Morality and ethics
Human organ donation & harvesting
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Background:
Organ harvesting and donation involves the removal of functioning organs from
the bodies of recently deceased persons and implanting them in the bodies of
sick and often terminally ill persons.
There is a massive gap between the number of available organs
and the number of people on waiting lists hoping to receive one or more organs. Thousands
of the latter die each year in North America because a suitable organ cannot be found in time to
save their life. In the
meantime, millions of potential donors die each year with their organs unharvested,
simply because they have forgotten or refused to fill out a donor card, or their families
refuse to give their consent at the time of death.
Originally, organ harvesting was
generally done only when the donor is determined to be brain dead. However, delays are
often critical. The earlier that an organ can be removed and transplanted, the more likely it will be
able to function in the body of the recipient.
According to the Washington Post, in recent years:
"... in the hopes of obtaining more organs, federal health
officials, transplant surgeons and organ banks have been intensely promoting
'donation after cardiac death,' or 'DCD.' DCD usually involves patients who have
devastating and irreversible brain damage but are not actually brain-dead. Their
families consent to removing life support, and their organs are removed minutes
after the patients' hearts stop beating."
That is, there may be some brain activity when life support is removed. It would
not be enough to maintain bodily functions like heart beat and breathing. The
patient has no chance of ever regaining consciousness. But, since the end of a
person's life is defined as the permanent cessation of brain activity, they may
be
theoretically still alive.
DCD transplants rose from 268 in 2003 to at least 605 in 2006, permitting surgeons to transplant more than 1,200 additional
kidneys, livers, lungs, hearts and other organs during 2006.
In 2007, the United Network for Organ Sharing, and the Joint Commission on Accreditation of
Healthcare Organizations started to require hospitals to decide whether to
allow DCD in their facilities.
The Washington Post reported in 2007 that:
"The National Academy of Sciences' Institute of Medicine examined the
practice, however, and concluded that it is ethical as long as strict
guidelines are followed, including making sure that the decision to withdraw
care is independent of the decision to donate organs and that surgeons wait
at least five minutes after the heart stops.
Hospitals take care to review each case by an independent panel. The decision to
withdraw life-support is kept separate from the decision to harvest the
patient's organs.
A typical DCD scenario:
- A patient has suffered irreversible brain damage that
would normally have killed them. They are close to being brain-dead.
However, their body's functions are kept going by the use of
a ventilator and/or other life-sustaining devices.
- The next of kin make the difficult decision to "pull the
plug" and let the patient die. It is only after they have
made this decision that an organ-bank representative
approaches the family to discuss organ donation.
Occasionally, a patient suffering from a terminal
degenerative disease like Lou Gehrig's disease (ALS) decides
to terminate further care, and allow themselves to die. They
may elect to donate their organs.
- Assuming that consent for organ donation and the
withdrawal of life support is received, the life-supporting
equipment is turned off. In rare instances, the heart
continues to beat, the patient is moved back to their room
and allowed to die there. Usually, the patient's heart stops
beating after a short interval. Surgeons wait a few minutes
to confirm that the heart will not spontaneously restart
itself -- a rare occurrence. Death is pronounced. Finally,
the surgeons begin to harvest the patient's organs and make
them available to the waiting transplant team.
Doctors in some hospitals wait 5 minutes after the heart stops before
pronouncing the patients dead. Others wait three or two minutes. Surgeons at the
Children's Hospital in Denver wait 75 seconds before starting to remove hearts
from infants, in order to increase the possibility that the organ will be useable
for transplanting.
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Ethical aspects associated with DCD:
- Positive aspects of DCD:
- The procedure saves the lives of many organ recipients who would
otherwise die. Over 95,000 Americans are waiting for organs. Francis L.
Delmonico, a transplant surgeon at Harvard Medical School,
speaking for the United Network for Organ Sharing said:
"People are dying on the waiting list. ... This is vital as an
untapped source of organ donors."
- Many families suffering the loss of a loved one take comfort in knowing
that the harvested organs made it possible for one or more dying people to
live.
- Negative aspects of DCD:
- Jerry A. Menikoff, associate professor of law, ethics and medicine
at the University of Kansas said:
"The person is not dead yet. They are going to be dead, but we
should be honest and say that we're starting to remove the organs a
few minutes before they meet the legal definition of death."
- Some surgeons and medical ethicists are concerned that the use of
DCD might pressure family members and medical personnel to remove life support
to facilitate harvesting of organs.
- In some intensive-care units for pediatric patients, the same nurses and
doctors care for both potential donors and potential recipients. This
presents a potential conflict of interest.
- Medical personnel routinely inject morphine, valium and other drugs into
patients before life-support equipment is turned off. This makes certain
that they do not suffer from the procedure in the event that some level of
consciousness exists. Sometimes, a blood thinner or other drugs are also
injected to help preserve the organs. The latter may hasten death.
- Some people may decide to not sign organ donor cards because they fear
that their organs might be removed while they are still alive.
- There is also a slippery-slope argument. David Crippen, a critical-care
specialist at the University of Pittsburgh asked:
"Now that we've established that we're going to take organs from
patients who have a prognosis of death but who do not meet the strict
definition of death, might we become more interested in taking organs
from patients who are not dead at all but who are incapacitated or
disabled?"
References used:
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
- Rob Stein, "New Trend in Organ Donation Raises Questions As Alternative
Approach Becomes More Frequent, Doctors Worry That It Puts Donors at Risk,"
Washington Post, 2007-MAR-18, at:
http://www.washingtonpost.com/
- Rob Stein, "Transplant Procedure Ignites Debate Ethicists
Question Strategy in Which Hearts Are Removed Minutes After They
Stop Beating," Washington Post, 2008-AUG-14, at:
http://www.washingtonpost.com/
Copyright © 2008 by Ontario
Consultants on Religious Tolerance
Original posting: 2008-AUG-26
Latest update: 2008-AUG-26
Author: B.A. Robinson
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