By John-Henry Westen

OTTAWA, June 27, 2006 ( – In a press conference at the Ottawa Hospital today, doctors announced the first-ever non-heart beating organ donation (NHBD) procedure preformed in Canada.Â

The procedure, also known as donation after cardiac death (DCD), typically involves a person who requires a ventilator and, although he has measurable brain function, is determined to have no hope of recovery. The doctors then remove ventilation from the patientÂand wait for the heart to stop beating. If the heart stops for five minutes, death is pronounced and the organs are harvested by another surgical team.Â

One of the major ethical problems with the procedure is that there are cases where the heart has recommenced beating and circulation after five minutes of stoppage; another is that the stoppage of the heart is caused by the removal of the ventilator.

Organ donation by “brain death” remains controversial after 30 years of the procedure being practiced, but DCD is even more controversial since there is very little time left for ethical considerations. While with “brain death” organs can be harvested at leisure since machines keep air flowing into the lungs and blood circulating, with DCD the stoppage of the heart necessitates very quick harvesting as organs deteriorate without blood flow.

The presentation of Canada’s first DCD sounded more like an emotion-laden sales pitch than a medical press conference. The Therien family was on hand to lend support to the organ donation method as their 32-year-old daughter, Sarah Beth, was the first-ever donor in Canada. Sarah’s father noted that the family was Roman Catholic and needed to be assured that the procedure was not in violation of the faith. Mr. Therien said that he was assured by hospital staff, “Dr. Kim and his team”, that it was not in violation of the Catholic faith.

Those assurances, however, ring hollow. The Catholic Church has not even finally pronounced itself on organ donations by “brain death” let alone the new DCD procedure. In 2003, the Archdiocese of St. Louis condemned the NHBD protocol saying it is “cruel and dangerous and does not meet standards of respect for human life.” It called for an immediate moratorium on the practice “until such time as clearer, objective moral standards of determination of death are enacted.” spoke with Dr. Moira McQueen, President of the Canadian Catholic Bioethics Centre about the matter.Â

Dr. McQueen told that waiting only five minutes after cessation of cardiovascular circulation was “frankly . . . not nearly enough.” She noted there have been cases of auto-resuscitation after more than five minutes without a heart beat. Even though organs may be harmed by waiting for a sure determination of death, the principal concern is an accurate determination of death, since otherwise the patient is being killed by organ extraction.“The important thing for us is that the person donating has to be dead,” explained Dr. McQueen.“The organs are a secondary consideration, that being established first.”

Dr. Cameron B. Guest, Chief Medical Officer for Trillium Gift of Life Network, the agency that handles organ donation in conjunction with the hospitals, spoke with about the controversy over timing. Speaking of auto-resuscitation, he said, “All of the cases that were reported happened in less than a minute.”Â

Dr. Guest, also the Chair of the Organ and Tissue Donation Committee at Sunnybrook and Women’s College Health Sciences Centre in Toronto, informed that Catholic hospitals in Ontario were looking to take on the DCD method.

Dr. Guest conceded however, that “If there were evidence to show that large volumes of patients” were resuscitating after five minutes his team would look into altering their protocols. That concession is not good enough for Catholic hospitals says Dr. John Shea, the medical advisor to Campaign Life Coalition. Where there is a doubt about ending life, Dr. Shea told, we cannot ethically proceed.Â

The pro-life movement is opposing DCD for those same reasons.Â

“The laudable purpose of saving lives does not justify the donation of an organ whose removal could cause the death of a donor,” said Jim Hughes, National President of Campaign Life Coalition (CLC). “Harvesting organs just five minutes after the heart stops is just plain frightening. There are cases of people whose hearts have re-started after a longer period of time,” he said.

“These situations put the physician in the difficult decision-making position between the care of their patient and balancing that care against the possibility of passing on the patient’s organs to someone else,” said Mary Ellen Douglas, National Organizer CLC. “The code of the physician is to do no harm and a heart-wrenching decision between two patients places the physician in the role of playing God.”

  See a short paper by Dr. Shea on NHBD


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