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Transplant Dramas on the Critical Listby John F. Neylan, MD >Reprinted from TV Guide, April 25 - May 1, 1998 Each day, dramas great and small play out in my office at Emory University Hospital in Atlanta as my patients cope with the great challenges of organ transplantation. This modern medical miracle has it all emotional hardships, cutting edge technology, life and death struggles. So it's no wonder stories about transplants have become mainstay of TV dramas as ER, Chicago Hope, Law & Order, New York Undercover and Profiler this season. And this week, CBS airs the TV-movie Nicholas' Gift, based on the true story of a family and their decision to donate. But too often these shows are simply not accurate, or, worse, they are blatantly wrong. You may say that's fine, nobody takes them seriously. Unfortunately, that's not true. According to a recent Gallup poll, 46 percent of people with knowledge of organ donation and transplantation cite movies and TV shows as important sources of information on the subject. There are 58,000 people waiting for organs in this country, and if everyone accepted what they saw on TV, it is likely few viewers would want to donate their organs or those of a loved one. Am I exaggerating? Let's see how TV's dramas measure up to reality. Just look at TV's most popular drama, ER. In an episode that aired in October (called "Friendly Fire"), a pretty young woman was brought into the emergency room by her husband, who found her in a peaceful but unresponsive state. Naturally distraught, he was all but unhinged as the doctors made a quick assessment and advised him to think about donating her organs. Moments later, she woke up and began to speak. Chicago Hope, which has turned to transplant plots a number of times this season, had a similar twist in an episode in which a critically injured accident victim was pronounced dead, only to show signs of life as incisions were about to be made for organ retrieval. It seems a resident cut a few corners in making the diagnosis of brain death, a blunder that prompted a scolding from the chief of staff "Hundreds of people...die because people are afraid...they'll be cut open before they're dead." If they're afraid, it's because shows like these so flagrantly ignore the world of difference between coma and brain death. The truth? There are many causes of coma and many chances for recovery. But brain death, which is usually the result of trauma, bleeding or inadequate delivery of oxygen to the brain, is irreversible. The pronouncement of brain death can only be performed through a series of tests administered by a physician (in many states, two physicians) not associated with the transplant team, and only after these tests have been performed is an organ made available for transplant. In the entire annals of modern medicine, a patient has never awakened from brain death. Or how about Chicago Hope's "Guns 'n' Roses" episode? Here, a wealthy man mysteriously arranged for the payment and procurement of a new heart. The transplant team was suspicious but went through with the operation anyway. Afterward, the recipient admitted his deed, and the local police closed in, no doubt ready to confiscate the evidence. In fact, doctors can't just take organs out of one patient and stick them in another, no questions asked. The National Organ Transplant Act of 1984 tightly controls transplantation and makes the sale of human organs a federal crime. In real life, whenever an organ is donated, the federally regulated U.S. Organ Procurement and Transplant Network steps in to match the organ to a recipient, using a national prioritized list that takes into account such factors as medical urgency and time waiting, not how much money a person makes. New York Undercover's "Spare Parts" episode showed two men harvesting body parts from teens picked up on the street. The chief of surgery at a New York City clinic then performed transplants using these organs for profit. It's amazing how the urban myth of people being robbed of their organs persists. In truth, it has never been documented to occur in the United States. This is only one of this episode's many untruths. Organs are not left anonymously on hospital steps. All donors and recipients must be followed through the national system, and all transplants must be performed at federally approved facilities. But even if you take this ludicrous plot line seriously, you have to wonder why a sick patient would want an organ picked up on the street. Who's to say the organ would be a match? Without proper testing, who's to say it would be useable? Why would the teams of transplant surgeons and recovery people lay themselves open to this risk? Worst of all was the Law & Order episode, "Harvest," in which a young woman struck by gunfire was brought to the hospital, barely alive. An unscrupulous surgeon saw an opportunity to procure organs for transplantation and person gain. He pronounced her dead and proceeded to take her heart. Later, as the fact came to light, both of her assailants (the shooter and the surgeon) were brought to justice. The successful prosecutors sat back to recap the story and concluded, "There's going to be some fallout from this. People are going to think twice about signing their donor cards." After watching this dreadful program, I came to the same conclusion. What a relief it was to see Nicholas' Gift, the true story of an
American family vacationing in Italy whose son is struck down by gunfire
on a lonely stretch of road. In this deeply moving account (starring
Jamie Lee Curtis and Alan Bates), we are shown a far more realistic
picture of the struggle that accompanies such tragedies, as well as the
empowerment and restitution that organ donation can provide. Interwoven
is the story of the young Italian boy who receives Nicholas's heart. If
only TV could treat the subject of transplantation with this much
delicacy and accuracy more often, the critical shortage of organs might
be reduced. Ten people die every day waiting for a transplant in this
country. I only hope that after people see Nicholas' Gift, families
facing the passing of a loved one will say yes to organ donation when
they might have said no.
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Children’s Liver Association for Support Services
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