Michael Mello, senior partner at Mello Jones & Martin, makes the case for organ donation and outlines some of the attendant issues, in an excerpt from his recent book "The Law of Wills and Estates in Bermuda"

Under The Human Tissue Act of 1976, any person 18 years of age or over may in writing at any time, or orally in the presence of at least two witnesses during his last illness, direct that his body or any specified part be used after his death for therapeutic purposes (i.e., organ donation) or for purposes of medical education or research.

This legislation also provides that the administrator of King Edward VII Memorial Hospital shall maintain a register in which any person may enter directions for the purposes of organ donation.

Why the shortage?

Why do so few potential donors actually become donors? The answer is twofold. Although the legislation provides the opportunity for KEMH to offer the next of kin the option of organ donation whenever it is appropriate, potential donors are not consistently recognised and referred.

In addition, many families, especially those who are discussing donation for the first time, feel they do not have enough information to make a decision that is comfortable for them, and usually refuse to consent out of an abundance of caution.

Family Discussion

If you wish to be an organ or tissue donor, you should discuss your wishes with your family — now. The emotionally charged period around the death of a loved one is a difficult time to initiate the discussion of organ and tissue donation. Ideally, the discussion should take place in a relaxed atmosphere, and family members should have a chance to ask questions and express their wishes.

Most people are not aware that, as a practical matter, consent for organ and tissue donation is requested of family or next of kin — even when the potential donor has signed a consent and is registered as an organ donor with KEMH. Thus, it is very important to have a family discussion to assist your family in making this decision and to ensure that your wishes are respected.

It is not often appreciated, where adult family members disagree on whether or not an organ donation should be made, that the organ donation cannot take place.

It is recommended that you make provision for organ donation in your Will, and that the executors of your Will or at least your immediate family members (e.g., a surviving spouse or adult children) be made aware of this provision, as you may be dead and buried before the Will is read.

The purpose of making this provision in your Will is to relieve your family of the burden of making the decision. At the appropriate time when your family is asked whether or not you would wish to make the donation, they will have the comfort of knowing that you have already made this decision and have provided for it in your Will, and it is unlikely that any member of your family will object or disregard your wishes.

The recipients

One donor may help many people who are waiting for organs and tissues. Kidney and pancreas transplants dramatically improve the quality of life for recipients. A donated kidney can free the recipient from dialysis treatment that can take many hours per week. A pancreas transplant can free a diabetic from daily insulin injections and other problems associated with diabetes. Small bowel transplants free recipients from the necessity of lifelong intravenous feeding.

Of course, heart/lung, lung and liver transplants can be nothing less than life-saving.

Donated corneas can restore lost sight; bone transplants can obviate the need to amputate a limb; donated skin provides temporary covering and protection from pain and infection for burn victims; donated heart valves are used for a variety of cardiac reconstructive procedures; and saphenous veins are used in procedures for peripheral vascular disease and as coronary by-pass grafts.

The donor families

The benefits of donation for the recipients are obvious, but how does the decision to donate help the donor family? At a time of tragic and unexpected death, often of a young and previously healthy person, it is difficult to imagine that anything could provide any consolation to the grieving family. Yet, many families who have chosen to donate the organs of their deceased loved ones report that the donation allowed something positive to result from an otherwise tragic and senseless situation (such as a traffic accident). They feel that some part of their loved one lives on in the recipients they help.

Your decision

Donating organs and tissues is your opportunity to give life and health to someone else. Make an informed decision, and if you choose donation, take these easy steps:

[bul] make a provision in your Will for donation;

[bul] complete, sign and mail to KEMH the Letter in Appendix G; and

[bul] tell your family.

Questions and answers

Q: Is there any disfigurement associated with organ and tissue donation?

A: No. The recovery operation is a careful surgical procedure in which the body is not disfigured in any way. The body remains intact for any funeral and burial arrangements the family wishes, including an open casket.

Q: Will it cost my family anything to donate?

A: No. All charges associated with organ and tissue donation will usually be covered by the hospital or the donee.

Q: Will the quality of my medical care be compromised if I make an organ donation?

A: No. The first priority of the health care provider is to preserve the life and health of every patient. Only after a patient is dead can organ and tissue donation be pursued. In addition, the Declaration of Death can only be made by a physician who is not associated in any way with the transplant team or the care of the potential recipient.

Q: Do the major religious organisations support organ and tissue donation?

A: Yes. Religious groups generally support organ and tissue donation as a charitable gift of life consistent with the basic tenets of their faith. (Editor's note: There are exceptions to this general rule.)

Q: Who is likely to get a transplant?

A: As organs become available for transplant, clinical considerations such as blood type, body size, medical urgency, waiting time, and in some cases geographic proximity are the criteria for distribution. These criteria are consistent with international rules for organ allocation. It is illegal to offer for sale an organ for transplant and Bermuda only permits recognised organ procurement organisations that are authorised to recover and distribute human organs for transplantation to harvest organs.

The author wishes to acknowledge that the information for this chapter was provided by the New England Organ Bank, which is an independent not-for-profit agency whose mission is to recover, preserve and distribute human organs and tissues for transplantation.