Down on the Transplantations
Doctors Admit the Obvious: You Can’t Get a Live Organ from a Dead Body
by Anita Kuhn
In a remarkably candid article about organ donation in the New England Journal of Medicine (NEJM), a doctor and a bioethicist make the unnerving observation that, in cases involving vital organs, many “donors” may not actually be dead at the time their organs are taken from them. While this statement corroborates the view of many pro-life groups, scientists, and physicians, it is likely to be news to the general public.
In their article, published online on August 14, 2008, Dr. Robert D. Truog of Harvard Medical Center and Children’s Hospital Boston, and Dr. Franklin G. Miller, a bioethicist at the National Institutes of Health in Bethesda, Maryland, note that organ donation has been guided from its inception by the “dead donor rule,” which “simply states that patients must be declared dead before the removal of any vital organs for transplantation.” The traditional criteria for determining death, they note, was “straightforward: patients were dead when they were cold, blue, and stiff.”
Death Newly Defined
The problem for transplant medicine is that by the time many organs, especially vital organs, are extracted from such donors’ bodies, they are no longer usable for transplantation. So, in 1968, a committee formed and headed by Henry K. Beecher at Harvard proposed a new definition of death based on so-called brain-dead criteria: A patient with “devastating neurologic injury” could then be considered eligible for organ removal under the dead donor rule. Brain-dead criteria have been in use ever since.
But, Truog and Miller write, these criteria are problematical because patients whose injuries are entirely intracranial “look very much alive: they are warm and pink; they digest and metabolize food, excrete waste, undergo sexual maturation, and can even reproduce. . . . The arguments about why these patients should be considered dead have never been fully convincing.”
In recent years, another definition of death has been proposed for prospective organ donors: cardiac death. Under cardiac criteria, a patient can be declared dead on the basis of “irreversible cessation of cardiac function” if his heart stops beating for as little as two to five minutes. Such a patient’s vital organs can then be removed for transplant while they are still usable.
But the authors point out that this definition also has problems, centering around the meaning of the term “irreversible.” This word is commonly understood to mean “impossible to reverse,” but it is well known that a patient whose heart has stopped for up to five minutes can often be resuscitated. So in order to meet the criteria of “irreversible cessation of cardiac function,” the word “irreversible” has to be interpreted to mean “we won’t try” to resuscitate rather than “we can’t.” The dishonesty of this becomes apparent in what the authors describe as the paradoxical situation in which a heart declared to have permanently lost all function while in the chest of its original owner may in fact function very well when it has been transplanted into the chest of another person.
Given all this, the authors candidly admit that, with respect to both “brain death” and “cardiac death,” the justification for removing vital organs from patients “cannot be that we are convinced they are really dead.” In these cases, the dead donor rule may be invoked, but it is not followed.
Organs from the Living
Anita Kuhn is the managing editor of Touchstone. She lives in Chicago, where she attends St. John Cantius Roman Catholic Church.
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