Whether we are renewing our driver’s licenses, watching the TV news or just picking up a newspaper, it’s impossible to miss the campaign to persuade us to sign an organ donation card such as this one. We see story after story about how grieving relatives have been comforted by donating a loved one’s organs after a tragic death, and how grateful the people are whose lives have been changed by the “gift of life”.
But are ethical lines being crossed in the zeal to obtain organs to transplant?
While most people presume that organs can be removed and transplanted only after “all efforts to save your life have been exhausted” and brain death has been determined, that presumption is no longer necessarily true.
Now, organ donation can occur with a person who is in a coma and considered close to death but who does not meet the criteria for brain death. In those cases, a organ donor card or relatives who have agreed to withdraw a ventilator (a machine that supports or maintains breathing) and have the person’s organs removed for transplant if or when when the heartbeat stops. This was called DCD or donation after cardiac death until some doctors found that the stopped heart could be successfully restarted it in the patient receiving the transplant!
Now, that ethically questionable procedure is called donation after circulatory death (also DCD) since circulation stops when the heart stops.
If circulation does not stop within 60 minutes, the organs are deemed to be too damaged for transplant and the patient dies without donating organs.
IT GETS WORSE
Last month a September 29, 2022 article in Medpage titled “No Brain Death? No Problem. New Organ Transplant Protocol Stirs Debate-Is it ethical to pull the plug in patients who aren’t brain dead, then restart their hearts?” reported on a new procedure to get more organs:
“With little attention or debate, transplant surgeons across the country are experimenting with a kind of partial resurrection: They’re allowing terminal patients to die, then restarting their hearts while clamping off blood flow to their brains. The procedure allows the surgeons to inspect and remove organs from warm bodies with heartbeats.” (Emphasis added)
The article also said that this new procedure is being criticized by doctors like Dr. Wes Ely and the American College of Physicians that warned the procedure raises “profound ethical questions regarding determination of death, respect for patients, and the ethical obligation to do what is best.”
MY JOURNEY TO DISCOVER THE FACTS ABOUT BRAIN DEATH
Back in the early 1970s when I was a young intensive care unit nurse, no one questioned the innovation of brain death organ transplantation. We trusted the experts and the prevailing medical ethic of the utmost respect for every human life.
However, as the doctors diagnosed brain death in our unit and I cared for these patients until their organs were harvested, I started to ask questions. For example, doctors assured us that these patients would die anyway within two weeks even if the ventilator to support breathing was continued, but no studies were cited. I also asked if we were making a brain-injured patient worse by removing the ventilator for up to 10 minutes for the apnea test to see if he or she would breathe since we knew that brain cells start to die when breathing stops for more than a few minutes.
I was told that greater minds than mine had it all figured out so I shouldn’t worry.
It was awhile before I realized that these doctors did not have the answers themselves and that my questions were valid.
I also discovered that some mothers declared “brain dead” were able to gestate their babies for weeks or months to a successful delivery before their ventilators were removed and that there were cases of “brain dead” people like Jahi McMath living and maturing for years after a diagnosis of brain death or even recovering like Zack Dunlap.
If the legal definition of brain death is truly “irreversible cessation of all functions of the entire brain, including the brain stem”, these cases would seem to be impossible.
PRESUMED CONSENT AND LAW
Another problem is “presumed consent” which is the assumption that everyone is willing to donate his/her organs unless there is evidence that they would not want to donate. Illinois narrowly avoided a “presumed consent” statute a few years ago where people who didn’t want to donate had to file an opt out document with the Secretary of State.
Some countries already have “presumed consent” laws, most recently in England that states:
“it will be considered that you agree to become an organ donor when you die, if:
- you are over 18;
- you have not opted out;
- you are not in an excluded group”
Even more horrifying, there have also been proposals to even link organ donation and assisted suicide as “a potential solution to the organ scarcity problem”. Countries like Belgium and the Netherlands already allow this.
Organ donation can truly be “the gift of life”, and innovations such as adult stem cells and the donation of a kidney or part of a liver by a living person generally pose no ethical problems and hold much promise to increasingly meet the needs of people with failing organs. I have a grandson whose life was saved by a stem cell transplant and another relative who has had 2 kidney transplants.
Personally, I have offered to be a living donor for friends and my family knows that I am willing to donate tissues like bone, corneas, skin, etc. that can be donated after natural death.
Everyone can make his or her own decision about organ donation but it is crucial that we all have the necessary information to make an informed decision..
One thought on “PLEASE READ BEFORE YOU AGREE TO BE AN ORGAN DONOR”
Good commentary. Thank you!
Thought you might like to see my letter to the editor that was published in Charleston in 2005, relating to organ donation.
March, 4, 2005
Post & Courier
134 Columbus St.
Charleston, S.C. 29403-4800
Responding to Peter A Brown’s commentary regarding the lack of sufficient organs for transplant, if only the solution was as easy as allowing payment for organs. Like most social problems, it isn’t that simple to solve, and the reality could create yet another opportunity to exploit the vulnerable among us.
Mingled with the question of motivation for monetary reward and who would receive it, would be the issue of determination of death, and who would declare it, and by what standard.
According to Dr. Stuart J. Youngner, director of the Center for Biomedical Ethics at Case Western Reserve University, “We’ve kind of gerrymandered the line between life and death.” The main incentive for this sliding scale determination of death, is the organ transplant business and the “quality of life” ethic.
I have met people who have benefited from organ transplants, yet I am more and more uncomfortable living in a society where one class of people is waiting in anticipation for another class of people to be declared dead, within urgent and wavering parameters.
There is room for much improvement within our healthcare system and the organ transplant business, but we must work to improve it without undermining its essential mission of health and mercy, and without discrimination by social or economic status.
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