The organ harvest

My colleague Les Sillars has written a fascinating article on the history of organ donation and how different definitions of death and kinds of ethical reasoning developed to accomodate the practice. He combines the humorous with the grotesque with the thoughtful. A sample:

It is now unethical to take organs from anyone who is not at least a little bit alive (via life support, of course)—look at the risk to the recipient if you do otherwise! The organs might deteriorate in the interval between certain death and the operation. As Truog predicted, the big thing is consent. Mostly dead, plus consent, and you’re good to go.

Doctors, remember, don’t decide what’s ethical and then do it; rather, if enough of them start doing it, eventually they decide it’s ethical. As Truog said in a panel discussion connected to his commentary (talking about a transplant team that had waited 75 seconds after heart stoppage before taking the heart of an infant), “We know that if they said, ‘We’re not going to do this until there’s a national panel and we get approval,’ that it’s never going to happen. And the way change happens in medicine is somebody goes out and does it.”

That’s just how life is. Abortion and then physician-assisted suicide went through the same process—from unthinkable to unimpeachable—in about the same amount of time. Likewise, donation after cardiac death was somewhat controversial in the early 1990s because it was pretty close to that dead/not dead line. There were only a few dozen cases per year, but by 2009 there were hundreds of cases a year and transplant doctors regarded it as beyond question.

He is NOT criticizing organ donation, just chronicling the workings of medical ethics.