Since the 1970s, organs have been harvested when the donor has been declared brain dead. Now organs are being aggressively harvested when the donor’s heart stops beating but there’s still brain activity, clinically known as donation after cardiac death. The result is more organs for those waiting for them—now numbering more than 95,000 and rising—but more organ vulturism and possible risk to donors as well.
According to Rob Stein’s report in the Washington Post, 605 donation after cardiac death procedures occurred in 2006, compared to 268 such procedures in 2003.
The United Network for Organ Sharing—the organization that oversees organ procurement in the US—and the Joint Commission on Accreditation of Healthcare Organizations—which accredits hospitals in the US—are requiring all hospitals to decide whether to allow donation after cardiac death procedures. Some hospitals are simply opting-out, based on the ethical dilemma.
“Some doctors and bioethicists, however, say the practice raises the disturbing specter of transplant surgeons preying on dying patients for their organs, possibly pressuring doctors and families to discontinue treatment, adversely affecting donors’ care in their final days and even hastening their deaths.”
Stein reports that the procedure is particularly gruesome: “Once the decision has been made, a transplant team waits nearby so surgeons can begin removing organs soon after the heart stops. Because the heart can sometimes restart spontaneously, doctors wait a few minutes after pronouncing death before allowing the surgeons to begin. If the heart does not stop quickly, usually within an hour, the procedure is aborted and the patient is taken back to his or her room until death comes.”
The only ethical guidelines, established by the National Academy of Sciences’ Institute of Medicine are that the decision to donate organs is wholly independent from the decision to stop care and that transplant surgeons wait at least five minutes after the heart stops beating to harvest organs. And these guidelines are apparently pretty slippery. According to Stein, “doctors at some hospitals wait three minutes, others two. In Denver, surgeons at Children’s Hospital wait 75 seconds before starting to remove hearts from infants, to maximize the chances that the organs will be useable.”
Additionally, Stein reports that “doctors often insert a large tube into an artery and inject drugs such as the blood thinner heparin to help preserve the organs” well before death by any definition takes place. Some professionals say such measures may actually hasten death.
Is this any way to run a railroad? Based on how you define death, the donor isn’t dead—not brain dead—when the harvest of his or her organs begins.
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