donor rather than a deceased donor, and more likely to succeed.
But what benefits do anonymous donors get that balance the potential risks?
Vanneste has a simple answer. Watching her brother-in-law turn from jaundice to pink after his liver transplant made her understand the life-saving difference the gift of an organ can make.
Annemieke Vanneste shows her butterfly tattoo.
“It was incredible. I had already signed my donor card years before this, but that was when it really hit home how important this was.”
“There are people in this world who do an awful lot for other people and want very little for themselves,” says Wright, the University Health Network bioethicist. “Those people exist. Our job is to do a good evaluation process, to make sure it is as safe as possible and they are fully apprised of the risks and benefits, and we do that in spades.”
Still, the rise of living donations is not embraced by all.
Ronnie Gavsie, president and CEO of Ontario’s Trillium Gift of Life Network, which oversees deceased organ donations, says that with enough deceased donors, no one would have to ask for a living donor.
“Living donors are amazing, they offer an incredible gift, but it is a gift that should never be required,” she said.
Many involved with living donation programs agree that more donations from the deceased are needed, and in fact, Ontario has seen an increase in both the numbers of people becoming organ donors and in transplants, according to the Trillium Gift of Life Network. But there remain more than 1,620 Ontario residents on the most medically urgent wait list for a transplant, with hundreds of others waiting as well.
Trillium is encouraging people to not only sign donor cards but to talk with family members about their wishes, something Ottawa’s Kathleen and Gordon Stringer say they did with their daughter Rowan, whose organs were donated after she died following a high school rugby match in 2013.
In 2012, 256 Canadians died while on waiting lists for donated organs. Despite improvements in Ontario in getting people to sign organ donor cards, the demand continues to outpace the supply.
It’s no surprise, then, that people waiting for kidney and liver transplants know their chances of survival are higher if they can find a living donor, whether a relative or friend or even a stranger.
Related
The nature of living organ donations is changing. Officials expect more social media campaigns in search of donors and are working on national guidelines to help transplant centres handle such cases.
Eugene Melnyk was not the first to make a public plea for a donated organ, but his case was a game-changer in Canada. His high profile as the owner of a National Hockey League team gave him a platform that most in desperate need of an organ do not have, critics say.
There is an intrinsic unfairness to finding a living donor, says Wright. Some people have more compelling stories than others. Some have no family members able to donate and little ability to make a compelling public plea.
Wright says such public appeals have the potential to balance some of the intrinsic unfairness of living donations. People without family or friends who are able or willing to donate can make a plea for a stranger to direct an organ donation to them.
And such cases can indirectly benefit people on organ waiting lists by moving them up. Melnyk’s high-profile plea not only took him off the waiting list for a deceased donor, allowing others to move up, but resulted in between 25 and 30 people who agreed to consider donating their livers anonymously to someone else in need. That, said Wright, is a huge win.
Eugene Melnyk (L) of the Ottawa Senators stands next to double-lung transplant receipent Helene Campbell (R).
Still, social media campaigns raise ethical questions that many transplant programs are questioning how to deal with.
Arthur Caplan, the bioethicist at New York University, says social media campaigns advantage the “rich and the photogenic.”
“It means that the squeaky wheel commands the most attention, and that doesn’t square with who has the most urgent need.”
Caplan would like to see a regulatory system in place in which organs from anonymous donors go to whoever is the best match or neediest.” Family and friends could still direct their donations under such a system.
“The bottom line is if we wanted to get the maximum good out of people’s willingness to help, it would be nice to have a system similar to the cadaver system (a donor waiting list).”
Then there is the question of what donor programs do when a recipient offers a lavish thank you to a donor. There are laws forbidding the exchange of money or goods for an organ, but among family and friends that can become complicated.
Although the University Health Network says its donor screening program works hard to weed out any less than altruistic motives among organ donors, it is almost impossible to stop recipients from saying thank you to close friends or family members.
Levy, from Toronto General Hospital, said a young man who had donated part of his liver to his father asked him to come outside after a routine post-surgery checkup. When he got there, the young organ donor showed Levy the new Maserati his father had bought him.
“If we think giving of gifts through a familiar relationship is not going to happen we are thinking wrong,” Levy said.
Perhaps more worrisome is the potential for coercion within families — something Levy and others say screening programs should be designed to weed out.
There is also the potential for psychological problems among donors whose organ was rejected in the recipient or in cases in which the recipient dies. In families, or among friends, a donor may feel the gift is not properly appreciated, especially if the recipient doesn’t take care of his or her health.
The potential for subtle coercion should be considered carefully when screening donors, noted Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, in a 2006 paper about living organ donation consent. “When the recipient is a family member, a donor may feel morally obligated to donate, but, in reality, may not want to.”
Support for donors before and after surgery and thorough psychological screening to make sure they understand the risks, benefits and what to expect, can prevent most serious after-effects and make sure consent is clearly understood, Wright says.
As many as a quarter of live donors experience either depression or financial hardship after donating an organ, according to a 2002 paper. It is one reason, Caulfield argued, that transplant programs need a comprehensive disclosure policy “that aims to provide donors with all information relevant to the donation process.”
Many donors, however, report psychological benefits.
“The vast majority of living kidney donors say they are very glad they did it and they would do it again if they could,” says Caulfield. Among other things, living kidney donors say the act improved their relationships with other people and, in many cases, increased their self esteem.
“That is also because we are getting pretty good at selecting suitable donors,” said Wright.
Binh, left, and Phuoc Wagner’s father gave part of his liver to his daughter Phuoc.
‘Wear my scar with pride’
In March, on the three-month anniversary of donating her right kidney to a stranger, Vanneste got a tattoo on the inside of her wrist. The monarch butterfly wing and green ribbon is the symbol of living organ donors.
Like her scar, Vanneste wears her tattoo with pride. She gladly tells anyone who is curious what it stands for. In fact, she says she would do it again, this time to donate part of her liver, if the need arises in her family and she is the best match.
She wants people to hear her story, to know it is possible to do what she did.
Vanneste has never met the woman who received her kidney, but she did send her a letter, just to let her know she was OK after the surgery.
“I told her I was honoured to have done it, that I would wear my scar with pride and that the only regret I had was that I should have learned to sleep on my back.”
Six months after surgery, Vanneste has a small scar, a symbolic tattoo and a T-shirt (“I gave my spare”), to show for her act of kindness.
And this: “I know I saved someone’s life. It gives you a real sense of accomplishment.”
Organ transplants in Canada, by the numbers
4,500: People waiting for organ transplants.
256: People on waiting lists who died before receiving transplants in 2012.
2,124: Organs transplanted in 2012.
17%: Increase in the rate of deceased donors rate in Canada between 2003 and 2012, from 13.3 to 15.5 donors per million population. Canada is still outpaced by Spain, the U.S., France and the United Kingdom.
421: Deceased donors in 2003.
540: Deceased donors in 2012.
— Sources: Canadian Blood Services, Canadian Institute of Health Information
Get more information on being a living donor:
• Canadian Blood Services’ kidney matching program.
• University Health Network multi-organ transplant program.
And register to donate your organs and tissues after death here: Register for organ donation in Ontario
查看原文...
Annemieke Vanneste spent last Christmas in a hospital bed trying not to roll on her side and dealing with some nasty side effects from painkillers.
The Ottawa woman wasn’t there because of an accident or a disease, or even a mental illness — although there was a time when some thought people like Vanneste must be crazy.
Why else would anyone eagerly choose to give one of her kidneys to a complete stranger?
The title of a 2003 scientific research paper captured the skepticism of the time: “The living anonymous kidney donor: lunatic or saint?” it asked.
Times have changed. Living organ donors like Vanneste are now responsible for a significant number of organs transplanted each year. Living donors even slightly outnumber deceased donors in Canada when it comes to kidney transplants. In 2013, there were 588 living organ donations in Canada, compared to 553 deceased organ donations.
Two high-profile cases this year — the Ottawa Senators’ extraordinary plea for a liver donor to save team owner Eugene Melnyk’s life, and a Kingston family’s plea for a liver to save one of their twin Vietnamese toddlers — have put living organ donation in the spotlight.
Most living donors are family members or close friends. Anonymous donors, like Vanneste, are still relatively rare, but are increasingly important to transplant programs.
Sisters Caroline and Annemieke Vanneste are both living organ donors: Caroline, left, gave her kidney to a friend and Annemieke gave hers to a stranger.
Vanneste is no saint, she insists, although the facts aren’t entirely convincing.
The 54-year-old agreed to undergo surgery to have her kidney removed on Dec. 24, meaning she would spend Christmas at Toronto General Hospital instead of at home in Ottawa with family and friends. She was given the option of changing the date, but declined.
“They offered me Dec. 24 and I said that would be the coolest Secret Santa gig ever. I think the symbolism is pretty cool.”
Vanneste is naturally altruistic and may even be part of a rarer group of extreme altruists whose unusually empathetic brains have been the subject of recent research. They are so unusual that they are sometimes treated with suspicion. Researchers note that anonymous donors they studied were often reluctant to talk about their stories because of the negative reaction they sometimes get.
Vanneste works with disabled children at Crystal Bay Centre for Special Education in Ottawa’s west end and has a second job working in a group home with developmentally disabled adults. She is also a frequent blood donor and a regular volunteer (she and her rescue dog Rory visit the dementia wing of an Ottawa nursing home every second Sunday).
She has witnessed the benefits of organ donation within her own family — her sister Caroline also donated a kidney last year, to a friend. Vanneste’s brother-in-law, Dr. Aubrey Goldstein, who is president of the Canadian Transplant Association, received a liver from a deceased donor in 1998.
The desperate need for donated organs is something members of the family understand well. Caroline Vanneste said she donated to a friend after getting to know so many people who had benefitted from organ transplants through her husband’s involvement with the Canadian Transplant Association. “I met a lot of people who had benefitted from transplant. I felt that I had this advantage and thought I should share some of my health somehow,” said Caroline.
For her sister Annemieke, becoming an anonymous donor made perfect sense.
Vanneste, who is petite and fit, has been called crazy. More frequently, though, she is called amazing. She says she is just someone who appreciates the difference an organ can make to a person in need, at relatively little cost to a healthy donor.
“Most people’s reaction is ‘Oh my god, you are amazing,’” she says. “No, I don’t see myself as being all that amazing. Yes, it is amazing for the recipient. But I am not amazing.”
Just 11 years after the first living anonymous donor kidney transplant was performed in Canada — in Vancouver in 2004, — people like Vanneste, while still the exception, are becoming better understood and increasingly relied on to save lives.
Dr. David Landsberg, medical lead of the kidney transplant program at St. Paul’s Hospital in Vancouver, and the chairman of Canadian Blood Services’ Living Donor Advisory Committee, was an author of the paper that asked whether anonymous donors are “lunatics or saints”. He admits he had to be convinced. His initial reaction was “We can only do surgery on people who are sane and by definition giving a kidney to a stranger is an act of insanity. I didn’t think it was the right thing to do and people challenged me.”
His research to study the question proved his concerns unfounded. Most anonymous donors, it found, were psychologically intact and very altruistic.
“For years we have treated these people like they are nuts,” says Linda Wright, director of bioethics at the University Health Network in Toronto, which includes North America’s largest living liver donor program. “They are not.”
Many observers were surprised at the overwhelming response to the plea on behalf of Eugene Melnyk. Within a week, hundreds of people had answered the call, many of whom had no idea you could even donate part of your liver until they heard about Melnyk’s desperate plight. A donor who volunteered to have up to 70 per cent of his or her liver removed and transplanted into the critically ill businessman was selected. The surgery was a success and both donor and recipient are recovering. The donor remains anonymous, both to the public and to Melnyk, at least for now.
The case raised awareness about the chronic shortage of organs — something the Senators are vowing to make the focus of a public campaign — as well as the growing trend of transplants from living organ donors.
It also raised numerous ethical questions.
For one, performing surgery on a healthy patient is a violation of the hippocratic oath’s pledge to do no harm.
Careful attention to donor screening and informed consent, in addition to advances in medical technology, help balance the risk donors face by undergoing surgery. “In general, you will find there is an enormous amount of work done to make sure the donation is as safe as possible for the donor,” said Dr. Katherine Tinckham, who is medical adviser on transplantation for the Canadian Blood Services, which runs a program to match kidney donors with recipients. In Canada, more than 97 per cent of living donor kidney transplants are successful, she said.
That does not mean there are not risks.
Liver donation, especially to an adult recipient, which requires that a larger portion of the donor liver be removed than with a donation to a child, comes with more risks than kidney donation. One study put the risk of death for living liver donors at one in 500, while the risk of death for living kidney donors is about one in 3,200, according to a study published in the Journal of the American Medical Association in 2010.
In the United States, five living liver donors have died.
Toronto General Hospital, part of University Health Networks, which is home of the biggest living liver transplant program in North America, has had no deaths among nearly 700 donors since the program began more than a decade ago. But Dr. Gary Levy, who now leads the living donor liver program there, says that does not mean there are not risks. About 40 per cent of donors experience complications, ranging from pain to infection, pneumonia and other symptoms.
The information package given by the hospital to prospective liver donors has this to say about risk: “It is worth noting that the risk of death is higher after live donation than the risk of death after routine bypass surgery.”
Kidney donations are not as risky. They can be done laparoscopically or, as with Vanneste, with a micro-incision. Donating a liver is a much longer procedure and requires more recovery time, although livers grow back to full size within a matter of months and donors go on to lead normal lives. Still, donating a kidney is no picnic, notes Arthur Caplan, head of the division of medical ethics at New York University. “Most transplant surgeons have two kidneys; if it was so easy, they wouldn’t.”
Balancing potential risks with benefits makes sense for family members or close friends who have a strong incentive to want to help their loved one survive and become healthy again. It is also slightly safer for the recipient to receive an organ from a living donor rather than a deceased donor, and more likely to succeed.
But what benefits do anonymous donors get that balance the potential risks?
Vanneste has a simple answer. Watching her brother-in-law turn from jaundice to pink after his liver transplant made her understand the life-saving difference the gift of an organ can make.
Annemieke Vanneste shows her butterfly tattoo.
“It was incredible. I had already signed my donor card years before this, but that was when it really hit home how important this was.”
“There are people in this world who do an awful lot for other people and want very little for themselves,” says Wright, the University Health Network bioethicist. “Those people exist. Our job is to do a good evaluation process, to make sure it is as safe as possible and they are fully apprised of the risks and benefits, and we do that in spades.”
Still, the rise of living donations is not embraced by all.
Ronnie Gavsie, president and CEO of Ontario’s Trillium Gift of Life Network, which oversees deceased organ donations, says that with enough deceased donors, no one would have to ask for a living donor.
“Living donors are amazing, they offer an incredible gift, but it is a gift that should never be required,” she said.
Many involved with living donation programs agree that more donations from the deceased are needed, and in fact, Ontario has seen an increase in both the numbers of people becoming organ donors and in transplants, according to the Trillium Gift of Life Network. But there remain more than 1,620 Ontario residents on the most medically urgent wait list for a transplant, with hundreds of others waiting as well.
Trillium is encouraging people to not only sign donor cards but to talk with family members about their wishes, something Ottawa’s Kathleen and Gordon Stringer say they did with their daughter Rowan, whose organs were donated after she died following a high school rugby match in 2013.
In 2012, 256 Canadians died while on waiting lists for donated organs. Despite improvements in Ontario in getting people to sign organ donor cards, the demand continues to outpace the supply.
It’s no surprise, then, that people waiting for kidney and liver transplants know their chances of survival are higher if they can find a living donor, whether a relative or friend or even a stranger.
Related
- Organ transplants — without a donor?
- Inside the brains of extreme altruists
- Do you have what it takes to be a living organ donor?
- New transplant guidelines could end high-profile pleas like Melnyk's
The nature of living organ donations is changing. Officials expect more social media campaigns in search of donors and are working on national guidelines to help transplant centres handle such cases.
Eugene Melnyk was not the first to make a public plea for a donated organ, but his case was a game-changer in Canada. His high profile as the owner of a National Hockey League team gave him a platform that most in desperate need of an organ do not have, critics say.
There is an intrinsic unfairness to finding a living donor, says Wright. Some people have more compelling stories than others. Some have no family members able to donate and little ability to make a compelling public plea.
Wright says such public appeals have the potential to balance some of the intrinsic unfairness of living donations. People without family or friends who are able or willing to donate can make a plea for a stranger to direct an organ donation to them.
And such cases can indirectly benefit people on organ waiting lists by moving them up. Melnyk’s high-profile plea not only took him off the waiting list for a deceased donor, allowing others to move up, but resulted in between 25 and 30 people who agreed to consider donating their livers anonymously to someone else in need. That, said Wright, is a huge win.
Eugene Melnyk (L) of the Ottawa Senators stands next to double-lung transplant receipent Helene Campbell (R).
Still, social media campaigns raise ethical questions that many transplant programs are questioning how to deal with.
Arthur Caplan, the bioethicist at New York University, says social media campaigns advantage the “rich and the photogenic.”
“It means that the squeaky wheel commands the most attention, and that doesn’t square with who has the most urgent need.”
Caplan would like to see a regulatory system in place in which organs from anonymous donors go to whoever is the best match or neediest.” Family and friends could still direct their donations under such a system.
“The bottom line is if we wanted to get the maximum good out of people’s willingness to help, it would be nice to have a system similar to the cadaver system (a donor waiting list).”
Then there is the question of what donor programs do when a recipient offers a lavish thank you to a donor. There are laws forbidding the exchange of money or goods for an organ, but among family and friends that can become complicated.
Although the University Health Network says its donor screening program works hard to weed out any less than altruistic motives among organ donors, it is almost impossible to stop recipients from saying thank you to close friends or family members.
Levy, from Toronto General Hospital, said a young man who had donated part of his liver to his father asked him to come outside after a routine post-surgery checkup. When he got there, the young organ donor showed Levy the new Maserati his father had bought him.
“If we think giving of gifts through a familiar relationship is not going to happen we are thinking wrong,” Levy said.
Perhaps more worrisome is the potential for coercion within families — something Levy and others say screening programs should be designed to weed out.
There is also the potential for psychological problems among donors whose organ was rejected in the recipient or in cases in which the recipient dies. In families, or among friends, a donor may feel the gift is not properly appreciated, especially if the recipient doesn’t take care of his or her health.
The potential for subtle coercion should be considered carefully when screening donors, noted Timothy Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta, in a 2006 paper about living organ donation consent. “When the recipient is a family member, a donor may feel morally obligated to donate, but, in reality, may not want to.”
Support for donors before and after surgery and thorough psychological screening to make sure they understand the risks, benefits and what to expect, can prevent most serious after-effects and make sure consent is clearly understood, Wright says.
As many as a quarter of live donors experience either depression or financial hardship after donating an organ, according to a 2002 paper. It is one reason, Caulfield argued, that transplant programs need a comprehensive disclosure policy “that aims to provide donors with all information relevant to the donation process.”
Many donors, however, report psychological benefits.
“The vast majority of living kidney donors say they are very glad they did it and they would do it again if they could,” says Caulfield. Among other things, living kidney donors say the act improved their relationships with other people and, in many cases, increased their self esteem.
“That is also because we are getting pretty good at selecting suitable donors,” said Wright.
Binh, left, and Phuoc Wagner’s father gave part of his liver to his daughter Phuoc.
‘Wear my scar with pride’
In March, on the three-month anniversary of donating her right kidney to a stranger, Vanneste got a tattoo on the inside of her wrist. The monarch butterfly wing and green ribbon is the symbol of living organ donors.
Like her scar, Vanneste wears her tattoo with pride. She gladly tells anyone who is curious what it stands for. In fact, she says she would do it again, this time to donate part of her liver, if the need arises in her family and she is the best match.
She wants people to hear her story, to know it is possible to do what she did.
Vanneste has never met the woman who received her kidney, but she did send her a letter, just to let her know she was OK after the surgery.
“I told her I was honoured to have done it, that I would wear my scar with pride and that the only regret I had was that I should have learned to sleep on my back.”
Six months after surgery, Vanneste has a small scar, a symbolic tattoo and a T-shirt (“I gave my spare”), to show for her act of kindness.
And this: “I know I saved someone’s life. It gives you a real sense of accomplishment.”
Organ transplants in Canada, by the numbers
4,500: People waiting for organ transplants.
256: People on waiting lists who died before receiving transplants in 2012.
2,124: Organs transplanted in 2012.
17%: Increase in the rate of deceased donors rate in Canada between 2003 and 2012, from 13.3 to 15.5 donors per million population. Canada is still outpaced by Spain, the U.S., France and the United Kingdom.
421: Deceased donors in 2003.
540: Deceased donors in 2012.
— Sources: Canadian Blood Services, Canadian Institute of Health Information
Get more information on being a living donor:
• Canadian Blood Services’ kidney matching program.
• University Health Network multi-organ transplant program.
And register to donate your organs and tissues after death here: Register for organ donation in Ontario
查看原文...
