There is an increased vigour to register more organ donors now that there are about 5 000 people in South Africa who are on waiting lists for life-saving organ transplants, writes SAALEHA BAMJEE
ORGAN donation is being hampered by cultural and religious beliefs. Although no religion explicitly states that organ donation is forbidden, the complexity of the issue is cause for most of the concern.
In a ruling issued by the Jamiatul Ulama of KwaZulu-Natal, a body of Islamic theologians, which subscribes to the Hanafi school of thought, the transplant of a human organ is allowed for the terminally ill.
It is also permissible for someone to donate a kidney to a family member who is in dire need of a transplant.
However, Muslims are forbidden by Islamic law to bequeath their organs because it is believed that the human body is a trust given to the people by God, and as such, they are unable to give away what is not rightfully theirs.
A similiar belief is held in the Judaic tradition.
"Organ donation is a complex issue and it is by no means clear-cut. We believe in the resurrection of the dead in which the soul is to return to a body, which should be whole. At the same time, a primary element to our belief system is to save human life," said Rabbi Ari Shishler.
"It really is context specific. There would be nothing against someone donating a kidney to a terminally-ill person," Shishler added.
According to Hashmukh Velji Shah, international trustee of the World Council of Hindus: "The important issue for a Hindu is that that which sustains life should be accepted and promoted as dharma (righteous living). Organ donation is an integral part of our living."
Most Christian denominations view organ donation as an act of charity and neighbourly love and the Vatican has deemed the procedure morally and ethically acceptable.
Matsie Pooe, the transplant co-ordinator at Chris Hani Baragwanath Hospital, said black communities generally believed that a person should be buried in their entirety.
While this is in line with other world views and religions, the concept of people being buried in their entirety is negated by the fact that the donation of their organs is linked to the saving of human lives. In such a case, the bar falls on the side of the greater good.
Pooe said: "Older people weren't exposed to the concept of organ donation and many of them don't understand what it means."
For many who are apprehensive about donating the organs of their loved ones, it is more a case of mis-education and ignorance than adhering to cultural norms.
"Sometimes it's not a problem with living donors (those who donate a kidney or a piece of liver to a sick family member). Issues arise when a person is brainstem dead and is kept alive on machines," Pooe said.
In such cases some family members find it difficult to believe a loved one has passed on because the machines give the impression that they're alive.
"Some cannot accept that brainstem death is irreversible and the relative who advocates the organ donation is often seen as the one who "killed" the patient. There are so many sick people out there who really need transplants," said Pooe.
She visits schools and churches to build organ donation awareness. She is often accompanied by people whose kidneys are malfunctioning and need dialysis treatment or people who have been recipients of organs to reinforce her message.
The most common transplant organs in South Africa are kidneys. There is no specific organ that is needed more than others, as hearts, kidneys, livers and pancreas transplant waiting lists are equally lengthy.
Tissues, like corneas, heart valves, skin and bonemarrow are also required.
It is illegal to buy or sell organs in South Africa, according to the National Health Act.
Mande Toubkin, a transplant manager at Netcare, said organ demand is greater than organ availability.
After a person has been certified brain dead by two independent doctors who are not affiliated to the organ transplant programme, the family of the deceased are approached by a doctor or a transplant co-ordinator.
"Vast amounts of counselling are involved as the bereaved are going through a traumatic period," Toubkin says. "For some, giving permission to donate their loved ones' organs aids in their recovery process as they feel some purpose could come out of the death."
Living donors may give a kidney to someone with whom there is an exact match, or a piece of liver, as in the case of a mother-to-child donation.
South Africa operates on an opt-in system when it comes to organ donation. This means that people are not donors unless they stipulate that they want to do so.
In other countries, such as France and Spain, an opt-out system is in place, where it is assumed that every person is a potential donor and if someone does not want to donate, he or she would have to state so in writing.
According to the Organ Donor Foundation, anyone in good health, who does not suffer from cancer, hepatitis, diabetes or HIV/Aids can become a donor.
There is no age limit, but it is a general practice for people under the age of 70 to be preferred.
Toubkin adds that it is a simple process to become a donor.
One may register on the internet or by calling the Organ Donor Foundation toll-free.
After the registration, donors will be sent a sticker to put on their ID document and driver's licence.
Potential donors are recommended to discuss their decisions with their families, as it is up to them to give the final approval at the time of the donor's death.
No organs may legally be removed for transplant without consent from the family of the deceased.
Statistics provided by the Organ Donor Foundation show there were 1 500 transplants in 2003, and 744 people had their sight restored through cornea transplants.
For many who choose to donate, its a way of saying, "My death is not without purpose, for in me being so, I have given you life."
Potential donors may register at http://www.organdonor.org.za or they could call the Organ Donation Foundation on 0800 22 6611.