Never Let Me Go: the organ donation debate continues

To live, someone else must die. To ensure there are enough spare parts to go around, the government must breed people to provide organs for others. That is the crux of the new British movie Never Let Me Go. Based on Kazuo Ishiguro's 2005 novel, the film opens in Australia this week at a time of renewed debates about organ donation.

Australiaand most western countries suffer from a decline in organ donation – Canada has the lowest rates. There are calls in the UK for the Government to consider the merits of a legalised market in organs for transplant. Professor John Harris, an ethicist at the University of Manchester, believes a debate and the introduction of an organ market are long overdue. Opponents say that disadvantaged people would end up selling parts of their bodies, potentially with disregard for the risks involved. (The Independent on Sunday, Jan 5)

Despite the enormous publicity surrounding organ donation in Australia following the death of sporting identity David Hookes in 2004, organ donation soon slunk into a decline. Various theories have been put forward for this reason – everything from apathy to ignorance. However, I wonder if the age-old desire to be buried whole is a powerful unconscious reason people turn away from signing up for organ donation.

Mary Shelley, who wrote Frankenstein in 1817, had a profound attachment to body parts in real life as well as fiction. When she died in 1851, her husband's heart was found amongst her belongings. It was reported to be wrapped in one of the sheets of Adonais - Percy Bysshe Shelley's famous elegy to Keats. She kept it in a desk drawer, after his untimely demise in a boating accident. Would she have given consent for Shelley's heart to be transplanted into another?

The ancient Egyptians perfected elaborate mummification techniques and stored organs in canopic jars around the body, because the body needed to be intact to be resurrected again in the next life. There is the ancient Egyptian myth of Isis, who reassembles the fragments of her murdered lover, and for the first time in history performs the rights of embalmment which restores the murdered god to eternal life. Organ donation doesn't figure in this myth. Isis wouldn't have wanted it.

A lot of people feel that way when asked to decide about consenting to their loved one being used for organ donation. It is the young and fit who make the best organ donors. This means it is often distraught parents who are asked to be altruistic when their child is on life support.

This is where "presumed consent" seems like the answer. It is an opt-out organ donation system to overcome shortages. It has become standard practice in Spain, France, Belgium and Sweden. Victorians could become potential donors under "presumed consent" unless they register a formal objection. This will be one of the options currently being examined by a parliamentary committee. (Herald Sun, Feb 14)

There are moves in WA towards such the opt-out system. But not everyone is happy about the idea – WA Health Minister Kim Hames admitted he had mixed feelings about presumed consent. (Feb 18, The West Australian)

Double lung transplant recipient Jessica Sparks is strongly committed to presumed consent and took it to the People's Parliament earlier this month. The articulate university student from NSW, who is studying a double degree in law/journalism, represented Australia at this year's World Transplant Games in Sweden. She says since the transplant "The world has once again opened up and I've claimed back my dreams." (www.dailytelegraph.com.au, March 03)

Yet Jessica has cystic fibrosis, and the transplant has not cured that condition. A transplant is never a cure. It extends someone's life, often at the expense of their long term health care of the anti-rejection medication they must take each day. It also relies on someone else dying. Enter Ishiguro's novel about cloned, live organ donors.

Never Let Me Go, starring Keira Knightley, Carey Mulligan and Andrew Garfield, is a disturbing "what if" exploration into the bioethical conundrum of organ donation.

This quiet science fiction borders on the Gothic horror; it's a love triangle about young people who just happen to be clones created in a laboratory and raised in order to provide their organs to severely ill patients. Ishiguro's clones do not die – they "complete".

The movie has already prompted renowned ethicist Margaret Somerville to write that issues in the disturbing plot might be closer to us than most of us realize.

Ishiguro's novel was published at a time when infertile women in their 40s began sourcing eggs from young women and when parents of sick children turned to IVF to create perfect "saviour siblings". As a society, we've only got better at using people's bodies for our own gains; look at Nicole Kidman's recent announcement of a new baby via what she dubbed "a gestational carrier."

Such commercial surrogacy illustrates what Somerville calls "convergence" -interventions that become possible only through the combination of separate technologies. Ishiguro's clones are the result of "genetic, reproductive and organ transplant technologies". Somerville writes: "Each technology, taken alone, raises serious ethical issues, but combined they raise ethical issues of a different order, as we see in Never Let Me Go." (themark.com, Nov 25, 2010)

Accordingto The Independent on Sunday, the "superb" film adaptation of Ishiguro's literary novel demands that the decision not to award it the Booker Prize in 2005 "should surely be revisited." However, one of the judges, Rick Gekoski, told the newspaper that he has no intention of seeing the film. "It's too creepy", he says, "It's effective but a film about organically reared children farmed for their organs? At my age? No." (Jan 30)

The trouble is that avoiding the issues won't make them go away. Somerville rightly points out that this new movie depicts "a morally compromised world not unlike our own."