Undermining Public Trust in Organ Donation

There is a story out today that I find very disturbing, for it both reflects the apparent urge among some organ professionals to cross crucial ethical boundaries and promotes public confusion about when someone can be properly declared dead. It involves heart transplants from babies and implies strongly that ethical rules were ignored in the organ procurement procedure. From the AP story:

The Denver cases are detailed in Thursday’s New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.

They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted “dead donor rule” and the waiting time between when the heart stops and when it is removed to make sure that it doesn’t start again on its own.

In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.

State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn’t meet the rule since it was possible to restart the transplanted hearts in the recipients. “In my opinion, it’s an open-and-shut case. They don’t have irreversibility, and they don’t have death,” said Robert Veatch, a professor of medical ethics at Georgetown University.

When I agree with Robert Veatch, it is a rare day! I support “heart death” procurements with the 5 minute waiting period, and still support brain death as dead, despite some admittedly important issues being brought up about that matter—which we will not discuss here.

Alas, some wish to push boundaries beyond even brain and heart death protocols to people unquestionably alive. From the story:

But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.

That sentence should have been explored more fully because it strongly implies advocacy to dismantle the dead donor rule, which I suspect (being me) that the editors of the NEJM would support. Be that is it might or might not be, there are many voices writing in the most prestigious and bioethics and medical journals in the world arguing to follow the Siren song of utilitarianism by dismantling of the dead donor rule—either by redefining death as a diagnosis of PVS, or just permitting procurement from the unquestionably living. We have discussed these matters here at SHS often (for example, this post) and I have covered it extensively in my other writing (for example, this NRO piece) and in Culture of Death.

If organ professionals and bioethicists want to destroy all public faith in organ transplant medicine, I can’t think of a better way than taking organs before true irreversible cardiac arrest and pushing for procurement rights before actual death. The impulse to help sick people is laudable, but principles and standards that apply to transplant medicine exist for a reason. The time is now to stop pushing at the boundaries, otherwise that sound you will hear will be people tearing up their organ donor cards. And that would be a tragedy.

And for goodness sake people, create uniform rules for organ procurement to apply throughout the country so we don’t have such varying procedures being followed in different hospitals!

FOLLOW UP: I have been told by someone I trust—but have not yet read it myself—that at least one of the NEJM articles referenced in the AP story does indeed advocate for doing away with the dead donor rule on the basis that both heart death and brain death diagnoses allow organs to be procured from people who are not really dead, so let’s open it up some more. That’s a disastrous opinion on many levels, assuming it was accurately represented to me. I am loaded with work at the moment but will read these articles as soon as I am able. More then.