Dr. Bruce Wainman – Part 1

“If somehow, you could add up all the good done by a body donated to the anatomy lab, maybe it’s the same as donating an organ to one person”

Interviewed by Kevin Chen, Alexander Mastrolonardo, and Grace Lee

McMaster Chapter

Dr. Bruce Wainman is the director of the Education Program in Anatomy at McMaster University and the McMaster Surgical Skills Lab. He has begun to work with the Trillium Gift of Life network to facilitate a new program allowing those ineligible to donate their organs for transplantation to instead donate their bodies to education. We had the opportunity to chat with Dr. Wainman about the anatomy of organ transplantation and his work with procuring new anatomical specimens.

This documents the first part of our discussion with him. To see the second part, click here.

The first question that we have for you is quite fundamental: what sort of diseases have you seen that can be treated by organ transplantation?

Dr. Wainman: Liver and kidney failure is the thing that we see incredibly commonly, and I don’t know how many of them were on transplant lists, but certainly a lot of them. And the other one that we see a lot of is cardiac issues, cardiomyopathies, and that sort of thing. Again, I don’t know how many of them were eligible for transplant, but I have to say that when you run an anatomy lab, you don’t obviously see very many healthy people. They’re here for a reason, which is because they’re deceased. But the amount of pathology that people die with is really quite spectacular. We don’t see people with healthy kidneys. Very seldom do we see a liver that’s really super healthy. Now, it’s not that they necessarily would have died of that, but they often have them impacted. One of the things it says to us, is that the elderly are not going to be a good source of organs for donation necessarily because so many of them have pathology already. On the other hand, it does suggest to us that a number of people could probably have benefited from having organ transplant. [Ultimately,] we don’t know; we don’t have that source of information and we don’t push the families to find out anything more about that.

Is the idea, then, to give patients transplant early enough, so their disease doesn’t start affecting their other organs?

Dr. Wainman: Yeah, well the trouble is, as anyone will tell you who does organ transplantation, the longer the person goes without being transplanted, the less able they are to be transplanted. And that’s the terrible irony of the whole situation. You know, so often someone would’ve been a fantastic candidate for transplantation only months before, and then their health has gotten worse and worse because of a lack of transplantation. That issue has gotten a lot less serious, and we are really a lot better, particularly with people with kidney disease, treating them long enough to get them transplant ready in time, without them having really bad health.

That being said, what are some of the factors which might influence whether a patient is deemed to be “eligible” for a transplant?

Dr. Wainman: I’m not a transplantation doctor, but I know it’s extremely complex, and many things come into the calculation.  Obviously the age of the transplant candidate, the degree of the disease, whether they can still be dialyzed[…] there’s a lot of issues that are still going on.  There’s a number of other health problems. It’s not uncommon to have someone come in for transplant, and then find out for other health issues, they can’t be transplanted at that moment, which is always a bit tragic.  Again, they’re spiraling downwards, by the time they need to be transplanted.

Do you see a lot of people coming into the anatomy lab, who otherwise, you think might have been on a transplant list but didn’t make it?

Dr. Wainman: We don’t see a lot of people like that. Mostly the people we see are the elderly that have multiple problems with multiple organs. No, we don’t see a lot of people who are on lists, but what we do see is a lot of people who have who have been transplanted, which is very exciting for us, to see that they’ve gone through a healthy life. You also have people who have obviously been transplant donors, which is interesting, they’ve been live donors, because you can see the scar. Again, remember, people who come to put their bodies into anatomy, are pretty altruistic people. For many people, this is the last best thing they can do with the body that they have and it’s not too surprisingly that during their life, they are be the people who would be a live donor. When you think about it, that’s kind of the way they lived their life, and that’s the way they decided to die, so they could be useful. It’s kind of inspiring, right?

It really is! Didn’t you also mention that you have started to work with Trillium Gift of Life (TGLN)?

Dr. Wainman: We’re developing a relationship with TGLN, because we have found that occasionally, people who would like to be organ donors, turn out to be ineligible for some reason, something in their history that makes them a poor candidate. The family, who have finally decided that they would like to make that person’s death meaningful in some way, are then told that it won’t be possible. We would like to give them the option of being part of medical education and research.

But in many ways, it seems like donating to the anatomy lab is quite similar to TGLN.

Dr. Wainman: Yeah it is similar, and you know, the impact is a lot less focal. It’s a lot less one to one, than “I’m going to make a huge difference in your life, ” you make a difference in a lot of people’s lives, but to a lesser degree. If somehow, you could add up all the good done by a body donated to the anatomy lab, maybe it’s the same as donating an organ to one person, so it’s great for that one person and it’s mostly that person and their circle of acquaintances and family. But a body donated to education and research has a lot of effect. It’s a smaller effect, but with a lot more people.

What sort of myths are there about donation in general?

Dr. Wainman: I think people are just afraid about what they don’t understand. And some people would be afraid that the bodies are not respected in the way that they should be. Perhaps, they’d be afraid that the procedures done on them would be disrespectful, and that students are not respectful in what they’re doing. Perhaps, they’re afraid that all the remains are commingled, and then what do we do with them afterwards. They wonder, would we cremate the bodies individually? There are many, many things, and in general, people are just very afraid of what they don’t understand. Then you add on top of that, a very deep ingrained fear we have of death, and the discomfort around that, and that’s really a perfect storm for people. They’re afraid of what they don’t know, and they’re afraid of death. So you put those two together, and people are just plain afraid of what we do. At least when we do the Service of Gratitude, and when I get to chat with families, just to show them, it’s just education and research, that’s what we do, there’s nothing particularly, nothing special about us, other than we want the students to learn.

Is there a way for families to find out exactly what their family member’s body is used for?

Dr. Wainman: We discourage people from getting too heavily into it. We normally say “education and research,” if someone really needs to know, we would say “surgical skills” or something like that. Or “prosection.” People in general, we’ll tell them in very general terms what happens. You know, in Canada and in the United States, and in Europe, we keep a layer of discretion between the donor’s families and what happens in the lab.

What’s the reasoning behind that?

Dr. Wainman: Part of the reason is that, we’re not sure that families need to know all of that information. We also feel that it might be difficult on the learners, having families looking over their shoulders while they’re doing dissections or whatever. That’s the way we’ve gone, and that’s the way everyone has gone, and around the world there is variation. In Taiwan, for example, not only do they dissect the bodies with the families watching, in the end, the students clean out their crematorium and bring their bodies into the crematorium. It’s a completely different, eye-opening situation. It’s very cultural. It seems culturally appropriate to me. But you have to understand that the value that people put on the human body varies dramatically between cultures. And what we think is socially acceptable here, may or may not be socially acceptable in a different country. Practices are very different all over the world, and you see that with organ transplants as well. Here, in Canada and the US, they have a very “proprietary” view of the organs, even when the person is essentially brain dead. For some reason, we assume that the family should be able to say whether or not those organs are transplanted, and that’s just a legal definition now. In other countries, they just presume consent.

And it depends on if you are a Benthamist philosopher or not. Jeremy Bentham was a famous philosopher, and he was actually publicly dissected, to show that it was a noble thing to do, rather than having his body snatched, which was happening at the time. Most of the bodies for medical education were taken from graves, were stolen from the families – which was just wrong.

Essentially, they passed a law, the Anatomy Act of 1832 which said that “one cannot pay for bodies”. The impact of that was monumental. It also means you can’t pay for any tissue. In Canada, other than human plasma you can’t buy anything. But that is very much a European or English construct that got put into English common law and propagated through a number of countries. That’s not necessarily true of every country. We judge people severely for going to other countries to receive an organ transplant, and I have to say for me, I find that repugnant, but I am using my lens to look at that. And my lens is formed from this strange period in 1832 when we said that this was not acceptable. Essentially, part of it came from the Burk and Hare conspiracy in Edinburg (Ed: During the cadaver shortage, Burk and Hare were convicted of murdering individuals and selling their bodies for use in dissection). But that made the legislation and Bentham really changed people’s minds philosophically, which informs what we have today. That didn’t happen in other countries; they’ve taken another path.

Certain people are victimized more than others.

Dr. Wainman: Of course. That’s exactly what is happening and will continue to happen. As easy as it is to judge people who go and do it, when it’s your life, or your child’s life, I try to see that side of it and try to understand. Very often, those people are told that the organs were obtained in some normal way. Often it’s not. But people can very easily convince themselves, just as the people in England convinced themselves as they were robbing graves for bodies.  

We’ve seen a few documentaries and articles talking about the fact that people get paid to donate their organs. A lot of the time, in Western cultures, we judge them for allowing it. But at the end of the day, if there is no demand, there would be no supply. It’s as if we in the West are contributing to the creation of this problem, yet we are judging other countries.

That’s exactly it. We create the demand. It’s a lot like some of the countries that historically produced, marijuana, cocaine, or opioids. ‘It’s not our fault. If you want it, we make it. It’s not our problem’. I think that’s a bit disingenuous to tell you the truth. But that’s where legislation comes in. You need to have some sort of universally acceptable moral kind of thing.

Realistically, people do this and make money this way. In the states, some people can get paid up front. But you also might get people who do it because they believe it’s the right thing to do. I have a friend who donated a kidney to a complete stranger. And I was amazed. No prior relationship at all.