TORONTO, March 23, 2006 ( – The Ontario government is continuing its campaign to pressure Ontarians to agree to organ donation despite ethics concerns regarding “brain death” definitions. The most recent implementation of this plan is a new law requiring 13 selected hospitals to report every death to an organ-donation program, the Trillium Gift of Life Network (TGLN).

The law, enacted January 9, 2006, requires that the provinces thirteen “type A” hospitals report every death to TGLN. A media release from the Network says the required routine reporting by hospitals, “ensures that accurate identification can be made of a potential donor and that eligible families be provided the opportunity to fulfill their loved one’s wishes.”

TGLN is now seeking to have the routine reporting requirement expanded to all hospitals in the province. This requirement, in addition to proposed “presumed consent” legislation – under which organs will be harvested without the specific consent of the patient or family – has some ethicists worried about abuses of patient safety and privacy. Issues of informed consent also arise when doctors themselves cannot concretely define “brain death”.

Ontario physician, Dr. John Shea, has written extensively on medical ethics and the problems of organ donation. He says that the devil of organ donation is in the details, particularly those of definitions. “When is a person considered dead? There is a lot of controversy over these definitions. What concept of brain death are they using?”

“In fact, organs from a person who is really dead are of no use for transplant. So the definition had to be expanded to mean, dead but not quite dead.” Shea said.

Shea and many other ethicists have pointed out that it is only with the advent of transplants that the definition of death has become problematic. An international meeting of medical ethicists at the Vatican warned that the definition is being loosened specifically in order to procure organs. In many cases, comatose patients on ventilators who have been considered “brain dead” by doctors have recovered.

Dr. Paul Byrne, former president of the Catholic Medical Association demanded a more accurate definition of when death occurs. “Brain death is not death,” Dr. Byrne said. In an article appearing in Catholic World Report in October 2001, Byrne argued that it is actually the removal of organs that causes death.

Informed consent is a contradiction in terms, since consent for organ donation is often obtained when families are under extreme stress and may not be able fully to understand what is being asked. Dr. Frank Markel, TGLN’s president and chief executive officer, said himself that the moment when they are asked, is often the most “devastating and tragic” in their lives.Â

Currently, there is no clear internationally accepted definition of brain death. Individual countries have varying standards and the medical community is split. Pressure for organ transplants grows as the huge, wealthy and politically powerful “baby boomer” demographic ages and continues to cling to health.

Shea told that these issues are not well understood by the public. An individual asked to donate an organ is only told the good news stories about saving children’s lives. “The question is how do they inform the potential donor?” Shea said. “What are the actual words they are using? Do patients and families understand that ‘brain death’ and being dead are not necessarily the same thing? Do they know that there are serious disputes?”

Read related coverage:
  Organ “Harvesting” Policy in Canada to Allow Terminal Patients to be Killed for Parts?

Ontario NDP Introduces Organ Donor Bill Which Presumes Consent of all Dying


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