No Coercion In Organ Donation, Say Expert

 

Organ donation after death plays a critical role in the national transplant system as living donations are limited to certain organs, such as the kidney. However, experts stress that there is no element of coercion in organ donation cases involving brain-dead patients in any hospital.

Decisions regarding organ donation ultimately rest with the family or next of kin, even if the deceased had registered as an organ donor, said Dr Yap Mei Hoon, an anaesthetist and intensive care specialist at Universiti Malaya Medical Centre (UMMC) here.

She added that not all brain-dead patients are eligible for organ donation as strict screening processes must be carried out by specialists from various medical disciplines.

According to Dr Yap, it is crucial to clarify organ donations involving patients declared as brain dead as there is a common misconception that the patients concerned are still alive and may recover.

“Our priority is to save lives and patients with severe brain injuries will receive the maximum possible intervention in the intensive care unit (ICU). However, there are times when patients cannot be saved and are clinically declared brain dead,” she said in a recent interview.

 

Elaborating, Dr Yap explained that declaring a patient brain dead is a process that requires multiple layers of clinical assessment, conducted by two independent specialists who are not involved in organ procurement or transplantation.

This process goes beyond routine clinical procedures, involving strict protocols to ensure that the diagnosis is accurate, transparent and free from any conflict of interest.

“Clinical tests are carried out twice, at specific intervals, to confirm the complete absence of brain function before death can be declared,” she added.

Among the tests conducted are assessments of neurological reflexes, the ability to breathe independently, and responses to external stimuli. In certain cases, additional tests to examine cerebral blood flow through radiology and electroencephalogram (EEG) are performed to confirm that there is no electrical activity or blood circulation in the brain.

“The second test is crucial in this process because only after it is confirmed can the official time of death be recorded by the hospital. This step is essential to ensure the diagnosis is absolutely accurate and to avoid any confusion.

“Every stage in the brain death confirmation process is meticulously documented, including the timing of each test and the results obtained. This documentation is vital to ensure transparency and to build public confidence in the national organ donation system,” she said.

Once brain death has been confirmed, the medical team will complete a comprehensive evaluation of organs that may be suitable for donation, ensuring they are safe and viable for recipients.

This assessment includes blood tests, radiological imaging, and functional evaluations of organs such as the liver, kidneys, heart and lungs. These screening procedures are critical to ensure that transplanted organs are in optimal condition.

“Even if the organs are still functioning, we must ensure that all clinical criteria are met before proceeding. The safety of the recipient must always remain our top priority,” she explained.

 

The type of organ being donated determines which surgical specialists will be involved in the transplantation surgery. 

“Logistical coordination and mobility are also extremely critical as each organ has a limited window of viability before it is no longer suitable for transplantation. Careful planning with all involved parties is essential to ensure that the organ reaches the recipient in the best possible condition,” she said.

Dr Yap noted that between 2023 and 2026, UMMC recorded nine organ donation cases involving brain-dead patients.

Meanwhile, describing organ donation as part of end-of-life care, Dr Yap highlighted the importance of clear communication with families or next of kin throughout the process.

“In this regard, we avoid using the term ‘organ harvesting’ as it can create misunderstandings, suggesting that organs are taken forcibly or unethically.

“We prefer the term ‘organ procurement’ as it is more accurate and better understood by the public. In modern medical practice, this process is a form of organ donation carried out with family consent and in strict accordance with clinical procedures,” she said.

 

UMMC’s Organ Donation and Transplantation Management (ODTM) unit also plays a crucial role in ensuring that communication with donors’ families is handled with care, heeding their sensitivities and emotional well-being.

UMMC head nurse Farahliza Ismail, who also serves as an ODTM coordinator, explained that the unit is responsible for ensuring the entire organ donation process runs smoothly and transparently, in line with established clinical procedures.

“Usually, once we inform the family that the patient has passed away due to brain death, they are in a state of shock, grief and sometimes, confusion. So, the best approach is not to immediately bring up organ donation.

“This is because we want to give them time to process the situation and come to terms with the patient’s condition before any further discussion takes place,” she said.

This approach allows families to gradually accept their loss before making what is often a deeply difficult decision.

Only after the family has fully understood the patient’s condition is the topic of organ donation introduced carefully, with each step explained clearly and presented as a choice.

Farahliza said at this stage, thoughtful and empathetic communication is essential as many families may have little or no prior exposure to the concept of organ donation.

A structured approach helps families better understand the medical procedures involved, the types of organs that may be donated, and how such donations can offer new hope to patients awaiting transplants.

“When families are given time and clear information, they are able to make decisions more calmly and fully understand the implications of their choice,” she added.

 

Farahliza said if the family agrees to proceed with the donation, several immediate steps are taken to ensure that viable organs are safely transplanted. The patient is temporarily supported by a life-support machine to preserve organ function, while surgical coordination is carried out by multiple specialist teams depending on the organs involved.

“In certain cases, other hospitals will also be informed to participate in the organ procurement and transplantation process, particularly when recipients are from those institutions,” she explained.

She also stressed that throughout and after the donation process, the dignity of the donor’s body remains a top priority.

Usually, once surgery is completed, all incisions are carefully sutured and the body is cleaned before being returned to the family for funeral arrangements.

“Every surgical area is meticulously closed to ensure there are no visible signs that could cause discomfort or concern. For example, internal sutures are used and wounds are properly sealed so the donor’s body appears whole, allowing the family to proceed with the funeral,” she said.

The ODTM team also ensures that the family’s cultural and religious practices are fully respected. This approach reassures families that organ donation is carried out professionally and that their loved one is treated with dignity throughout the process.

The ODTM unit also plays an important role in public education and advocacy, raising awareness about the importance of organ donation.

Regarding the selection of organ or tissue recipients, Farahliza explained that decisions are not made solely by the hospital. Instead, the organ transplantation process is managed and coordinated by the National Transplant Resource Centre (NTRC), where matching is conducted transparently based on clinical suitability, waiting list and other medical considerations.

She added that such a system ensures every patient on the waiting list has a fair opportunity to receive a suitable organ.