Irresponsible Headline: "Organ Harvesting Begins Before Brain Death"
The headline on this story is irresponsible because it implies that organs are being harvested before the donor is really dead. Not so. This organ procurement protocol, known as "non heart beating cadaver donor" removes organs from people who died from irreversible cardio/pulmonary arrest. (For ease of discussion, let's call this "heart death.")
The problem, I think, arises from the ubiquitous use of the often misunderstood term "brain death," a popular description for "death by neurological criteria." DNC does not require that every cell in the brain be dead, but rather, that the brain has irreversibly ceased functioning, both in whole and in each and every constituent part. (The term is also sometimes misused as a description of persistent vegetative state.) As one neurologist once described it to me, the experience of brain death (properly diagnosed) is akin to a headless body being animated by machine. (As I have written previously, some bioethicists claim brain death is not really dead, not to prevent organs from being procured from living people, but as an argument to gain permission to expand the pool of harvestable people to patients diagnosed with persistent vegetative state. But let's not get into that here.)
And here's a kicker: If brain death isn't really dead--as some pro lifers also claim--then the only ethical way to permit vital organ procurement would be through the protocol mentioned in the story. Life support for the patient would be removed, there would be an immediate cessation of breathing ("brain dead" patients can't breathe because their brains don't send the requisite signal for a breath to be taken), followed immediately by cardiac arrest. (This is also the protocol for non brain dead organ donors today.) A necessary waiting period after the heart stops beating comes next--which I don't believe should be shorter than 5 minutes--and then organ removal from the dead body. (It is true, that some brain cells may still be alive at this point, but that is also true in "brain death" procurements.)
This is not to say, of course, that the protocol I just described could not have serious ethical problems. Indeed, I discuss these concerns at some length in Culture of Death. But I do believe that if it is done correctly, using donors who died from heart death is totally appropriate and morally upright.
Labels: Organ Donation. Brain Death.
posted by Wesley J. Smith @ 9:39 AM
7 Comments
7 Comments:
Hmmm. I'd gathered from somewhere the impression that for some organs--the heart, in particular--it is considered extremely desirable that they continue to be oxygenated right up until the moment they are removed for transplant. Hence the practice of removing organs after brain death is declared but while the body continues to be kept operating with ventilators.
If this is true, how does this interact with the "heart-death" criterion? I'm trying to picture taking the person off the ventilator, waiting while his heart stops and he stops breathing, waiting five minutes and then...what? Starting the machines *back up* during the organ removal process?
I'd like to think I'm wrong about that picture, and probably I am. Because if they do that, then there would seem to be a real question as to whether they might accidentally resuscitate the person, since they didn't wait for brain death. In which case, the organs would be removed from a living person.
I hope this doesn't sound too far-fetched. (Or maybe I hope it _does_ sound too far-fetched.)But I worry that organ procurers wouldn't be happy with organs taken from a body that wasn't breathing and being oxygenated, because they would fear that taking them from a true cadaver who was not even oxygenated by machine would harm the quality of the organs.
What?! This is crazy, I can't believe it?! No way!!!
but................Wesley and I agree on something
;)
Lydia: Taking organs from bodies that remain suffused with blood is optimal. But in some cases, people die who are not brain dead after life support is removed. The protocol discussed permits these dead patients to be donors (as they were before "brain death" was defined).
If it means the heart can't be used (I don't know if this is true), so be it. I do know kidneys are not affected adversely from this approach, nor are other parts, such as corneas.
This kinda tickles a weird part of my brain, because I remember hearing something about organ donation from college but I can't be sure.
I *think* that even though organs have a limited shelf life, hence the reason organ doners are pounced upon the moment it's legal to do so, the five-minute wait won't significantly affect the heart being transplanted - the cells haven't started dying yet. I'm not sure, but I think I remembered something about that from college biology.
Take that with a grain of salt. I passed bio with a C.
This approach is sometimes called the "Pittsburgh Protocol" because an organ center there pioneered it. But they only waited 2 minutes, which I think is too short. There have also been problems involving giving non therapeutic substances that can only help the organs. But here is the thing: Sometimes they take off life support and the patient does not go into cardiac arrest. When this happens, they cease to be qualified as donors under this protocol.
Do I take it that you're making a contrast, here? In other words, on the "brain death" protocol, can a person be treated differently if he survives being taken off life support on the basis of his having been designated a donor previously?
I remember reading (I think it was from Nancy____, can't remember her last name) about a young man whose parents had decided he was to be taken off life support and had consented to his being a donor. He was, and he didn't die, and he then wasn't given antibiotics for some condition for which he needed them, because they'd already decided no more treatment was to be given. Her emphasis was that they had been influenced in this decision by the pressure to agree to his being a donor.
If this non-heart-beating protocol avoids any situations like that, so much the better.
Lydia: On the brain death protocol, if the person did not stop breathing immediately upon removal of the respirator, he wouldn't have been brain dead and hell should be paid. When a brain is completely non functional, there is no impulse to permit breathing. This leads quickly to cardiac arrest. (The heart does have some autonomous ability to beat without a message from the brain, but the diaphragm, which must contract and expand to permit breathing, does not.)
The protocol I was discussing was the "heart death" protocol. This is a person who is thought to be completely dependent on advanced life support to survive, but who is not dead by neurological criteria. If the person does not go into cardiac arrest with a short period of time, my understanding is that life support is restarted and the person is never again considered a donor under the protocol.
Heart death candidates are usually catastrophically brain injured, but not brain dead.
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