Death, Donation and Dubious Organs.

 

NHS Organ Donor Register

After expounding my views on dissection last week, I had planned to give the 1752 Murder Act, anatomy and salacious stories about surgeons a wide berth, but events have conspired against me as my week has been dominated by talk of organs! Let me explain.

It all started with the worrying, but not hugely unsurprising, allegations that Prime Minister Cameron may have, in the follies of an over privileged youth, inserted his organ into a long deceased pig. As far as dark comedy goes, it’s certainly a step up on Python’s dead parrot sketch. While we’re on the subject of comedy, I thought my line on Facebook about whether the pig was sourced from Maggie’s Farm was woefully unappreciated – hopefully it will find a more receptive audience here.

As if the Cameron organ revelations weren’t enough, I then found myself at a fascinating talk, put on by Cafe Culture in Newcastle, entitled ‘Donors, Money and Body Parts: Should we pay people to donate body parts?’ The two speakers were Head of Medical Humanities at the Wellcome Trust, Dr Dan O’Connor and Professor Neil Sheerin, a Nephrologist (kidney specialist to you and I) from Newcastle’s Freeman hospital. The talk raised some fascinating questions for my study, but still I was trying to resist the pull of writing another medical histories blog. The tipping point came shortly after this talk when I received an email from a reader, who reminded me of some fascinating debates in the Newcastle Magazine around the 1820’s and 1830’s regarding dissection, burial and the Anatomy Act. At that point I gave in….hopefully next week we’ll be back more directly to execution.

So, where to begin. What really struck me about the Cafe Culture talk, and resultant debate, was the notion of shame – the theme of my last few blogs. Dr Dan O’Connor asked the audience how many of them had signed up to be an organ donor and in a room of roughly 50-60 people only 3 raised their hands. I felt ashamed that I was in this ungenerous minority, but then that shame got me thinking, why was I not on the organ donor list and why are so many others not? In fairness, if anyone has justification to be a little distrustful of surgeons it’s me (I’ve spent too many long hours reading of their dark and dubious practices – plus I’m pathetic with needles, scalpels, anything medical!). As it turned out though, I was not unrepresentative of the country as a whole, with as little as 1% of deceased bodies in the UK donating organs each year, the result of which is a “demand for organs….far outstripping supply”[1]

With these figures in mind, I began to wonder about the power of historical, cultural fears and to what extent the public opprobrium at the body snatchers, Burkers and pre Anatomy Act (1832) surgeons still resides in our collective memory.  Evidence of the residual fear of medical practitioners can be seen in a poll undertaken of 1000 adults in which the “most prominent fear” of people who hadn’t voluntary registered to ‘opt in’ was that “doctors would not try as hard to resuscitate them because they hope to use their organs.”[2} Further Testament to the strength of the public’s underlying distrust can be seen in the result of the Government’s commissioned report into the possible introduction of an ‘opt out’ or ‘presumed consent’ donation system. Despite findings that ‘opt-out’ systems had “far higher rates” of organ donation and being championed by the Prime Minister, Gordon Brown, Chief Medical Officer for England and the British Medical Association (BMA) the report refused to endorse a system of ‘presumed consent’ fearing, amongst other things, that it may “erode trust in NHS professionals.”[3]

To a certain extent the popular fears that played such a key role in the establishment of the Anatomy Act are still occasionally evidenced in reactions to current medical practice. Practitioners of anatomy are often at pains to describe the levels of respect that they impart on the body under examination. A missive on anatomy lectures at Leeds University, expresses this sentiment very clearly, making a marked note that when dealing with a body, “we must also remember that Mr X was someone’s husband, father, uncle, lover and treat him accordingly.” It goes on to state how the body is carefully dealt with after its use, the parts being clearly collected and placed in a coffin for burial or cremation “according to the wishes of the deceased” and the University even goes to the additional length of having a member of staff attend the funeral as “a mark of respect.”[4]

The necessity of the sort of language and measures employed by Leeds University are the direct result of popular fears in the c17th and 18th century. Writing on the passage of a parliamentary bill, that what was to later become the Anatomy Act 1832, the Newcastle Magazine’s editorial of August 1829 stated that,

notwithstanding the necessity of some enactments both for the promotion of anatomy and protection of his Majesty’s subjects, we were rejoiced to see the feeling with which Mr Warbuton’s bill was received by the House of Peers.

W. A. Mitchell, ed., “The Anatomy Bill.,” The Newcastle Magazine 8, no. 8 (August 1829): p.354

The ‘feeling’ referred to was one of great distaste and displeasure at the suggestions of the bill. Chief amongst them the grouping of bodies deemed acceptable for dissection. At the time of writing, only the bodies of executed men or women were allowed to be dissected, but this bill was proposing that the bodies of persons dying unclaimed during imprisonment in any prison, or dying in any hospital or workhouse, were to be given for dissection to any licensed person. The failure to distinguish between the criminal classes and the workhouse sick or poor, angered the magazine’s Editor.

This was one of the clauses which caused the greatest consternation. To begin with persons dying during imprisonment in any prison, was in itself the most injudicious proceeding, it was at once classing the inhabitants of hospitals and workhouses with criminals, or at any rate, with persons of bad character….If they had inclined to make anatomy a matter of greater prejudice than ever – if they had wished to throw more difficulties in the way of that science, to increase the probabilities of body stealing, resurrectionism and Burking, they were pursuing the best of all imaginable courses. Instead of making the anatomy of unclaimed persons an excellent civic arrangement for the promotion of a science of the utmost importance to the species, this confinement of the measure, was placing hospitals mid poor-houses under an exclusive curse. If the bill had passed into a law, it would have caused many a poor person to prefer dying in a ditch to going to the hospital, which had been hitherto the hope and cheering receptacle, of the maimed and diseased who could not obtain medical or surgical relief elsewhere.

Ibid., 355.

The implication is clear, the practice of dissection will become indelibly linked with the criminal classes, as it invariably was at the time, and will continue to be a mark of great shame as opposed to a thing of honour or civic virtue. Thus hobbling the progress of scientific research in the publics mind for generations to come. Three years after writing this Editorial, the Anatomy Act was passed bringing with it the very clauses that Mitchell and the Newcastle Magazine were bemoaning and perhaps he has been proven right. It would appear that historical fears may well still be a powerful factor in the debate of organ donations.

But lets address possible solutions. Firstly, there is the central question of whether paying for body parts is in itself unethical or wrong. This was the key focus of the Cafe Culture debate. As it stands, specifically in England, it is illegal to sell an organ to another person or financially profit from this in anyway. However, in his talk, Dr Dan O’Connor provided an interesting insight into examples of financial purchases, that we are often glibly unaware of, involving body parts. Citing the example of a Caribbean hair shop near his home in London, he noticed how they advertised 100% human hair and eventually inquired into its source. It turned out to be human hair sold, predominantly by women in Eastern Europe. What does this example tell us?  Surely, we must look at the economic reality that fuels this trade and indeed ask who is most likely to justify the loss of their hair for a financial gain. Is it, more often than not, going to be the choice of the poorest in society? An article on the trade by the BBC gives an indication of how lucrative it can be. We have a famous example of this practice from the world of fiction, in Victor Hugo’s Les Miserables. In Hugo’s masterpiece, a recently jobless and increasingly destitute Fantine is forced to sell her hair and teeth to provide for her daughter. The implication is clear, it is an act of utter desperation brought about by economic necessity and one that is deeply shameful. 

So, there are obvious negatives, but is it always a bad thing to pay for an organ? One group of theorists who would say no, according to Dr Dan O’Connor, are US libertarians. Michael Sandel, author of  What Money Can’t Buy: The Moral limits of Markets has written very incisively on this libertarian viewpoint and where he believes it is flawed in its logic.

Consider the case for a free market in human organs—kidneys, for example. Textbook economic reasoning makes such proposals hard to resist. If a buyer and a seller can agree on a price for a kidney, the deal presumably makes both parties better off. The buyer gets a life-sustaining organ, and the seller gets enough money to make the sacrifice worthwhile. The deal is economically efficient in the sense that the kidney goes to the person who values it most highly.

But this logic is flawed, for two reasons. First, what looks like a free exchange might not be truly voluntary. In practice, the sellers of kidneys would likely consist of impoverished people desperate for money to feed their families or educate their children. Their choice to sell would not really be free, but coerced, in effect, by their desperate condition.

The second limitation to market reasoning is about how to value the good things in life. A deal is economically efficient if both parties consider themselves better off as a result. But this overlooks the possibility that one (or both) of the parties may value the things they exchange in the wrong way. For example, one might object to the buying and selling of kidneys—even absent crushing poverty—on the grounds that we should not treat our bodies as instruments of profit, or as collections of spare parts. Similar arguments arise in debates about the moral status of prostitution. Some say that selling sex is degrading, even in cases where the choice to do so is not clouded by coercion.

“If I Ruled the World: Michael Sandel | Prospect Magazine,” accessed September 24, 2015, http://www.prospectmagazine.co.uk/regulars/if-i-ruled-the-world-michael-sandel.

This passage reminded me of Lord Darlington’s famous reply to Cecil’s question, ‘what is a cynic?’, in Lady Windermere’s Fan,

Lord Darlington: A man who knows the price of everything and the value of nothing.

Oscar Wilde, Lady Windermere’s Fan, 1997, http://www.gutenberg.org/ebooks/790.

So, if we have rejected an ‘opt-out’ system and find the notion of paying for an organ morally reprehensible,  as it may create a market system that exploits the poorest and most vulnerable, how do we counter the huge shortage of organ donations in the UK? One alternative is to make donation a thing of civic pride and something we all aspire to. This brings me right back to where I started and the helpful reader who jogged my memory about the Newcastle Magazine debates. This reader was also responsible for collecting and transcribing the diaries of a local doctor, working in Newcastle for a short period in the 1820’s. In his diaries he proclaimed a burning desire to be immortalised after death as a prime medical specimen.

I do not mean to insinuate that I am a mummy, gentle reader, — by no means. I hope you will give me credit for my due share of flesh & blood, whatever I may be in regard to sense. Not that I in the least despise, but rather admire and venerate that sage-looking relict of mortality and specimen of immortality. I intend one day to become one of the fraternity myself. I have no notion of being devoured by reptiles when I & my body quarrel, and feel inclined to follow the example of the late professionally patriotic gentleman who bequeathed his corpus to be useful to others; only I shall make a further proviso, viz. that I shall be injected and properly prepared; so as to cut a figure among the rest of my companions on a lecture room table, or in an anatomical museum. I can indeed contemplate with perfect satisfaction the idea of being stuck in a glass case— the terror of young ladies and little boys — the admiration and study of professors — and being at any rate, able then to contribute to the good of society whatever advantages I may have been to it during life. But this is sadly too long a digression my chapter is not on Patriotism.

Thomas Giordani Wright and Alastair Johnson, The Diary of Thomas Giordani Wright, Newcastle Doctor, 1826-1829 (Boydell Press, 2001).

Perhaps if their were more people like Giordani Wright and less like me we’d have this problem solved in no time.

Footnotes:

[1] “We Need Organ Donor ‘Opt-out’ System Urgently | @guardianletters,” The Guardian, accessed May 5, 2015,   Interestingly, the ‘opt-out’ system has been implemented in Wales by the Welsh Assembly, it will be fascinating to see what effect this has on donation figures longer term.

[2] “Word on the Street – Organ Donation | Survey | OnePoll | Onepoll,” accessed May 5, 2015.

[3] Organ Donation Taskforce, “The Potential Impact of an Opt out System for Organ Donation in the UK: An Independent Report from the Organ Donation Taskforce,” n.d., 34.

[4] “Introductory Anatomy,” accessed May 5, 2015, http://www.leeds.ac.uk/chb/lectures/anatomy1.html..

 

Distraction 1: Brian Sewell Dali?

This week saw the passing of art critic and gériatrique terrible (excuse my French) Brian Sewell. Sewell, love him or hate him and there were plenty in both camps, was a force of nature. I first came across his work through a documentary about Salvador Dali and so I returned to that this week. It is a remarkably candid documentary on a brief and utterly bizarre meeting between these two eminent eccentrics. Not for the faint hearted, easily upset or sexually timid (if you’re all three then maybe watch it lying down).

Distraction 2: Filming

Alongside my studies I have been on the rollercoaster that is pre-production for my comedy groups’ latest sitcom, Storydweller. It has been very time consuming, but a welcome relief from the grind of study (and burdened in large/massive part by another member, which has made it much more bearable). One of the joys of filming and producing things is the bizarre tasks you have to undertake, from persuading great actors to do odd things, to securing stately homes for free. You realise how accustomed you’ve got to acquiring and asking for unusual things when you receive the following text as I did this week. “Good news. We have confirmed the live goat for the satanic ritual scene.”* Nothing quite lifts you out of the fug of PhD study like that.

*no goats will be harmed in the making of our comedy! As for Dali’s, I can’t be sure.

FRANCE - CIRCA 1953: Salvador Dali With A Goat In Paris, France In 1953 (Photo by REPORTERS ASSOCIES/Gamma-Rapho via Getty Images)
FRANCE – CIRCA 1953: Salvador Dali With A Goat In Paris, France In 1953 (Photo by REPORTERS ASSOCIES/Gamma-Rapho via Getty Images)

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