Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, July 12, 2015

Altriuism on Steroids

"They offered me December 24 ad I said that would be the coolest Secret Santa gig ever. I think the symbolism is pretty cool."
"Most people's reaction is 'Oh my god, you are amazing.' No, I don't see myself as being all that amazing. Yes, it is amazing for the recipient. But I am not amazing. It’s absolutely incredible to know that something that is actually an extra for me is working in somebody and letting them regain their life."
"I’ve had the comment 'But you could die'. Yeah, and I could be crossing the street and get hit by a bus. I don’t believe you can live your life waiting to die. If something happens on the operating table, let them harvest everything they can."
Annemieke Vanneste, Ottawa, Ontario

Peter J. Thompson/National Post
Peter J. Thompson/National Post    Annemieke Vanneste, left, laughs with sister Caroline Vanneste and 
Dr. Michael Robinette as she prepares to head into her anonymous kidney donation operation at Toronto 
General Hospital.
"I met a lot of people who had benefitted from transplant. I felt that I had this advantage and thought I should share some of my health somehow."
Caroline Vanneste

"We can only do surgery on people who are sane and by definition giving a kidney to a stranger is an act of insanity. I didn't think it was the right thing to do and people challenged me."
Dr. David Landsberg, kidney transplant program, St.Paul's Hospital, Vancouver

"There are people in this world who do an awful lot for other people and want very little for themselves. Those people exist. Our job is to do a good evaluation process, to make sure it is as safe as possible and they are fully apprised if the risks and benefits, and we do that in spades."
"For years we have treated these people like they are nuts. They are not."
Linda Wright, director of bioethics, University Health Network, Toronto

But they certainly are not representative of the attitude of the general population for whom the very prospect of submitting to a surgical procedure that is not personally needed to save one's own life, and to do it for a purpose that in the end will save someone else's life, knowing that undergoing surgery can also threaten one's life, and certainly would require a long recovery period; all of which knowledge is more than sufficient to make the prospect out of the question for most people.

On the other hand, it's somewhat different when you have the experience of someone you love suffering poor health that continues to deteriorate to the point where they will die without the saving grace of a transplant. And for most transplants that take place, it is required that people in the general population agree that if their organs could help others after their death they will agree to surrender them for surgical transplant.

Other than the difficulty of persuading enough people to sign such a consent form and keep it on their person readily available, and to discuss their decision with their closest family members, there remains a paucity of those who will commit, leading to a severe shortage of cadaver organ transplant opportunities. Into which vacuum step some quite extraordinary people. People who may have convinced themselves because they have witnessed the need.

Take, for example, Annemieke Vanneste and her sister Caroline. Caroline is married to Dr. Aubrey Goldstein, president of the Canadian Transplant Association. Annemieke witnessed her brother-in-law, Dr. Goldstein, become healthy following his liver transplant; that brought home to her what a precious gift an organ can be in saving a life. "It was incredible. I had already signed my donor card years before this, but that was when it really hit home how important this was", she said.

Her sister Caroline also donated a kidney, to a friend last year. The first living anonymous donor kidney transplant took place in Vancouver in 2004. Since then it has become not entirely uncommon for family members to step forward and offer parts of their own body viscera to help a loved family member deny the invitation of the Angel of Death to accompany him to the netherworld, for a person not yet prepared to abandon life.

Dr. Landsberg, the chairman of Canadian Blood Services' Living Donor Advisory Committee, authored a paper positing that anonymous donors are surely either "lunatics or saints", admitting at the time he needed to be convinced. He discovered that most anonymous donors were well balanced psychologically, simply altruistic in character.

And in that category Annemieke Vannese certainly stands out. She works with disabled children, and also works with developmentally disabled adults. She is a frequent blood donor, and volunteers on a regular basis for various needs. She visits the dementia wing of an Ottawa nursing home every second Sunday with her rescue dog. She is a committed kind soul.
Sisters Caroline and Annemieke Vanneste are both living organ donors:  Caroline, left, gave her kidney to a friend and Annemieke gave hers to a stranger.
Sisters Caroline and Annemieke Vanneste are both living organ donors: Caroline, left, gave her kidney to a friend and Annemieke gave hers to a stranger. Darren Brown / Ottawa Citizen

Donor screening and obtaining informed consent is vital. Advances in medical technology assist in balancing risk faced by donors undergoing surgery. For such surgery performed on a healthy patient could be viewed as a violation of the Hippocratic oath's pledge to 'do no harm'. "In general, you will find there is an enormous amount of work done to make sure the donation is as safe as possible for the donor", Dr. Katherine Tinckham, medical adviser on transplantation for Canadian Blood Services states.

Liver donation can be risky, particularly if an adult is to be the recipient, since a larger portion of the donor liver is required to be removed than for a child. It has more risks than a kidney donation. The risk of death for living liver donors is placed in one study at one in 500. The risk of death for living kidney donors on the other hand is about one in 3,200, according to a study published in 2010 in the Journal of the American Medical Association. Five living liver donors have died in the U.S.

There have been no deaths among almost 700 donors since the program began over a decade ago at Toronto General Hospital, part of University Health Networks, home of the largest living liver transplant program in North America. About 40 percent of donors experience complications, from pain to infection, pneumonia and other symptoms post-surgery. "It is worth noting that the risk of death is higher after live donation than the risk of death after routine bypass surgery", cautions the hospital to prospective liver donors.

Donation of a liver results in a much longer surgery, requiring greater recovery time. Livers grow back to full size in months leaving donors to go on with their normal lives. Kidney donations on the other hand, not as risky, can be accomplished laparoscopically or with a micro-incision. "Living donors are amazing, they offer an incredible gift, but it is a gift that should never required", comments Ronnie Gavsie, president and CEO of Ontario's Trillium Gift of Life Network overseeing cadaver organ donations.

Linda Wright, director of bioethics, University Health Network, Toronto

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