BioethicsThu Nov 3, 2011 - 6:03 pm EST
Shock: requiring death before organ donation is unnecessary, say experts
TORONTO, November 1, 2011 (LifeSiteNews.com) – Because organ donors are often alive when their organs are harvested, the medical community should not require donors to be declared dead, but instead adopt more “honest” moral criteria that allow the harvesting of organs from “dying” or “severely injured” patients, with proper consent, three leading experts have argued.
This approach, they say, would avoid the “pseudo-objective” claim that a donor is “really dead,” which is often based upon purely ideological definitions of death designed to expand the organ donor pool, and would allow organ harvesters to be more honest with the public, as well as ensure that donors don’t feel pain during the harvesting process.
The chilling comments were offered by Dr. Neil Lazar, director of the medical-surgical intensive care unit at Toronto General Hospital, Dr. Maxwell J. Smith of the University of Toronto, and David Rodriguez-Arias of Universidad del Pais Vasco in Spain, at a U.S. bioethics conference in October and published in a recent paper in the American Journal of Bioethics.
The authors state frankly that under current practices donors may be technically still alive when organs are harvested – a necessary condition to produce healthy, living organs. Because of this, they say that protocol requiring a donor’s death is “dangerously misleading,” and could overlook the well-being of the donor who may still be able to suffer during the harvesting procedure.
“Because there is a general assumption that dead individuals cannot be harmed, veneration of the dead-donor rule is dangerously misleading,” they write. “Ultimately, what is important for the protection and respect of potential donors is not to have a death certificate signed, but rather to be certain they are beyond suffering and to guarantee that their autonomy is respected.”
Instead of the so-called Dead Donor Rule (DDR), the authors propose that donors should be “protected from harm” (i.e given anesthesia so that they cannot feel pain during the donation process), that informed consent should be obtained, and that society should be “fully informed of the inherently debatable nature of any criterion to declare death.”
The doctors note that developing the criteria for so-called “brain death,” which is often used by doctors to declare death before organ donation, was an “ideological strategy” aimed at increasing the donor pool that has been found to be “empirically and theoretically flawed.” They also criticize the latest attempts to create new, even looser definitions of death, such as circulatory death, which they argue amount to simply “pretending” that the patient is dead in order to get his organs.
The legitimacy of “brain death,” “cardiac death,” and even “circulatory death” - which can be declared only 75 seconds after circulatory arrest - as actual death has been an ongoing debate in public commentary on organ donation. Many experts assert that doctors familiar with organ donation are aware that the terms, intended to delineate a threshold of probable death, is different from actual bodily death, rendering highly uncertain the moral status of organ donation.
Meanwhile, countless stories have emerged of “miraculous” awakenings following brain death, providing weight to the arguments of doctors and others who say that the process of procuring viable organs not only fails to ensure that a patient has certainly died, but is impossible unless a body is still technically alive.
Dr. Paul Byrne, an experienced neonatologist, clinical professor of pediatrics at the University of Toledo, and president of Life Guardian Foundation, said he was not surprised at the recent statements, which he said merely reflect a long-open secret in the organ donation field.
“All of the participants in organ transplantation know that the donors are not truly dead,” Byrne told LifeSiteNews.com in a telephone interview Tuesday.
“How can you get healthy organs from a cadaver? You can’t.”
Byrne affirmed that giving pain medication to organ donors is routine. Doctors taking organs from brain-dead donors “have to paralyze them so they don’t move so when they cut into them to take organs, and when they paralyze them without anesthetics, their heart rate goes up and their blood pressure goes up,” he observed. “This is not something that happens to someone who’s truly dead.”
The neonatologist said he has personally studied the theory of “brain death” since 1975, seven years after the first vital organ transplant in 1968, and has found that death criteria has continually been changed to accommodate a demand for fresh organs. The idea of a “dead donor rule” did not even emerge until the 1980s, he said, and didn’t enter common parlance until years later.
“There really is no dead donor rule, although they’re trying to make it seem like there is,” said Byrne.
Byrne led a Vatican conference on “brain death” criteria in 2008 in which a large group of international experts, many of whom are world leaders in their fields, attested to the illegitimacy of “brain death” as an accepted criterion for organ removal.
The comments by the Canadian and Spanish experts have come under fire from the organ donor community, some members of which have expressed concern that the statements could lead people to opt out of donating their organs.
“In the overwhelming majority of cases, the concept of death is easy, obvious and not really subject to any complex interpretation. It’s very clear,” Dr. Andrew Baker, the medical director of the Trillium Gift of Life Network, which oversees Ontario’s transplant system, told the National Post. “They’re dead, you can see it, there is no return of anything.”
James DuBois, a health ethics pro-fessor at Saint Louis University, also criticized the comments, saying that removing the Dead Donor Rule could “have negative consequences: decreasing organ donation rates, upsetting donor family members and creating distress among health care workers.”
See related article: Vindication of criticisms of organ donation