Killing to Heal? Ethical Problems with DCD (Donation after Circulatory Death)

This first appeared as an item in the Pro-Life Wisconsin Monday Update, 7-13-15. It is a short overview of ethical concerns about DCD (donation after cardiac or circulatory death and formerly called NHBD, non-heart beating donation).

Killing to Heal? Ethical Problems with DCD (Donation after Circulatory Death)

By Nancy Valko, RN, ALNC and Julie Grimstad, Patient Advocate, Prolife Healthcare Alliance

Donation after Circulatory Death (DCD) is ethically controversial because it links the so-called “right to die” with organ donation, opening a terrible Pandora’s Box. In the quest to secure life-saving vital organs, DCD is pushing the boundaries of what constitutes death. Those with the responsibility to determine death are cautioned to take ample time, even in hospice patients, lest death be declared prematurely. When death is hastily declared for the purpose of acquiring organs, as the DCD procedure requires, the paramount ethical principle – the sanctity of human life – can be overridden by utilitarian calculations of whose life is worth more, the organ donor’s or the recipient’s. Consider the following:
1. DCD involves taking organs from patients who have not been determined to be “brain dead” but who are on ventilators and considered hopeless in terms of predicted survival or “quality of life.” U.S. guidelines (from The Organ Procurement and Transplant Network) even allow conscious disabled people on ventilators to agree to the DCD procedure. In spite of the fact that the patient’s or family’s consent to removal of the ventilator must precede consent to organ donation, these guidelines imply that disabled patients’ organs are more valuable than their lives.

2. As noted by reporter David Wahlberg, “…critics, including some Catholic hospitals and the disability rights group Not Dead Yet, say circulatory death donation can pressure families to withdraw life support. Some say drugs given beforehand can hasten death.” [“UW Hospital a leader in alternative to brain death organ donation,” David Wahlberg, Wisconsin State Journal, July 5, 2015]

3. The DCD procedure requires a doctor’s prediction that a person’s heartbeat and breathing will stop within 1-2 hours after the ventilator is removed, but doctors are often wrong. A study presented at the 2015 Transplant Congress by University of Wisconsin doctors stated, “In 46 patients (27.2%) no organs were recovered because the patients did not expire within 2 hours.” Such patients are then just returned to their rooms to die without further treatment. There is something dangerously awry when doctors’ prognoses are so often wrong – fatally wrong.

4. The DCD procedure usually involves moving the patient-donor to an operating room and there removing the ventilator in order to bring about death in a controlled environment. The donor’s organs are taken only 2-5 minutes after breathing and heartbeat stop. Haste saves organs because they rapidly deteriorate without circulation.

5. The basic ethical principle guiding organ donation is the Dead Donor Rule: a person must be dead before the removal of organs for transplantation. Shouldn’t we be absolutely certain a person is dead before organs necessary for life are removed from him/her? What good is the Dead Donor Rule if the “dead” part is fiction?

6. Evidence suggests at least some DCD donors would survive and even recover given time and therapy. For example, NBC’s Today show, September 6, 2011, featured an interview with Shelli Eldredge, a young mother who was comatose after a traumatic brain injury from an accident on June 16, 2011. A doctor recommended stopping life support. Although Shelli’s husband, a doctor himself, also believed it was medically impossible for her to recover, he wouldn’t give up. After a month, Mrs. Eldredge woke up and started speaking. Three months later, she was giving this interview – alert, articulate, and working toward a full recovery.

A civilized society must not allow the deaths of some people to be manipulated in order to obtain organs for others.