By Georgia Michael
In the year 2022 in Cyprus, a culture and consciousness in relation to posthumous donors has not yet been cultivated and created.
[/B] The proof is that the number of posthumous donors on our island, almost every year, is... counted on the fingers of one hand!
Why should I become a posthumous donor? It may seem like a complicated question but the answer is simple. Mrs. Chrystalla Despotis has for years seen and cared for people on the other side, waiting patiently for a transplant to make their lives better or even to continue living. These patients were the most meaningful response he received. For nearly fifteen years she has been the Transplant Coordinator at Nicosia General Hospital.
She is the person who along with the doctor will inform the relatives of a brain dead patient that they can do the greatest act of all by making their grief, life for someone else. She experienced moments that are etched into her soul forever. Speaking to the Cyprus Times she explains what process is followed to identify potential donors, what it helps to have a clear answer as to whether or not we wish to become a posthumous donor and to make it known to our loved ones and a host of other questions
The nephrology ward "pushed" her. 65 patients in the waiting room for a kidney
The environment at work was her first stimulus. "Working on the nephrology ward I came into contact with patients reaching end-stage renal failure. We had a case of an 18-year-old who, while partying, was not feeling well and was taken to hospital where it was found that a special catheter had to be inserted immediately so that he could start dialysis. You don't choose when you get sick. These people are on dialysis three times a week for four hours. That's enough hours of our lives to be cooped up in a hospital. They don't know weekends or holidays. In a much more difficult situation are the people who end up in the final stages of heart, liver and respiratory failure. They don't have much choice about how to survive. They go on a list and wait for a transplant that will save their lives. When you step into the shoe of that person or their family then you say 'why not help'."
The National Waiting List for a kidney transplant, he noted, has about 65 patients registered during the year while patients waiting for other organs are referred through the Ministry of Health to overseas centres so that they can get a transplant.
5,500 interested parties in... 10 years
The National Registry of Potential Organ and Tissue Donors was created in 2013 and since then the census of potential donors has been started. "Next year marks the tenth anniversary and to date, about 5,500 of our fellow human beings have shown interest. These are people, of various age groups from 18 years and above, from all class backgrounds and from both genders. They are not only Cypriots but also foreigners living on the island."
Although it is a small country in terms of population, this number is still quite small. "At best in Cyprus there are 20 to 25 posthumous donors a year, which there are not, if you consider that there are 1,000 people on dialysis, you realise that the number is small. Last year there were five donors, this year so far we have had three donors."
Consent with... a driver's license. "Majority positive but very important no's"
In an effort to raise awareness and inform the public, now based on legislation, any candidate for a driver's license can give consent to become a posthumous donor.
"They are informed about organ donation and transplants on a special form that will accompany their application and have the right to give a positive or negative answer or even to ignore the question. The form is placed in a sealed envelope and sent initially to the Ministry of Health and from there to me. As far as we have seen so far, the majority answer positively but there are also those that are blank, a few that are illegible and of course there are the negatives. Before we did this process we did not have so many negative letters as people were never confronted with this question. But the no is also important. We are aware of the desire so if the unborn is in such a situation and it is negative we will not even go into the process of discussing such a possibility with their family."
Asked to comment on whether someone is ready at the age of 18 to give such an answer Mrs Despotis was absolutely positive. "If he is the right age to get a driver's license. It's a very, very important decision to get a driver's license. If you're not mature, it's like getting a murder weapon and moving around with it. If you are mature it means you can make decisions about anything that has to do with your life."
Important for our loved ones to know
Although for many people the mere discussion of the issue brings revulsion, Ms. Despotis stressed that it is very important for our loved ones to know what our wishes are on the matter.
"It is preferable for each of us to give our own answer and release our family from this decision and the stress of whether we will do or did the right thing. If they are put in a situation like this they should know what to do. It does not mean that I am seeking my death or that I will "leave" before those whom I inform. Discuss this in quiet time. Do not be afraid. Now in the event the deceased has not expressed their wishes, we are asking the family to consider what their loved one would want. To think about his life, his actions and let that be the trigger for their decision."
Brain dead or comatose... What's the difference
The Coordinator's role begins when the hospital is notified that there is an intubated patient in critical condition who has suffered severe brain damage.
"When there is brain damage the way to determine death is by specialized tests done to see if the patient is alive or dead. The test is done twice for confirmation as it is the most serious diagnosis, the diagnosis of death. Once death is confirmed, there is no way back. We are informed by the hospital that there is a patient on whom the brain death tests are done and then I get his details to look for whether while he was alive he declared his wish to become an organ donor or not. The doctor is the one who will give the family the bad news."
At these moments Mrs Despotis is present but, as she confesses, she only speaks when she realises that these people have become aware of what has happened to them.
"Whether they decide to donate or not, unfortunately the diagnosis does not change. Brain dead means his death has been confirmed. It has been documented by these tests that there is no brain function and he will not recover. His breathing and any organ functions are due to mechanical support. This is not a coma patient. This is different. The coma patient may have some reactions, may sometimes see you, understand you. He may be aware. His brain and his breathing work on their own."
"You tell them your child is dead, their whole world falls apart."Even though so many years in this position each time is just as difficult."
"We're talking about people who maybe even the day before were perfectly healthy. Their families have to deal with the most tragic scenario, the death of a previously healthy person, their own person. It cannot easily dawn on the mind that the day before, for example, their child was with them and today he is dead. You go and say "your child is dead", your whole world falls apart. They describe to you a perfectly normal life that has collapsed. We happened to have young children who have just started their lives and their wife is pregnant. Any reaction is justified. Sometimes the team psychologist is present but unfortunately not always."
For this reason, as Mrs Despotis explained, the family is given a short time frame of a few hours to decide what to do.
"As soon as we told him that she was dead, he asked us what to do with the organs."
However, there are also cases where the families themselves are sensitive and make the situation easier.
"We have had the family themselves ask us about the organs. It was several years ago once we announced to a man that his wife was dead he himself asked us what to do with the organs. As he had told us his wife was an organ donor and to see how we would proceed. That's why it's important to talk about it at some point with our people. To say here today that I am well if something ever happens to me this is my wish."
Even a child can become a donor but... not in Cyprus
Mrs Despotis pointed out that we can all become posthumous donors as long as we want to. "Even a baby can become a donor however in Cyprus there is no way to remove the organs and donate them. That is why there is no possibility."
Asked about which organs can be transplanted in Cyprus, she replied that the only organ is the kidney but also the cornea which is nevertheless tissue. "Each organ is very important. But mainly the heart, lungs and liver because people who need them if they don't receive them in a certain period of time it is really a matter of life and death. On the other hand the kidney, getting a kidney transplant means it will improve the health and life of the patient."
The lifespan of organs outside the body
Once the process of removing organs from the body starts then a race begins.
"Each organ has its own survival time after removal. The heart can survive outside the body for 4 to 5 hours, the lungs for up to six hours, the liver for up to 12 hours and the kidneys for up to 24 hours. If all organs are assessed to be suitable and healthy, up to eight organs can be offered: the heart, intestine, pancreas, kidneys, lungs and liver."
The first choice for kidney transplantation is Cyprus, depending on whether there is a compatible recipient. "The heart due to survival hours the only options we have are Greece and Israel. Lungs, previously we had an agreement with Austria and offered them there, but for the last two years they have been offered to the National Transplant Organisation of Greece."
What could be the reason...
Looking at the annual posthumous donors compared to the deaths we have every year, one realises that the number is quite small. Apart from the ignorance of many citizens on the subject, what else could be to blame?
"The cases exist but either we don't detect them or the brain death tests are never done. I estimate that some in cases with severe brain hemorrhage are not even tested to determine if they are brain dead so that we can proceed with the organ donation option. There needs to be awareness at all levels. And in society as well as among health professionals so that in such cases the right procedures are done."
"I had an incident with people in my environment."
Since 2007 coordinator... "Each time I put myself in the shoes of each family. I've had various reactions. All expected and denial and anger are normal. It's not so easy to watch a family mourn their own person. Cyprus is small. I happened to be in such a situation where it involved people close to me and it is even more difficult. Yet still at that time we are trying to turn all this bad news, which is no worse, into something good. Even dead man has so much 'power' to give life. Since the family is positive for me at that time all negative emotions are erased. I say to myself, now we start the process so that in the shortest possible time we can make this act succeed."
He even wanted to emphasize that there is a much higher chance that we or a loved one will be in the group of those waiting for a transplant rather than becoming a donor.
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Views & opinions expressed are those of the author and/or Cyprus Times
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