HEARTBEAT:'Medicine, to produce health, has to examine disease." Plutarch wrote this in approximately 70AD. "Resipse loquitor," it speaks for itself.
Dr Deirdre Madden's report on organ retention is concise and goes directly to the core of the matter. It will not, of course, please everybody. I agree with the Minister for Health when she says, "time to move on". Damage has been done, some of which may be permanent; but that is now in the past.
In earlier writing I described exposure to the dissecting room where the foundations of our anatomical knowledge were laid. I, like many students, possessed a skeleton for the study of osteology. I must say I never regarded him as a retained organ, although in reality that's what he was. Later, in the teaching of pathology, we were exposed to hospital and university collections of pathological specimens. This was an integral part of medical education.
In my own speciality, the study of retained hearts, particularly in children, laid the foundations of cardiac surgery as we know it today. Two of the great pioneers, Dr Walt Lillehei and Dr John Kirklin had access to the vast collection at the University in Minneapolis which contained nearly every kind of cardiac anomaly and allowed them plan the curative or palliative operations that have benefited countless thousands over the years. No medical person that I have known ever expressed an opinion that somehow this was a bad thing.
Things, however, changed radically and the term organ retention almost always used pejoratively burst upon the scene. It came about following the investigations into children's cardiac surgery in Bristol Royal Infirmary, when a mother of a deceased child found that the child's heart had been retained following post mortem. In the outcry and subsequent inquiry, Prof RH Anderson of Great Ormond Street Children's Hospital, inadvertently fanned the flames when he pointed out that such retention and such collections were the norm in Britain. He mentioned that one of the largest collections was at Alder Hey Hospital in Liverpool. Pandora's Box was open and reason flew away.
The fact that such organs had been retained for education, research and ongoing patient benefit mattered little. In fairness, it must be acknowledged that one pathologist in Alder Hey, a Prof Van Velzen, had accumulated a vast collection of organs with apparently no justifiable reason.
It was open season upon the doctors with the pathologists bearing the brunt of criticism on this occasion. Everybody lined up to have a kick, led by the politicians. The chief medical officer in England was asked by the secretary of state for health Alan Milburn to prepare an inventory of centre where such retention occurred. That was a simple problem, the answer was everywhere. Initial reports suggested that 50,000 such organs were retained; the true figure is probably more than double that. Milburn commissioned an inquiry, the Redfern inquiry. In its report the chief medical officer reported 16 staff, including Van Velzen, to Britain's General Medical Council. It took four years for the GMC to conclude that apart from Van Velzen, nobody had done anything wrong. Many of the unfortunate doctors had been suspended pending this clearance. No apology was forthcoming. Doctors were "secretive, unaccountable, arrogant and self-centred", according to Mr Milburn. There were implications of illegality, where none existed.
Meanwhile, grief and outrage had crystallised in some cases into demands for compensation, demands for somebody to blame and for heads to roll. Dr Madden states that fairness demands that doctors be judged by the standards of the time and that such procedures were universal. There is criticism also that doctors, hospitals and the Department of Health did nothing about it until it had been publicised by the media.
However, the hyperbole surrounding the issue has been damaging.
Post-mortem rates, other than those ordered by coroners, have fallen drastically. Such procedures were an important part of ensuring that hospital standards were maintained and that staffs were properly trained. Organ donations for transplants fell by 35 per cent while the waiting lists for such procedures grew. Tissue research to benefit a myriad conditions was halted or choked in miles of red tape. Young doctors looked sceptically at pathology as a career option, particularly in paediatrics. This will rebound adversely on the provision of hospital services. Some €20 million has been spent that could have been used elsewhere.
Legislation has been promised. This will help; because of now nobody owns a body, and the whole situation as shown was shrouded in uncertainty. It again illustrates the almost complete lack of understanding of how hospitals and doctors work and if it brings about better explanations and more involvement of the next of kin in such deliberations then so be it. It is a huge complex question in these days of organ donation, the bequeathing of bodies to medical science, cremation etc. Do you want your appendix back, your blood sample, or your amputated limb? Where does all this stop?
It's been a bad time to be a doctor. I will end with the motto of the Pathological Institute of McGill University in Canada. "Hic est locus ubi mors gaudet succurere vitae." (This is the place where death rejoices to come to the aid of life).
Maurice Neligan is a cardiac surgeon.