Fewer than 30 deceased organ donations have been orchestrated in Bermuda in the past 16 years, according to a hospital anaesthesiologist.

Kerry Brislane said demand for replacement organs in Bermuda was rising at a “frightening” rate and appealed for more people to sign up as organ donors.

As the island prepares to mark Organ Donor Week, the Bermuda Organ Donor Association is urging people to have that conversation with their families so that, if it comes to the worst, next of kin can find solace in knowing what their loved ones wanted.

“Less than half of families approached about donation agree to donate a relative’s organs if they are unaware of their relative’s decision to be a donor,” Dr Brislane, the group’s treasurer, told The Royal Gazette.

“Many people believe that all you need is to have it marked on their driver’s licence. However, if a person dies in circumstances where they could become an organ donor the family would be approached by specialist nurses and asked to support the decision to donate.”

Dr Brislane said there had been 25 deceased organ donations in Bermuda in the past 16 years with their organs given to 82 recipients, “whose lives were changed for ever”.

“I’ve seen the difference that it’s made in the recipient’s life — it really is the gift of life,” she said. But she added that only about six patients in Bermuda receive transplants every year.

“I think people underestimate the need,” Dr Brislane said. “We’ve got over 150 patients on dialysis now. That number will be double in five years, I can guarantee it. It’s frightening.”

Many people on the waiting list for an organ in Bermuda could die before they get them, Dr Brislane warned.

She explained that organ donations are carried out with the assistance of the New England Organ Bank and Bermudian patients are placed on the United States waiting list.

A number of factors determine who is at the top of the waiting list, although she said children were more likely to be first in line.

Dr Brislane was speaking as Bermuda prepares to mark Organ Donor Week, which will be launched at King Edward VII Memorial Hospital today.

This will be followed by two talks aimed largely at health professionals but Dr Brislane said the BODA would also be launching an education programme later this year.

The group is trying to get the younger generations in particular to talk about organ donation “so that they can then hopefully take that home to their families”. They have also reached out to the churches.

“It’s getting that conversation out there. Organ transplantation is a real and necessary part of even this small community.

“What we are trying to do is get the population talking about the general concept of organ donation so that it’s not something that’s new.”

There are two main types of organ donation: live donations, where the donor is still living, and deceased donations. The latter, in Bermuda, is only conducted when the patient is braindead.

“It’s always upsetting and usually in these instances quite traumatic,” Dr Brislane said. “That is always going to be unexpected and a shock and a very stressful situation and you are not going to have any say because you are going to be dead. It’s going to be your family that have that voice.”

She said it can be a big burden for families to make such an important decision at such a difficult time.

“If the family are going to gain some solace in the whole thing by being confident about the concept of organ donation, that would be great. In a time of great stress, that can be at least some positive outcome from that.”

But Dr Brislane said an official register was not a high priority in Bermuda and the only way to sign up is through the Transport Control Department.

However, she said that if applicants forget to tick the box on the form or are not sure, staff tick “no” by default.

“What we really want is that if the person is unsure, it is left blank. If it’s a yes, it’s a yes. We want them to really think about it rather than just say ‘nah, I don’t feel like it’.”

The group have also approached insurance companies about including the question, but “again, it’s on their priority list which is a shame because they are the ones paying out for high insurance costs”.

“Without an official organ donor register where people can actively express a definite ‘yes’ or a definite ‘no’, and because we have this thing with TCD where we are not really sure if they said ‘no’ or whether they just didn’t tick the box, it just comes down to the next of kin.”

Organ donation — How it works

While some organs can be donated by live donors, others are taken from patients who are braindead. Their age and the extent of injuries determines which organs are viable.

“When a patient comes they would generally be in the intensive care and we know that they’ve got a catastrophic brain injury, whether it is a severe stroke or an accident, a trauma,” Kerry Brislane, treasurer of the Bermuda Organ Donor Association, explained.

While the aim is always to save them, if there is no improvement or a deterioration, a test to check for any response from the brain can be done 24 to 48 hours after the injury.

Dr Brislane, who works as an anaesthesiologist at the hospital, added: “At that point we usually inform the family whether we are doing the testing to determine whether they are braindead because obviously continuing on then would be futile.

“It’s usually at that time that I open up the conversation about donation so they have some time to think about it because they still have to wait for the test.”

The New England Organ Bank is informed when the testing is going to be done. They send specialist nurses to talk to the family “because they know it is a difficult decision and they might have a lot of questions”.

If the patient is braindead, the family are asked for consent and if the family agree, then the surgeons will fly out from America to collect the organs.

The organ’s are then flown back to the US and are given to those who are at the top of the organ donor registry. “Usually children will get to the top of the list sooner but it also depends on your other illnesses,” Dr Brislane said.

The New England Organ Bank can then provide general information about who the organs went to, if the family wishes.

“Obviously nothing specific,” Dr Brislane added. “And then it’s up to the donor family and the recipient as to whether there is any formal contact made.”