The “pay-play it forward” concept for organ transplantation is simple. Simplistically, the organ donors’ data can be explored, if feasible, to determine incidence or prevalence of organ donations by the organ recipients, thus “paying it forward.” Thereafter, the organ recipients’ data can be explored, if feasible, to determine incidence or prevalence of pledged organ donors among the organ recipients. Finally, the transplant waiting lists’ data can be explored, if feasible, to determine incidence or prevalence of pledged organ donors among those on the waiting lists. Eventually, the data can be explored, if feasible, to determine incidence or prevalence of organ donations by those dying while waiting for organ transplants, thus “playing it forward.”
The question is not whose organs will eventually be medically suitable for transplantation after death. The question is who all are pledging for organ donation in the event of death when the pledging for organ donation is only limited by the consent of the pledging organ donor. Increased accessibility and utilization of extracorporeal membrane oxygenation (ECMO) have changed the rules of the game. ECMO can provide ample time for family, guardians, surrogates, and the professionals team to discuss and agree about donation after circulatory (cardiac) death, almost as similar to the time available for them to discuss and agree about donation after brain death.
The question is not whether the wishes of family, guardians, or surrogates align with the wishes of organ donors. The question is whether competent organ donors have timely pledged, documented, and communicated their wishes in their paper, electronic, or digital health records so that the health care systems can timely fulfill their wishes at the critical organ preservation times after their circulatory (cardiac) or brain death. Maybe palliative and end-of-life care professionals discussing and documenting dying patients’ wishes regarding withholding and withdrawing life support should also discuss and document those patients’ wishes regarding tissue, organ, and body donation. Terminally ill cancer and non-cancer patients can pledge not only whole body or tissue donations for research but also organ donations if medically suitable after their circulatory (cardiac) or brain death.
The question about the “pay-play it forward” concept for organ transplantation is not about sustaining the selfish legacy to “immortalize” the personhood of organ donors. Donated brains, if and when they become transplantable, along with their cryopreserved memories or consciousness, if and when feasible, may be the only futuristic “immortalization” of donors’ personhood if ever possible. The question is not about coercing organ recipients and those waiting for organ transplants into pledging for organ donations, thereby allowing donors’ wishes to outlast death and supersede recipients’ wishes while alive. The question is simply not to overlook that, armed and equipped with their own very personal experiences on the transplant waiting lists, organ recipients and those waiting for organ transplants can themselves become the torchbearers. Their pledges as organ donors can increase the overall numbers of pledged organ donors, thus potentially improving the eventual numbers of organ transplantations after circulatory (cardiac) or brain death.
Deepak Gupta is an anesthesiologist.
