I was consenting one of my patients for a routine operation the other day (more on "informed consent" another day), when while discussing the incidence of major complications such as stroke, myocardial infarction, or death, he said to me: "Doc, if anything like that happens to me, or if it looks like I'm going to die, I'd like to donate my organs."
It struck me as rather odd that he would say that. I am sure that he had his own reasons, and I was not all that interested in why, but it made me think... would there ever be a situation where I would seriously consider referring his organs for donation? We often consider patients who present with major trauma and sudden death for organ donation, or those in ICU with head injuries and effective brain death, but patients who die as a complication of elective surgery?
The fact is, if something goes wrong while you are having elective surgery, and you end up dying, you will probably have everything possible done for you until all of your organs fail and there is not much worth harvesting. Most fatal complications of elective surgery involve cardiac failure, respiratory failure, acute renal failure. We don't often give up before at least two of these organs have failed irretrievably, and by that stage the other organs are pretty much stuffed ("stuffed" - a medical term derived from the Latin "stuffio" meaning to be beyond salvage, analogous to FUBAR).
About the only organs left are the corneas, and I have only ever successfully convinced one patient to donate them.
On the other hand, I did have a patient who died recently that had arranged to donate their body to the Anatomy School at our local university where I have previously taught. His wife had died several years ago and donated their body to research and teaching at the university, and he had made similar arrangements in advance. Even in the setting of major organ damage, this can be a useful exercise, and, in fact, is even more educational for the students when there is major pathology present. Unfortunately, permission has to be arranged for this well in advance of death for the University to be able to accept such a donation, so it is not a decision that can be made by a family after a relative dies.
Perhaps my university is a bit of a dinosaur, but we still conduct anatomical cadaveric dissections, and I believe that it is an essential learning experience, and a major tool in medical research. So the next time you are thinking of filling out your organ donation form, think also about what you want to happen to your body if it is not suitable for organ donation... perhaps donation to medical science may be a more productive way to go?