By Hilary White

TORONTO, October 10, 2006 ( – A doctor and assistant professor in the faculty of medicine at the University of Calgary is warning that a change in the rules defining death for purposes of organ donations could place patients in danger and ICU doctors in a conflict of interest.

Dr. Christopher Doig, director of the intensive care unit at Calgary’s Foothills Medical Centre, wrote in an editorial in the Canadian Medical Association Journal that allowing organs to be removed from patients after cardiac arrest could place vulnerable patients at risk.

Currently Canada relies upon the “brain death” criterion to retrieve organs from patients. which definition is itself ambiguous and a source of much controversy. “We need to put the brake on things,” Dr. Doig said.

Even with medical ethicists attempting to sound a warning that what is called brain death is not always actual death, the Canadian Council for Donation and Transplantation is pushing for hospitals around the country to adopt the cardiac definition of death (DCD) to make more organs available for transplant.

The push for a change has strengthened since the announcement in June this year that the Ottawa Hospital would adopt the so-called non-heart beating criterion for organ donation (NHBD). Many ethicists have warned that the adoption of the new criterion would end by doctors killing patients by removal of vital organs.

Under the new rules at Ottawa Hospital, organs can be removed from patients five minutes after the heart has stopped beating.

Dr. Doig was on the forum convened last year to study how the new cardiac criterion can be implemented in Canada. The group has published their conclusions today in the Canadian Medical Association Journal and Dr. Doig has published an editorial in the same issue calling for a pause to re-think.

Dr. Doig, who has resigned from the Canadian Council for Donation and Transplantation, says he does not endorse the report and that he “cannot support proceeding” with the DCD criterion.

“DCD may represent an additional source of organs; however, DCD is a major change in end-of-life practice and poses significant ethical problems for end-of-life decision-making,” Doig writes.

Doig’s warning confirms that of other ethicists who say that the DCD criterion could result in critically ill patients being regarded merely as potential organ farms.

Cardiac arrest following withdrawal of treatment in the ICU, he says, is known as “controlled DCD,” in which methods to preserve organ viability are initiated before the donor’s death. The patient’s death can be “timed” to coincide with availability of organ transplant surgical teams.

“With DCD a patient must be considered a potential donor before their death,” he writes. “Therefore, there is an inherent conflict of interest for physicians caring for these and other individuals in the ICU who might also be candidates for controlled DCD.”

Dr. Doig told the National Post today that the change in criterion could exacerbate the already “profane” death of the ICU patient. Dr. Doig said, “Patients will die in a sterile operating room. When the heart stops, the clock starts ticking.

“Before he dies, there will be surgeons gowned, gloved, caped and masked, standing outside the door, clock-watching.”

Read the full text of Dr. Doig’s editorial:

Read related coverage:
  Controversial Organ Donation Method Begins in Canada – Organs Extracted 5 Minutes after Heart Stops


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