List lets Czechs keep organs -- for eternity

New database allows people to prevent posthumous use of their parts for transplants

Borek Svoboda, 58, underwent a heart transplant May 21 He says he supports the state's establishment of a nondonor database

By Peter Kononczuk

Staff Writer, The Prague Post

September 9, 2004

In life, a citizen's body may be his own, but in death the state can claim his organs for transplants.

Those who object, however, can now stop that from happening.

As of Sept. 1, people who do not consent to the posthumous harvest of their parts can make their wishes clear by signing a new national register.

The move brings the Czech Republic into line with many other European states where doctors must verify that a person is not on such a database before removing organs.

Medical and patients' associations in this country welcomed the change. They say it will help doctors and clarify a murky, unregulated area of medical practice.

"The will of the patient did not exist. Relatives did not have a right to interfere." Milan Kubek Doctor's Trade Union Association

Lubos Olejar, president of the national Patients' Association, said he expects 1 percent of the public at most to put their names on the register.

Higher numbers would worry surgeons, as currently there are nearly 1,200 seriously ill people waiting for transplants.

Until now, "every citizen of the Czech Republic was automatically considered an organ donor unless he stated otherwise," Olejar said. But making such a statement was no guarantee your wishes would be respected.

Someone not wanting to have his or her organs transplanted after death had to carry a statement to that effect along with a notary's certificate, or at least have a statement in their medical records, according to Olejar.

"If doctors did not find anything like this, there was no reason to believe that the person refuses to be an organ donor. Sometimes, it was a matter of not wanting to find anything," he added.

Milan Kubek, head of the Doctors' Trade Union Association, said that in the past no regulations governed the conduct of medical staff who were considering extracting organs from a deceased patient.

"In fact, the will of the patient did not exist. Relatives did not have a right to interfere."

Kubek hailed the new database as a step in the right direction because it allows people to state their wishes clearly.

"We followed world trends by introducing the register" of people who decline to have organs removed, he said.

"If it was the other way around, it would stop transplantation programs," Kubek added, referring to some countries that maintain a database only of people who are willing to donate organs.

ORGAN DONORS The law automatically considers every Czech citizen an organ donor. What's changed: As of Sept. 1, those who do not consent to the posthumous harvest of their organs may sign a new national register. Why the register?: Experts say it will clarify a murky, unregulated area of medical practice, bring the country into line with many other European states, and allow people to express their wishes clearly. How will this affect the number of available organs? The change is not likely to endanger transplant programs, according to cardiologist Ivan Malek.

Olejar said he was in favor of the Czech system because "the law should give preference to those who are alive, not to those who are dead.

"The new law will support transplantation programs, and will speed up and make easier the procedure of getting organs," he added.

Ivan Malek, deputy head of the Cardiology Clinic at Prague's Institute of Clinical and Experimental Medicine, said that if one in 100 people sign the register, as he expects, that figure "will not endanger any transplantation programs -- on the contrary, it will speed the procedure up."

State property

Borek Svoboda, 58, suffered heart problems from the age of 9 but refused a heart transplant until March, when he collapsed. He was put at the top of a waiting list, and finally underwent the operation May 21.

He supports the new register, saying that it brings clarity to donation procedures.

Svoboda, who worked as head of security at the National Theater, then later at the National Library in Prague, added that it was vital to explain to the public how important it is to offer organs.

"I understand that there are people that are against it, from religious or other reasons. But I would give my organs to someone else, if something happened to me," he said.

Sixteen other European countries including Austria, Belgium and all the post-communist states that joined the EU in May have laws similar to the Czech Republic's: Citizens -- unless they specifically opt out -- are assumed to have given their consent to use of their organs after death.

Eight of these states, including Poland and Hungary, run a national register.

Countries including Britain, Germany, Denmark and the Netherlands have the opposite system -- patients are not automatically considered to have given permission for their body parts to be transplanted.

Britain "does not want to move down the road that a person's body or organ becomes the possession of the state," said Peter Sas, press officer for UK Transplant, a British health ministry organization that coordinates transplants.

"The cornerstone of the system is informed consent. It's a principle that is absolutely sacrosanct to the department of health here," he added.

There were 2,800 transplants in Britain last year, with 5,873 people registered as waiting for such operations.

In comparison, 551 organs were transplanted in the Czech Republic, of which 400 were kidneys, according to the health ministry.

By Czech law, with the exception of kidneys, no donated organs can come from a live person.

Lenka Ponikelska contributed to this report.

Peter Kononczuk can be reached at pkononczuk@praguepost.com

Copyright © 2004 The Prague Post.

This article posted October 12, 2004.