The Alder Hey scandal initially begun
as nothing more than an inquiry: Professor R Anderson was asked to explain how
a collection of hearts at Alder Hey Children’s Hospital were being used in a
way that improved results of paediatric cardiac surgery. However, by this time,
an Action Group had formed demanding answers and explanations as to the
rumoured vast numbers of stored organs collected during children’s autopsies at
Alder Hey. The media picked up the story and investigated, resulting in a
‘scandal’ that was beamed globally around the world.
Interestingly Dr Harvey Cushing, the
father of neuroscience, amassed a vast collection of human brains himself,
which to this day is proudly kept on display at the prestigious Yale
University. Due to his significant contribution to his field, Cushing’s
questionable attainment of the brains (most likely consent-absent) was not an
issue, as neither the action group of angry relatives nor the
investigative-media existed to create such a global scandal. Perhaps if Van Velzen
had made such an enormous positive contribution to his field of paediatric cardiology as a result of the organ
collections, the spotlight from investigative forces may have been weakened,
and society may not have viewed him as a deceitful, organ-harvesting villain.
However such speculation will remain
just that, and a number of issues have arisen from the incident, first and
foremost consent or rather, trust.
HISTORY’S
PANTRY Most of the jars now at Yale’s Cushing Center contain a single brain; a
few hold slices of brains from several patients. They were collected by Dr.
Harvey Cushing, a Yale professor and one of the first neurosurgeons in the
United States
The contractual issue concerning Alder
Hey is complex, as an array of different contracts were agreed upon. The Human
Tissue Act (1961) states that doctors cannot make a decision themselves on
whether to keep organs unless the patient is a child who has died after a
pregnancy lasting less than 24 weeks, thusly medical stuff must offer up
contracts to next of kins, in this case the parents. However the contracts may
be ambiguous, for example if it stated that with the parents consent, hospital
staff will take a tissue sample for research purposes, the size or location of
said sample remains unknown. Whats more, an organ by definition is composed of
tissue, therefore questions arise as to what
should be removed: a cell; some tissue fibres; entire organs?
As contractual ambiguity was not
unique to Alder Hey, but present globally, the enormous breach of trust
displayed at Alder Hey was an example of the Sick-man Thesis on steroids. There
are many reasons for an emotionless ‘tick-the -box’ style request for organs,
yet common courtesy should be extended to the next-of-kins, such that an informed decision can be made.
Ironically, many of the parents whose children’s organs had be illegally retained, would
have consented had the presentation of the request been more courteous or
better structured. For example, if the parents were predisposed to view their
child’s donation as a significant advancement to medical science, the child's
death no longer would be viewed as random or pointless, now their death has meaning.
In this modern age, the gap between
practitioner and patient is no longer warranted; “there was always a risk that
professional self interest could be disguised as paternalism, but in an era
where the ignorance of the profession was only slightly less than that of the
laity, it might have been defensible” (Hall 2001). Whilst a complete upheaval of Sick-man
methodology is dramatically unnecessary, a concerted effort by all medical
staff should be made particularly
concerning courtesy, understanding and explanation towards the patient,
their families and all those that have a personal stake in the matter: this
effort should be made on all matter of subject, however that of request for
organ/tissue donation is in particular need of revitalisation. Perhaps a
restructuring of the 5 year tests physicians undergo will cause for the
inclusion of such delicacies, so that courtesy, understanding and explanations
are not lost upon the patient, despite the awkwardness or unpleasantness of the
topic. The events at Alder Hey had wider implications however, touching the
lives of many millions of miles away.
Following the public broadcasting of
the scandal, there was an immediate fall in organ donation numbers worldwide.
This repercussion of Alder Hey was detrimental on a global scale, and
demonstrated the loss of confidence the public had in the medical system. There
was, essentially, a global ‘breach of trust’, which ultimately resulted in the
demonization of medical professionals – doctors lost credibility in their field
and, problematically, the ‘doctor knows best’ attitude was lost.
Van Velzen claimed that he had hoped
to contribute to his field of research, however many doubted this due to the
fact that numerous specimens were not in any state to be analysed or
catalogued. He blamed the hospital for the practice of organ stripping,
claiming that he had removed and stored the organs due to not having access to
the resources needed to carry out detailed post-mortems. As there was a
shamelessly enormous number of specimens available for research, one cannot
help but wonder how Velzen ever planned to examine them all – the public was,
inevitably, left to decide between two alternatives: he either had ulterior
motives or along the way his actions became so mundane and unquestionably
legitimate that he ceased to logically consider the necessity for each specimen.
Van Velzen was, plausibly, a
passionate researcher. Though his fixation with obtaining organs resulted in
the tarnishing of medical practitioners’ reputations worldwide, driven
practitioners are imperative for the
advancement of medicine. For such complications to be avoided in the future, a
concerted effort on behalf of practitioners and management should be made; the
practitioners should strive to excel at patient-doctor relationships, ridding
such relationships of angst or doubt; the management should superintend such
attempts, thus ensuring that the correct practices are executed &
‘radicals’ cease to exist within the profession. In the way of organ donation,
a feasible solution to scarce numbers would be to raise awareness of what it
means to be an organ donor, and the contribution one would make should they
become one.