Education and organ donation: ‘the unfinished symphony’


Dear Sirs,

Without intending futurism, scientific evidences suggest that transplantation medicine might be considered a health guarantee for the 21th century. Nevertheless, the paradox of organ shortage, a social, psychological, ethical, moral and probably legal and political problem, is overriding transplantation, making this foreknowledge uncertain. This unjustifiable and harmful reality must imperatively be solved to avoid death on the waiting lists. Today, one person every 92 min dies in the USA; the value of lost life because of insufficient organ supply was estimated to reach $4.8 billion [1]. People’s current behaviour condemns patients on waiting lists to an unfairly dead. It is also true that thousands of people die every day because of unequal socio-economic conditions [2]. The difference concerning donation and transplantation is that the solution is in our hands.

This negative behaviour contrasts with the UNESCO declaration about Responsibility the Present Generations over Future Generations (November 12, 1997): “Recognizing that the task of protecting the needs and interests of future generations, particularly through education, is fundamental to the ethical mission of UNESCO, who’s constitution, enshrines the ideals of justice and liberty and peace founded on ‘the intellectual and moral solidarity of mankind”. Article 1 establishes needs and interests of future generations: Present generations have the responsibility of ensuring that the needs and interests of present and future generations are fully safeguarded. Furthermore, UNESCO Universal Declaration of Bioethics and Human Rights (October 19, 2005) stated: “whereas it is desirable to develop new approaches to social responsibility to ensure the progress of science and technology contribute to justice and fairness, and serves the interest of humanity”. And in Aim f) remarked: “to promote equitable access to medical, scientific and technological developments as well as the greatest possible flow and the rapid sharing of knowledge concerning those developments and the sharing of benefits, with particular attention to the needs of developing countries”.

Almost every day, intensive care units are rendered powerless to act because a potential donor cannot be ‘used’ because of family’s refusal [3,4]. Several explanations for this denial have been suggested. People are not aware that organ transplantation is a common part of medical care. Individuals are not aware that during life, there might be more potential organ recipients than organ donors [5,6]. Society is not conscious that the use of body parts after death offers a unique source of health [7]. Medical teams are untrained in the subject of organ donation because insufficient education on this topic [8]. It is necessary to educate people about the significance of brain death, including medical doctors and to redefine death as a process in which brain death is synonym of ‘current’ death [9,10]. Myths, misinformation and prejudges are strong barriers of greater solidarity and altruism, with increased selfishness and doubts.

The current solutions are an increase in living donor’s source, to expand donor criteria, economic incentives, legal instruments [11–14]. However, education is a noncontroversial solution. Nevertheless, educational programmes have been considered useless and as a needless action [15]. This opinion is roughly correct, because the shortage of organs is increasing every day, no matter the persistent message evoking organ donation as a ‘Gift of Life’. So the question is whether education and message to society failed?

Organ donation points to a social dimension where donors and recipients are part of the society [16,17]. The social aspect is also one of the elements that should be prevalent in making decisions in organ donation. The following notions could be a subject of discussion looking forward to reach a consensual rationale to be aware of, and become part of general education to convey a new message to society [5,6]: during life, we are more potential recipients than organ donors; organ donation means to share a possibility of welfare and life for everybody; the use of deceased organs and tissues should be accepted by the society as an implicit insurance policy for its own future health. This acceptance gives individual members of society the possibility of sharing our body after death as a unique source of health.

It is essential to educate the younger generations to stress their responsibility concerning organ donation faced to their family and society. The world’s young should be, through education, committed to consider organ donation as an integral part of their human rights and obligations to society. Structuring and developing programmes on education on organ donation and transplantation should include the four principle approaches from Beauchamp/Childress: respect for autonomy, nonmalfeasance, beneficence and justice [18].

Knowledgeable students could share the information with friends and families. The following topics should be included in the curriculum, pedagogic adapted to age, ethnics, socio-economic, customs and psychological characteristics: history of transplantation, what is end-stage organ failure, transplant waiting lists, brain death, our body at the end of life is a unique and irreplaceable source of health, monotheist religions support organ donation and transplantation, and transplantation is a chance to survive for thousands of people. To be successful, this programme must be fulfilled and developed following basic conditions. It should be permanent, motivated and implemented by specially trained personnel.

Education on organ donation gives the impression of being an unfinished symphony, consequently, is our duty to generate an urgent solution to assure a positive action to this promising challenge through main principles such as: “Rationalistic policies to override organ shortage might turn out to be ineffective and even counterproductive because of inadequate attention to the complex features of human body parts” [18]. Altruism should be the cornerstone of organ donation [19]. Lack of educational programmes on organ donation into all levels of society has been pointed as one of the main reasons of organ shortage.