By Dominic Wilkinson (@NeonatalEthics)
The BBC reports today on a recent organ donation initiative in Brazil. This initiative has led to a 400% increase in the numbers of heart transplants in a local hospital. The waiting list for organs in the city of Recife reportedly dropped to zero in the first year after introduction of this innovation.
What sort of initiative could lead to such a dramatic increase in organ donation numbers?
Most initiatives to increase organs are associated with ethical controversy. But this initiative has nothing to do with amending consent arrangements. It isn’t organ conscription or opt-out (presumed consent) donation. It isn’t about increasing the pool of organ donors, for example donation after cardiac death, elective ventilation or organ donation euthanasia.
The scheme is simple and (almost) completely unproblematic. Sport Club Recife, one of Brazil’s largest football clubs embarked on a publicity campaign two years ago to encourage its fans to become organ donors. At each home game a television advertisement is played that encourages those attending to become “immortal fans”. According to the BBC article, 66,000 people have signed up to become organ donors.(See here for a video with excerpts from the campaign)
There are several enticing features about this campaign. First, it seems specifically designed to appeal to young (male) sports fans. That is important because brain death often occurs as a result of serious injury (for example car accidents) in otherwise healthy people. Those most likely to have this sort of injury are often young and male. But they are also a group who traditionally have low rates of signing onto organ registries. Young, otherwise healthy, men don’t tend to think about their deaths or talk with their family about their wishes in the event of a catastrophic injury. Second, the Sport Club Recife organ donation campaign seems to have changed the public conversation about donation. Signing up to the organ donor registry isn’t seen to the fans as an optional extra, or as a form of middle-class altruism. The campaign has managed (apparently successfully) to connect fervent and competitive love for a sporting team with donation. Holding one of the bright red Sports Donor cards with your club’s insignia on it is seen as a sign of true loyalty to your team.
I said that the Recife initiative was almost unproblematic. (Ethicists can always find problems if they look hard enough). One quibble might be the nature of some of the messages that have been broadcast in the donation advertisements in Recife. Fans have been encouraged to donate so that their love for their team can ‘live on in someone else’s body’.
“I promise that your eyes will keep on watching Sport Club Recife,” says one man waiting for a cornea transplant in the television ad made to publicise the campaign.
“I promise that your heart will keep on beating for Sport Club Recife,” says a potential recipient of a transplanted heart.”
One possible concern about these messages is that they are, frankly, irrational. They tap into quasi magical thinking about the nature of consciousness and mortality. The notion of a heart ‘beating for the club’ after transplantion seems linked to folk beliefs about the heart as a focus for emotions or the soul. Is it ethical to encourage donation through the use of mystical and incoherent messages like these? If organ donation after death requires informed consent, along the lines of surgical procedures during life, then we might worry that this campaign could lead to consent on the basis of irrational beliefs. To know whether or not fans have truly given informed consent to donate organs we would need to know more details about what was in the Recife campaigns and what other information they were given.
Of course organ donation after death is different from decisions about medical interventions during life. We don’t currently apply stringent standards of informed consent to donation, nor should we. Organ donation after death is the ultimate in ‘easy rescue’. Whatever motivates fans to sign the organ donor registry we should be glad that they are.
The Recife organ donation campaign should be emulated elsewhere, and clubs in Paris and Barcelona have apparently expressed an interest. But we should not stop there. In a World Cup year there is a fantastic opportunity to take advantage of the huge media exposure and emotional investment in national teams. Perhaps the broadcasters could donate some airtime in each of the participating countries to their national organ donation organisations? Campaigns of this nature will hopefully encourage those who have never thought about organ donation to talk about this with their families and sign up to donor registries. They can perhaps convert organ sceptics into donors. Even more surprisingly, they might turn anti-sport philosophers into football fans…