Reconsidering Organ Donation


"It's a liver donor's card." from Monty Python's Meaning of Life

Signing that organ donor card always seemed like a simple decision, but with the slide in modern medical ethics, particularly where end-of-life and “brain death” issues are concerned, perhaps that’s no longer the case. I’ve seen enough reports over the years about people who were incorrectly declared brain dead only to come roaring back to life, to start moving to the skeptical side on the issue. Although there are neurological criteria for determining brain death, errors do occur. Sometimes the error is revealed before the patient gives up his organs, which naturally raises a simple question: how often are these errors never detected?

Dick Teresi’s WSJ story “What You Lose When You Sign That Organ Donor Card” makes some interesting points. Excerpt:

What if there is sound evidence that you are alive after being declared brain dead? In a 1999 article in the peer-reviewed journal Anesthesiology, Gail A. Van Norman, a professor of anesthesiology at the University of Washington, reported a case in which a 30-year-old patient with severe head trauma began breathing spontaneously after being declared brain dead. The physicians said that, because there was no chance of recovery, he could still be considered dead. The harvest proceeded over the objections of the anesthesiologist, who saw the donor move, and then react to the scalpel with hypertension.

Organ transplantation—from procurement of organs to transplant to the first year of postoperative care—is a $20 billion per year business. Average recipients are charged $750,000 for a transplant, and at an average 3.3 organs, that is more than $2 million per body. Neither donors nor their families can be paid for organs.

It is possible that not being a donor on your license can give you more bargaining power. If you leave instructions with your next of kin, they can perhaps negotiate a better deal. Instead of just the usual icewater-in-the-ears, why not ask for a blood-flow study to make sure your cortex is truly out of commission?

The Catechism only has this to say on the subject:

2296 Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons.

That’s hardly comprehensive, and leaves out some vital issues, such as the fact that the bodies of the brain-dead are kept “alive” by artificial means until the organs are removed. In one of its ethical directions, the United States Catholic Bishops’ Conference stated that (emphasis added):

The transplantation of organs from living donors is morally permissible when the anticipated benefit to the recipient is proportionate to the harm done to the donor, provided that the loss of such organ(s) does not deprive the donor of life itself nor of the functional integrity of his body.

Postmortem examinations must not begin until death is morally certain. Vital organs, that is, organs necessary to sustain life, may not be removed until death has taken place. The determination of the time of death must be made in accordance with responsible and commonly accepted scientific criteria. In accordance with current medical practice, to prevent any conflict of interest, the dying patient’s doctor or doctors should ordinarily be distinct from the transplant team.

James M. Dubois wrote a long and interesting examination of the issue for America Magazine, in which he observed:

First, organ donation risks treating human beings or their deceased bodies as “objects.” In John Paul II’s 2000 allocution on organ donation and brain death, he stated that “any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an ‘object’ is to violate the dignity of the human person.” He also noted that organ donation requires the informed consent of the patient or the patient’s family. Yet the continual shortage of organs leads some policymakers to consider payments for organs and even organ procurement without expressed consent. Overly hasty pronouncements of brain death—which are rare but have received considerable attention in recent years—also reinforce suspicions that a concern for organ donation is trumping care for patients.

How much do we really trust our health care professionals any more? With a couple million dollars in potential revenue riding on each decision, and with the growing chorus of voices urging us to nudge the the disabled and dying into the grave as soon as possible, how can we have confidence in the physicians making these calls?

Patients in a hospital functioning under strict religious guidelines can have some assurance that moral and ethic concerns are part of the decision-making process, but what about the rest? If Obama succeeds in getting the Church out of the healthcare business (and that is, quite transparently, one of his goals), who will be left to stand in the way and provide end-of-life care and decision-making that respects the dignity of the total person?

Never forget that one of things Obama said he most regretted about his time in the Senate was not opposing Congressional efforts to prevent the court-ordered murder of Terry Shiavo–who was not even brain-dead–by prolonged and cruel starvation. The Catholic understanding of the value of each human life–from conception to natural death–completely escapes him.

And American healthcare is being indelibly remodeled into his twisted vision.

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About Thomas L. McDonald

Thomas L. McDonald writes about technology, theology, history, games, and shiny things. Details of his rather uneventful life as a professional writer and magazine editor can be found in the About tab.

  • Chris

    It is really necessary to understand something about neurology, before the unexamined acceptance of Mr. Teresi’s article. He gets a basic neurophysiological fact wrong, and thus weakens the rest of his argument. Muscular movement/withdrawal in response to painful stimulus takes place at the level of the spinal cord–the brain is not involved. You perceive pain later than you react to it, as the spinal cord sends a signal to the brain, which arrives in the brain after withdrawal from the stimulus. This makes sense–you don’t want to have to “think” to get away from a damaging stimulus. A body can be brain dead–which is dead–and withdraw to painful stimuli, as long as the spinal cord is alive. However, the pain is not perceived, because the cortex is not alive to perceive pain, and the brainstem is not alive to transmit the signal. That’s why you can do spinal anesthesia or a peripheral nerve block, and the patient can be awake for the procedure. The spinal cord “circuit” is interrupted, the muscles are relaxed, there is no withdrawal response, the surgeon can operate, AND there is no pain transmission to the brain.

  • AshtaraSilunar

    “Never forget that one of things Obama said he most regretted about his time in the Senate was not opposing Congressional efforts to prevent the court-ordered murder of Terry Shiavo–who was not even brain-dead–by prolonged and cruel starvation.”
    Terri Schiavo was definitely in a persistent vegetative state, caused by a horribly low serum potassium level. She had severe cerebral atrophy, as proved by a CAT scan, and an EEG showed no brain activity. The autopsy showed that her condition was even worse than doctors had thought. So yeah, she was brain dead.

    “How much do we really trust our health care professionals any more? With a couple million dollars in potential revenue riding on each decision, and with the growing chorus of voices urging us to nudge the the disabled and dying into the grave as soon as possible, how can we have confidence in the physicians making these calls?”
    Bear in mind, family members do have the last say on whether organs are donated. The problem with the Schiavo case was that her husband and her parents disagreed on what should be done. If you don’t trust your family to make medical decisions when you’re incapacitated, write up a living will and name someone else, and elaborate what you want done under different circumstances. Practical measures are better than general paranoia.

    Biases: Registered organ donor, in the bone marrow donor registry, has a living will and has discussed end-of-life scenarios with family members.

  • AshtaraSilunar

    Excellent point. And in the original article Teresi quotes (full text viewable at http://journals.lww.com/anesthesiology/Fulltext/1999/07000/A_Matter_of_Life_and_Death__What_Every.36.aspx), Van Norman specifically points out, “Minor flexion of upper or lower extremities in response to painful stimulus applied locally to the same limb represents spinal cord reflexes *and not cortical activity*, and it does not preclude the diagnosis of brain death.” [emphasis mine]

    That’s the problem with quoting only the first few paragraphs of an article, I guess.


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