[NOTEBOOK]Bureaucracy and Organ Transplants

In March 1998, Dr. Kim Soo-tae, then a surgeon at Seoul National University Hospital, did something "big." He removed the liver of a 14-year-old brain-dead boy and transplanted it to a girl of the same age, who was dying from liver failure. The surgery was done when brain death was not a recognized cause of death, so legally Dr. Kim's action was equivalent to extracting an organ from a living human being. The police prepared to investigate whether the case was one of murder, but the media and the medical community argued strongly that it was time to recognize brain death, discouraging the police from pursuing the case. Dr. Kim's courage was rewarded; organ transplants by other doctors followed.

In Feb.2000, laws on organ transplant were enacted, providing legal grounds for transplanting organs from the brain dead. The Korean Network for Organ Sharing, newly established by the Ministry of Health and Welfare, took on the job of managing organ transplants, a job formerly done by private hospitals and organizations. But to the puzzlement of many, the system did not work as intended.

In Aug. 2001, the health ministry submitted data to a lawmaker showing that from Feb. 2000 to July 2001, after the government took over organ transplant policy, only 82 transplants were performed. That was less than the 92 transplants in 1997 and the 166 in 1999. Meanwhile, the number of patients on the waiting list for transplants was growing. At the end of 1999, 2,800 people were on the waiting list for organ transplants; there are 8,500 today.

Before the government intervention, the Korea Medical Association supervised and confirmed the diagnosis of brain death, and had links to all hospitals. At that time, the doctor's association spent 5 million won ($3,900) a year in operating funds on the job, which was managed by two persons. The government spent hundreds of millions of won to set up an organization for organ transplants and used tens of millions of won to operate the organization, but the result was worse than before.

This is not because those workers in the Korean Network for Organ Sharing are lazy. During the process of shifting the responsibility to the government, hospitals and private organizations turned their backs and the management methods became more and more complicated. In other words, bureaucracy reared its ugly head.

When the new law went into effect, the government took over the entire program, and compiled a waiting list of all potential patients throughout the nation. If an organ became available, it was distributed to the next person on the list. Even if a hospital put great effort into securing permission from family members to use the organs of a suitable donor, those organs would usually go to other hospitals. Thus, private hospitals have no reason to encourage organ donations. There is no benefit for doctors or hospitals, and small hospitals do not take necessary actions even when a brain death occurs in their facilities.

The process of diagnosing brain death also became complex. In other industrialized countries, two doctors can make the diagnosis, but in Korea, seven to ten doctors must agree unanimously. Though the purpose was to minimize errors in diagnosis, the procedure caused great delays. Sometimes, families of the brain dead gave up trying to donate organs because of the complicated process.

Of course, there is a reason for the government to be cautious. It worried that medical organizations would sell organs without due diagnosis or sell organs on the black market. But if the lethargic pace of the organ transplant system continues, it will taint the good intentions of the organ transplant law, which was to increase the availability of organs by recognizing the fact that brain death cannot be recovered from.

I do not argue that the standards of diagnosis of brain death should be eased or that underground organ dealing should be allowed. But in very few countries around the world does the government manage organ transplants as a monopoly. The current system must be overhauled so that the private sector role is increased and the government's role reduced.

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The writer is a deputy city news editor of the JoongAng Ilbo.

by Lee Gyu-youn