Stepping up to the organ donation plate -- a High Holidays plea

The High Holidays -- that time when the cycle of Judaism asks us to consider the implications of our own mortality -- are rapidly approaching. This year, I ask you to consider a possible gift that can come out of your own death: the possibility of organ donation. If you haven't checked the organ donation box on your driver's licence, for example, it's never too late.

Jane Brody -- the author of the Personal Health column in the New York Times -- has an excellent story today entitled, The Solvable Problem of Organ Shortages. Here's an excerpt:

When the wife and younger daughter of Rear Adm. Kenneth P. Moritsugu of the Navy were fatally injured in separate automobile accidents, he authorized the donation of organs and tissues from both of them.

Dr. Moritsugu, acting surgeon general of the United States, calls organ donation “the ultimate act of human kindness.” But the number of donor organs falls far short of the need. As of June, 97,000 people awaited lifesaving transplants, and each day the waiting list grows five times faster than the donation rate.

People typically wait three to five years for donated organs, and each day 17 of them die.

But, as Dr. Moritsugu noted recently in The Journal of the American Dietetic Association, “The shortage of donor organs is a medical problem for which there is a cure.”

At one time there was a lot of concern among Jews that organ donation would be a violation of Jewish law (as Jewish law forbids desecration of the dead body). Most religious authorities have moved past such a position. In my movement (the Conservative Movement), most authorities hold that not only is organ donation permitted but that Judaism's high regard for life as a religious value actually requires it. In the Orthodox world, however, authorities are more reluctant to give a clear green light to organ donation; they do, however, allow it in some cases where it is clear it would save a life.

The real savior

Doctors -- especially surgeons -- have long been accused of tending to acquire a "God complex." But I was still surprised, today, to see one turn up on the pages of the New York Times, especially because the physician in mind is part of a center of biomedical ethics at a world-class medical center:

"I saved your life!" Dr. Larry Zaroff reports telling a man he had treated while years earlier when that man demanded $300 from him in a business dispute. Before Zaroff made this pronouncement, the man, who had been unconscious at the time, had no idea Zaroff had ever treated him.

First of all, in my opinion, it's an act of incredible arrogance for any physician to credit his or herself with saving a life. Zaroff could have shocked this man's chest a thousand times and it wouldn't have helped one bit if the Blessed Holy One hadn't decided to make it possible for the heart to start again.

Second of all, to try and influence another person in a personal business dealing based on what you may or may not have done for them in a professional setting strikes me as a deeply troubling violation of ethical boundaries. Zaroff does say that now that he's "older" he would not do the same thing. But he does not seem to acknowledge the ethical problem. Nor the arrogance of claiming to save a life.

I'm curious what other folks think.

Here's an excerpt from the story:

During surgical residency, I’d learned to control the startle reaction. Don’t raise your head from the exposed heart even if the orderly knocks over the rinse basin or the nurse drops a tray of instruments. I had learned that calm worked best. I was not perfect the day we faced our prospective landlord. My head jumped back, my eyes widened. He did not notice; he had no idea we’d met the day his heart stopped.

After my shock passed, I had the same thought I’d had back then: “Why tell him? Surely he has suffered enough.” . . .

We had left a deposit when we signed the lease. Now the landlord checked the apartment like a lion after a wildebeest, zeroing in on the fireplace . . . He turned toward me. He became adjacent and angry. “You owe me $300,” he snarled, shaking with each word. . . .

I took a deep breath, and I gently asked him if he remembered his heart attack.

“Yes, sure.”

“Do you know your heart stopped?”

“I think so.”

“Well, I was the one who saved your life, brought your heart back.”

He hesitated. “I didn’t know that.”

He turned to the door, distressed, in pain. Turned again. “You still owe me $300.”

The caregiver and the scapegoat

Today, turned out to be a banner day for medical workers accused of criminal wrongdoing. Not only did Libya -- finally! -- release a doctor and five nurses who had spent 8 1/2 years in prison under threat of execution (on the flimsiest of evidence), but also a grand jury in Louisiana cleared the last of those accused of "mercy killing" during Hurricane Katrina:

NEW ORLEANS, Louisiana (AP) -- A grand jury Tuesday declined to indict Dr. Anna Pou, the surgeon accused of killing four seriously ill patients in the aftermath of Hurricane Katrina.

Pou and two nurses were arrested last summer after Attorney General Charles Foti's investigation concluded they gave four patients a "lethal cocktail" at Memorial Medical Center amid the chaotic conditions that followed the August 2005 storm.

What these two cases -- across the world from one another -- had in common is the element of scapegoating. In both Katrina, and the infecting of hundreds of Libyan children with HIV, there was a tragedy the result of which innocent people died. In both cases, there was an angry public. And, in both cases, the politicians in power were looking for somebody to blame.

It had always struck me as terribly unfair that the Dr. Pou, along with two nurses, were accused of criminal wrongdoing. It's not that I'm defending their actions (I really don't even know the details). But, at a time when dozens of police officers and others were abandoning their posts, these three caregivers chose to follow the call of their profession and stay. They stayed with their patients in a hospital where the electricity was out, where the first floor was under 10 feet of water and where the temperatures topped 100 degrees. Did they make some questionable decisions under those incredibly difficult circumstances? Maybe. But to haul them before a court of law when all they were trying to do was save lives? Absurd! I'm so glad it's over.

_______________

The next Katrina?

Episcopal Chaplain points out that the Dr. Pou case is anything but irrelevant to the work of hospital chaplains and ethcisits: the very kind of challenging ethical dilemmas that Dr. Pou faced in a sudden crisis (ie, not enough working medical equipment and care to go around) may be just around the corner for all of us. All takes is a (widely expected) flu pandemic or a major terrorist event (please, God, let it not come to be).

What will we do? Are we ready for these ethical decisions? Will we (again!) scapegoat the people brave enough to stay at their posts?