When is Dead Really Dead? Organ Donation Just Got More Complicated
A Frenchman who suffered a severe heart attack has apparently spontaneously awakened after 1 1/2 hours without a normal heartbeat (but mechanical heart message). From the story:
A man whose heart had stopped beating woke up just as surgeons were about to remove his organs for donation, it was disclosed yesterday.As soon as I read that I thought this could materially impact the ethics of non heart beating cadaver donor protocols that start procuring organs five minutes after cardiac arrest. I am not alone:
Doctors in Paris earlier this year called in transplant surgeons after failing to resuscitate a 45-year old man believed to have suffered a massive heart attack in the French capital. According to a report by the Paris university hospital's ethics committee--seen by Le Monde newspaper--doctors continued providing a heart massage for an hour and a half while they waited for the surgeons to arrive.
When the surgeons began operating on the man to remove his organs, he began to breathe, his pupils became responsive and he reacted to a pain test.
In particular, the case is likely to ignite public debate over so-called controlled non-heart-beating organ donation (NHBOD)--retrieving organs when the heart stops, which has only been legal in France since last year. Before then a patient had to be declared brain dead before transplant could occur. NHBOD is legal in the UK.I am not sure what the answer is. But it seems to me that the public's confidence in organ donation requires that this matter be looked at closely, as well as trying to determine if there are other such cases.
"All specialised medical literature on the subjects allows one to conclude that a person who has suffered cardiac arrest and has had proper heart massage for over 30 minutes is, for all purposes, brain dead," said Professor Alain Tenaillon, in charge of organ transplants at France's biomedical agency. "But one must acknowledge that exceptions do exist...there are no hard and fast rules on best practice," he told Le Monde.
posted by Wesley J. Smith @ 1:06 PM
6 Comments
6 Comments:
Dear Wesley,
This is an area of real concern and real denial. You mentioned not knowing what the answer is but I find it compelling that the lead ethicist from Harvard recently said that he doesn't think brain dead people (from whom organs are taken) are dead:
"It's completely ethical to remove organs from patients we diagnose as brain dead," says Dr. Robert Truog, director of clinical ethics at Harvard Medical School and a physician at Children's Hospital Boston. "It's just ethical for reasons other than that we think they're dead, because I don't think they are."
http://www.boston.com/bostonglobe/ideas/articles/2008/03/09/fatal_flaw/
States are moving more and more to a position of presumption when it comes to organ donation and this while deliberately ignoring the concerns that current death diagnosis raise.
Thanks for your work.
Freaky story, Wes. It says that he "woke up," but what does that mean? Did his heart start beating again? Is he lucid or severely impaired due to the poor circulation that massage provides?
Is this fellow still alive now?
matteson: I think those details are important. But what seems to have happened is that extended heart message intended to keep the organs transplantable, resulted in his resuscitation. The story says he is fine now.
gk51: This is a different issue than brain death. It is a "heart death" concern.
Dear Wesley,
Yes, I was aware of the distinction between heart and brain death but was playing off the topic of your post, "When is dead really dead" and the connection to organ donation.
The larger truth is that death, heart or brain has undergone a dangerous redefinition and it is apparent that it is about getting organs.
Is it not striking that a voice from Harvard would state that brain dead people are not dead? We have insisted for almost forty years (thanks to Harvard) that brain dead people are dead and have been assured that it is ok to take their organs now to be hearing something different.
The attempt from whatever angle is to redefine death so that organs can be taken.
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