Medical Staff as 'Ferrymen': Bridging Life and Death with Understanding in Organ Donation

[Great Love Organ Donation Series 1] (CNA Reporters Tsai Meng-yu, Lin Chiao-lien, Kaohsiung, 6th) In intensive care units where life and death intersect, some lives are counting down to their end, while many other patients continuously wait for a chance at rebirth. Organ donation is exactly this bridge between life and death, a journey that requires the joint fulfillment of patients, families, and medical teams. According to statistics, more than 10,000 patients in Taiwan wait for organ transplants on the edge of life and death every year.

Lin Yu-hung, chairman of the Organ Transplant Medical Committee at Kaohsiung Chang Gung Memorial Hospital, stated in an exclusive interview with CNA that while over 10,000 people in Taiwan wait for organ transplants annually, only a few hundred actual donation cases are completed each year. Caught between the traditional concept of 'leaving a whole corpse' and the unbearable grief of families, how to initiate the conversation for donation and how to perfectly conclude the final choice of life has become the most difficult yet warmest subject in Taiwan's medical system.

● No Significant Increase in Organ Donation Numbers

'This ratio has been the same for at least over ten years,' Lin Yu-hung said. In practice, the number of tissue donors (such as corneas, skin, bones) has increased annually, but the number of donated organs has not shown a significant rise. The actual number of organ donors is about 100 to 150 people per year, plus over 300 tissue donors.

According to statistics on the Ministry of Health and Welfare website, 42,746 people nationwide registered for organ donation last year, with Kaohsiung leading the country at 5,499. The Kaohsiung City Department of Health's statistics show that from 2015 to April 16 this year, 47,856 citizens in Kaohsiung have completed organ donation registration, with the average annual number of signees increasing from about 3,000 to 5,000.

However, a registration on a health insurance card is only the first step in promoting organ donation. In medical practice, 'family disagreement' remains the hardest chasm to cross in advancing organ donation.

'Organ donation is another choice when life reaches its end. For the medical team, the hope is to fulfill the wishes of the patient and the family,' admitted Lo Yun-lun, an organ procurement coordinator at Kaohsiung Chang Gung. Frontline workers often face the dilemma of divided family opinions. Even if a patient signed the consent while alive, once they become critically ill and the family objects, the organ donation process must stop.

Chen Hsiao-chin, a social worker at Kaohsiung Chang Gung, also shared that some citizens have not truly communicated with their families when registering. When the medical team mentions organ donation to the family of a critically ill patient, the family often looks bewildered or, overcome by grief, even suspects that their loved one was deceived into signing.

'It's not that many families disagree with organ donation; they just don't know if they can make this decision for their dying family member,' Wang Ting-ying, a social worker at Kaohsiung Medical University Hospital, gently expressed the families' inner thoughts. Many families have worried, 'Will he resent me for donating his organs?' Therefore, hospitals hold organ donation events every year, not just to get more people to register voluntarily, but most importantly, to encourage them to discuss it with their families.

Wang Ting-ying observed that many terminally ill patients who meet the criteria for organ donation have not registered during their lifetime. Families, facing the massive shock of their loved one's impending death, must also bear the heavy burden of deciding whether to donate their organs. They often break down and ask themselves: 'If I agree for him, will he resent me?' Even after agreeing to donate, they must silently endure the rumors and accusations from relatives. This process is an extremely agonizing secondary injury for the family.

To build trust, Taiwan's organ donation mechanism is extremely strict. Lin Yu-hung explained that before proceeding with organ donation, the donor must pass two strict brain death determinations, and the recipient must strictly follow a fair ranking system. More importantly, the medical team absolutely respects the family's wishes. 'Even if the patient is registered, as long as the family disagrees, we will not force it.'

● 3D-Printed Organ Models Maintain the Integrity of the Body's Appearance

Many people have misconceptions about organ donation, thinking that once they agree, the hospital will give up on resuscitation, or the body will become 'unrecognizable.' Lin Yu-hung said the team only initiates the procedure when it is absolutely certain that the life cannot be saved and it complies with regulations. Furthermore, after organ removal, the medical team uses 3D-printed organ models to carefully fill and suture the area, maintaining the complete outward appearance of the body, which brings considerable comfort to the families.

Chang Wen-tsan, director of the transplant center at Kaohsiung Medical University Hospital, pointed out that from organ donation to transplantation, it is a relay race that pools the efforts of many. From the patient's dying wish and the family's great love to the assessment of physical condition, and then to the golden window for donation and implantation, every link must be flawlessly precise.

'Every time a great love donor passes the assessment, the medical team pays deep respect to the donor and their family,' Chang Wen-tsan said emotionally. 'We tell the families: These organs will be put to good use, thank you for your great love and your willingness to let go.'

Compared to European and American countries, Taiwan still has a long way to go in promoting organ donation. Lin Yu-hung cited that Spain uses an 'opt-out' system (considered consent unless explicitly registered as refusal), and Europe and America have better-developed systems for Donation after Circulatory Death (DCD). Taiwan currently still relies primarily on brain-dead organ donation. How to overcome the issue of organ quality after cardiac arrest through medical technology is a direction for Taiwan's future efforts.

'Promoting organ donation requires a lot of effort, and the rejection rate is very high, but we will not give up,' Lo Yun-lun and Chen Hsiao-chin said with a smile. In their interactions with families, they are deeply moved by this great love. Seeing families turn the pain of losing a loved one into strength makes the team realize that this is more than just a job; organ donation is an extremely meaningful act. 'It teaches us that there is love in this world, and it is worth holding onto our beliefs to continue.'

Hospitals hold family care events and memorial services every year, allowing donor families to see the recipients living healthy lives after being reborn. This is the best gift passed on by their great love. (Editor: Huang Ming-hsi) 1150606

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