Poles do not want to donate organs for transplant. Why is this happening?

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The number of declarations received by Poltransplan regarding refusal to consent to transplant is growing. Poles do not want to donate organs, not only after death, but also in life – for family transplants. Why is this happening? Explains Mateusz Zatorski, psychotransplantologist.

1. – In the Catholic religion we will find nothing that would indicate that we will not be saved without a heart or a kidney. John Paul II said that transplantation is a good thing. And we? We are not sure about it – explains Mateusz Zatorski, psychotransplantologist
2. Sometimes the patient did not oppose the organ donation. Relatives in a state of shock and trauma do not know how to clearly assess the situation. Because he did not consent in writing. Maybe he did not want it after all?
3. – A good donor is a conscious donor. He cannot make decisions only on the basis of altruistic premises – says Dr. n. Hum. Mateusz Zatorski

Agnieszka Filas: Are Poles a nation of egoists? Why don’t we want to donate organs for transplant?

Mateusz Zatorski: The increase in the number of objections has been visible since 2010. It is not just about statements that are entered into the Poltransplant database. but also about the so-called organ donation authorizations that take place in hospitals. This is because the doctor asks the patient’s family if he or she has expressed any reservations about the possibility of organ donation. Let us note that the question of relatives’ consent to organ donation is not asked – which must only be done in the case of a minor patient. But the family may express their doubts about the will of the deceased, and in such a case, no transplantology team will decide to undergo surgery. It happens that the patient has not objected to organ donation, but relatives in a state of shock and trauma are not able to clearly assess the situation. It should be emphasized that the procedures in force in hospitals (based on models from countries much more advanced when it comes to the progress of transplantation) are very good, they clearly define how and when to talk to relatives. Doctors are constantly trained in this area.

And yet there are no approvals and organs. Why?

Well, everything works, and there are no effects. In transplantology, we operate in outbursts, instead of educating in a systematic and constant manner. In Poland, transplants are a taboo subject and we certainly do not treat them as a standard procedure in some medical cases. If we have a cold, do we have a dilemma whether to take aspirin? We certainly do not treat transplants as a drug that will always be reimbursed, only that its availability does not depend on the ministry, but on the people.

Some argue that a religious worldview is responsible for this.

What worldview? We assume that they are Catholic, because most Poles are of this religion. And there is nothing in the Catholic religion to indicate that we will not be saved without a heart or a kidney. The authority that John Paul II is for many even said that transplantation is the same good. It is worth disseminating such knowledge in churches or places of religious meetings. Educational teams should include a priest and ethicist, psychologist and doctor. The latter could answer another, also very widespread, question. Often relatives reason this way: this person could have survived, after all, she was only in a coma, giving her organs for transplantation gives the final judgment. Meanwhile, there is no way that organs can be harvested from a person who has a chance of survival. Brain death (and future cardiac arrest) must be confirmed. The person is dead, even if he is breathing with the apparatus and his skin is still warm. This is in line with the current state of knowledge.

What other beliefs underlie our reluctance to transplant?

Two years ago, an idiographic study was conducted in the Netherlands, involving interviews with families who had expressed their reluctance to donate their relatives’ organs. One of the main reasons turned out to be the lack of clear information about the patient’s will. It cannot be otherwise when we so rarely discuss such matters at family dinner. It is easier for us to talk about our own death, and it is more difficult to ask a wife or children what their beliefs are in this regard. This even applies to transplant doctors. When I asked them if they had talked to their family about a possible organ donation, e.g. with their 20-year-old daughter, the answer was negative. The second reason that influences the lack of consent is the cause of death, e.g. suicide. The family is then accompanied by an enormous trauma, the syndrome of “closing the grave”, a sense of guilt, which they do not want to further deepen by donating the organs of the deceased. The dynamics of family processes is also important, in other words, to put it simply, the relations we had with the deceased during his lifetime. Was he a good man or a bad man? Were we in conflict with him? Were there any unfinished business between us? When our relationships were complicated, we express more doubts about the deceased’s intentions. The decision is also influenced by the identification of the context of death and the course of the conversation with the doctor. When a loved one dies, we see a «film» with him / her, frame by frame. When the doctor raises the subject of transplant in the “wrong” cage, it may have an impact on the conclusion of the conversation.

Ordinary selfishness may also be involved.

Yes, and the problem will continue to worsen, because nowadays children are not brought up in the spirit of empathy or community, but rather fighting for theirs, pushing elbows. Let us turn the situation around for a moment and ask: why do people decide to donate an organ for transplantation at all? First, out of altruism, knowing that other people are suffering. To increase such awareness, contact with potential recipients, e.g. a visit to a dialysis unit, is of key importance. Then we see real people waiting for help, for whom our decision may not only change their lives, but also affect the fate of the whole family. Another incentive is the efficiency of the system, the belief that my organ will not go to waste, that it will be properly used. It is also very important to have clear information about the transplant process itself and what impact it has on the recipient’s life. It must be said that one unfavorable and false information about, for example, illegal transplants is an atomic information blow – it can destroy months or even years of systematic education.

Apparently, the most common declarations of disagreement are made by people aged 30-49.

We can only meditate on the causes of this state of affairs. Younger people have a fresh perspective, and they are also looking for some belonging to a group, identification with an important matter. In turn, older people make summaries of life, wonder what will be left of me? They may come to the conclusion that giving someone a part of their life is an extension of their own existence. People aged 30-39 are at the stage of consolidating their worldview, some hardening of the stereotype. Those who are a decade older, in turn, usually go through a kind of life crisis, experience uncertainty and fear. It seems, however, that the reluctance to donate organs is less related to age, more to the level of education, type of work, and place of residence.

We are talking about transplants after death. What about living donors?

This is an important distinction, as important as the type of transplantation. It seems that the situation is very good for bone marrow transplantation. We owe it to information campaigns and foundations that carry out effective activities reducing ignorance and fear of this type of help. The field I deal with on a daily basis looks worse, i.e. kidney transplants. In Poland, only 5 percent. kidneys come from a living donor, while in countries such as Spain, the Netherlands or our close Czech Republic, this percentage is 40-60 percent. all the transplants!

Maybe because some doctors are against family transplants?

If such a transplant causes problems in the family over time, it means that the selected donor should not be accepted. Out of 10 couples we work with before the transplant, only 3, 4 are psychologically eligible for the procedure. A good donor is a conscious donor. He cannot make decisions only on the basis of altruistic premises, he must understand what he is taking part in, must have conditions (time, financial) to undergo the procedure. He should also feel the meaning of what he is doing, and not donate the kidney just because he “has to”. Transplantation cannot be a type of therapy in which the father gives a kidney to his son or the wife to her husband, because things are not going well between them. The recipient’s attitude is also taken into account. If he cares less transplant than the donor, and this disproportion is large – it is also a psychological contraindication to the procedure. But family transplant, after proper examination and qualification, is definitely worth popularizing.

Dr. n. Hum. Mateusz Zatorski. Pioneer of psychotransplantology. Assistant professor at the Department of Clinical Psychology and Health, SWPS. Associate of the General and Transplant Surgery Clinic of the Medical University of Warsaw at the Infant Jesus Clinical Hospital in Warsaw. She works with people waiting for transplantation, their families and people after transplantation. Since 2011, a member of the interdisciplinary team dedicated to the innovative project of living kidney donation.