| 媒體採訪篇Copyright 2001 China
Times Inc. 1. 中時晚報
Supply and demand is unbalanced in Taiwan's market for organs; many people suffer, waiting for many years and never find a heart donor. The strange thing is, there are also many people who would like to be donors, but are unable to have their wishes carried out. What exactly is causing this unbalance between demand and supply? Religious factors? Flaws in the system? Or are there problems with the whole system of education about death in Taiwan? Focusing on the Taiwan's currently developing concept of organ donation, the Taiwan News held a forum, to which we invited Master Shih Chao-Fei, president of the Life Conservationist Association of the R.O.C.; Wen-Je Ko, SICV director at National Taiwan University Hospital's Department of Surgery; and Dr. Cheng-Deng Kuo, principal investigator and attending physician at the Veterans General Hospital's department of medical research and education. The forum was moderated by our Editor-in-Chief, Rex Wang.
Shih Chao-Fei, Founder and President, Life Conservationist Association
Cheng-Deng Kuo, MD, Principal Investigator and Attending Physician, Dept. of Medical Research & Education, Veterans General Hospital
Wen-Je Ko, SICV Director, Department of Surgery, National Taiwan University Hospital
Q: Let's start by asking Dr. Ko to approach this question from a medical viewpoint.
Ko: Patient organ donation started with brain-dead patients; the convention of brain-dead people originated in the 1960s in France, where if, two and a half years after patient became brain-dead, there was no way of curing them, doctors could then carry out organ donation. Taiwan's most famous patient in vegetative state is Wang Hsiao-ming - she is still alive, and so she can't be put on the list of organ donors; medically speaking, there's no reason to put somebody in a vegetative state on the organ donors list, we only need to verify that there's no longer any possibility of curing the patient, then they can be put on the list of organ donors.
Q: What is the current situation in Taiwan?
Kuo: Basically, I am in favor of organ donation, but I also respect the donor's right to know and consent to his or her organs being donated. As far as I know, when some organ donors go in to the operating theater to have their organs removed, the hearts still start to beat faster, but most doctors pay no attention to these reactions, and they do not administer anesthetics to the patient to reduce the pain, because anesthetics cause low blood pressure, and adversely affect the circulation of the organ, and when it is transplanted into the new body, the probability of survival is lowered - that's why doctors frequently avoid giving anesthetics if they can.
Although I am in favor of organ donation, from a humanitarian standpoint, we ought to allow the organ donors to give up their organs without pain, and if there is a physical reaction during the organ harvesting, we should give anesthetics in response. The second point is, we need to obtain the consent of the donor him or herself before we can carry out the organ transplant operation; soliciting the patient's request is a worldwide trend, and it's also a reasonable position to take.
Shih: A large part of Buddhism in Taiwan is conducted in accordance with the views of Pure Land Buddhism, and these views certainly have an influence on people's wishes as concerns organ donation. Many people think that the ideas in Pure Land Buddhism come from ancient texts. From my own studies of Buddhism, I also think the classics are evidence of this. The viewpoint of Pure Land Buddhism is that after people die, sop?d?nasya vijn?na (an idea about the persistence of life after death) does not leave the corpse immediately, but very slowly, and this period of time is very painful. The spirit takes about eight hours to leave the body, so the body should not be moved or disturbed during this period, so as to allow the soul to leave the body slowly. If one collides with the soul, one could make it angry or unhappy, or cause it pain. The Buddhist view is, when people die, the best thing is to fill them with light, happiness and hope, not pain and vexation. Many people think that even so, rather than waiting until I reach the Western Land, I will discipline myself to a certain level and then help them. This view has an extremely strong influence.
From a Buddhist viewpoint, can people feel pain after death? Can they, after all, feel angry or annoyed? According to the ancient texts, after people die, sop?d?nasya vijn?na (a kind of persistence in life) can leave the body, and the body then becomes a cold corpse. This process can start slowly from the feet and move on to the heart, so the body doesn't become cold all at once. But during this process, there is no clear evidence to support the idea that the body can still feel pain or anger, or that there are still neurotransmissions, this kind of explanation doesn't really tally with the Buddhist view.
Kuo: Some people think that the quickening heartbeat of some people who are already brain-dead during the organ harvesting operation is on the contrary an autonomic [i.e. involuntary] nervous reaction, and has no significance. I'd like to hear what Dr. Ko has to say.
Ko: When doing animal experiments, for instance, after we cut off the head of a frog, its legs will still continue to twitch; it's the same with brain-dead patients, it's as if they're already dead, their spinal column reflex is still there. However, not long after the necrosis of their organs, these reactions will disappear too. So, the critical moment for removing the organs is within a very short period between pronouncement of death and necrosis of the organs.
Actually, the most important thing is still the consent of the person him or herself. On driving licenses in Texas, in the U.S., filling out whether or not you consent to donating your organs is mandatory. Actually, we in Taiwan did think about following this example in the past, but at the time, most people found this way of doing things unacceptable. The Singaporean government has stipulated that people must accept the donation of their organs after death: unless you apply not to be a donor, everybody is assumed to accept organ donation.
Q: Master Shih, do you have a view on this?
Shih: In Buddhism, when we talk about bodhisattvas, we mean that by the spirit of sacrificial dedication, we can expect to become this kind of bodhisattva. But this doesn't mean that you will definitely become a bodhisattva, so I don't agree with what they're doing in Singapore.
I think that brain-dead is a word created especially for organ donation. Demand outstrips supply on the organ market. Those on the verge of death have become the oppressed side. But the organs have grown in their bodies, and they have the absolute right to decide whether or not to donate them.
Ko: The person and his or her family members have the right to decide whether or not to donate organs. We can't force people to donate.
Q: But from theological, Buddhist and philosophical standpoints, the concept of "being able to offer the very last thing before death" should be advanced.
Ko: I'd like to add something, the highest organ donation rate in the world is in Catalonia, in Spain, and their attitude is: today, I will donate something to somebody who needs it, and in the same way, if one day, one of my family or friends needs an organ, there will be a fellow countryman who is also willing to donate to them. They have already turned their entire country into a community of life. In actual fact, how high or low the rate of organ donation in a country is can be seen from how high or low their culture of ethics and morals is.
At present, the government does not have a body with special responsibility for matters concerning organ donation. Fundamentally, when we carry out organ donation, we still have to carry out blood tests; there can only be four hours between harvesting the organs and transplanting them into recipient's body, and carrying out this kind of process requires a big organization. However, Taiwan doesn't have this kind of system. Actually, Taiwan also has many people who are willing to be organ donors, but the people who would like to be donors still need to go to the hospital themselves to donate. For instance, not long ago, there was a case where the body of a dead person was taken by her family to the hospital by MRT to register, but since the person is already dead, how could she register?
Q: Master, what do the people you commonly come into contact with think?
Shih: The Buddhists I am in contact with are all very enlightened, perhaps because we all have a better understanding that life must inevitably face death. Demand exceeds supply on the organ market, and some people want to take organs from the bodies of animals, they would even like to harvest organs from human clones, this is a mistaken ethical concept. There's a very important concept in Buddhism, which is that people cannot presumptuously take something from the body of a living creature for their own selfish purposes. If today you transplant an organ from a pig into your body, are you a human being or a pig?
Ko: I'll give another example of organ donation. When [the actress] Yu Feng hanged herself, her family took her to the Veterans General Hospital, and the doctors pronounced her dead. Afterwards, her family brought her body to National Taiwan University Hospital, in the hope that they could donate her organs, but the doctors said they were willing to do their best to see if they could bring her back to life, and of course the family gave their consent. Thereupon, the doctors used large quantities of steroids, to make the last possible efforts for the patient, and the result was that after her death, all her organs were bleeding, and not even her internal organs could be used. So actually, the people in Taiwan who can't accept death are the doctors, not the families.
Graduates from National Taiwan University's medical department need between 270 and 290 credits, but only one mark of these credits is related to life and death studies. Medical education in Taiwan doesn't really contain any education on the study of life and death. This creates a very interesting phenomenon: a doctor who has to deal with life and death on a daily basis does not know how to face the issues of life and death, which is a great pity. When a doctor makes the rounds of the cancer ward, the patient's family asks how many more days the patient can be expected to live, but the doctor tells the family not to imagine such silly things, they must be assured that the patient will be cured. The doctor is thought to be omnipotent, but how can he or she save everybody? Why is the rate of organ donation so low in Taiwan? Because a person on the verge of death urgently needs the care of the outside world, but the doctors and nurses around him or her haven't been taught "how to face these people," and the situation with organ donation is just the tip of the iceberg.
Chinese people are deeply influenced by Confucianism, and the concept of "if you don't understand life, how can you understand death?" means that from childhood we cannot accept any education related to death.
Kuo: Actually, doctors can't win either way, because if they hesitate in the process of saving someone, they may be sued by the family, and the courts also stipulate that a doctor must do his or her utmost to save a life. In the process of saving someone, where is the energy to care for the dying supposed to come from?
Q: Does anyone have any ideas about the education side of things?
Ko: I was thinking, in both medical education and general compulsory education, we should add how to face the question of death.
Kuo: Social education also needs an element of life and death studies. Even Buddhism doesn't call death "death", they call it "going towards life."
Shih: According to Buddhism, death is a kind of beginning of life. This concept is part of Pure Land Buddhism.
Q: Apart from what we've just said about education, is there anything else we want to say?
Ko: We should have a mark on our ID cards, driving licenses or national health insurance cards, and this task could be undertaken by the Department of Health. And if we then change our minds again, we could register to cancel this mark.
全文完Compiled and edited by Tina Lee/Translated by Elizabeth Hoile 編輯李美儀/英文翻譯何麗薩