I think that the hue and cry against non heart beating cadaver donor protocols—what I have called “heart death”— is misguided. And it reflects a misconception about the concept of “brain death,” a popular term for death by neurological criteria—which does not mean that every brain cell is dead, but that the brain and each constituent part has ceased to function as a brain. What is even more ironic, is that some pro life advocates oppose brain death as not really being dead because the patient’s heart is still beating.
This statement from a story on this issue in LifeSite is wrong factually:
“The person is not dead yet,” said Jerry A. Menikoff, an associate professor of law, ethics and medicine at the University of Kansas. “They are going to be dead, but we should be honest and say that we’re starting to remove the organs a few minutes before they meet the legal definition of death.”
No, irreversible cardio/pulmonary arrest is dead, and in these cases the arrest is irreversible because there will be no CPR. When writing Culture of Death, I inquired of many neurologists as to whether patients would have any awareness after such a time. The answer from pro life and non pro life doctors alike was unanimous: No.
Death by neurological criteria, is the other method of declaring death. In other words, there are two methods of declaring death, with heart death being the tried and true one from time immemorial.
Some of these “heart death” protocols permit organ procurement as short as 2 minutes after cardiac arrest. I think this is too short, not based on the patient having any awareness—which I was again told unanimously was not possible—but based on giving the benefit of the doubt to caution and the lack of tests about whether such reverses are irreversible after such a short time.
I think a few people believe there should be no organ transplants because they don’t think it can be done ethically. They don’t believe in brain death—which is an arguable position. But they also don’t believe in heart death along these protocols. That’s fine. But we should not let these well meaning advocates panic us. The real danger, in my view, to ethical organ procurement comes not from heart death donor protocols, or from brain death procurements, but rather from shoddy following of ethical rules and from advocacy among many bioethicists to expand the donor pool to people who are not really dead.
Let’s chill out there and keep our priorities straight.
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