Ethical Issues In Organ Donation

Saving Lives When Is It Ethical The decision to be an organ donor is not an easy decision to make, but the donor has the easiest part of the donation process. The decision of when to extract the organs usually falls on the family and the attending physician. The question since organ donation began has always been when are you really dead? This one question has been an ongoing controversy not only with the public, but with churches, and the government as well. The government has tried to put rules in place to help make the decision of when donor removal is ethical. One such rule is called the dead donor rule, which states that the patient must be declared dead before the removal of any vital organs for transplantation (Robert D. Troug M.D.).
This rule was accepted as ethical premise that did not require reflection or justification, because it appeared to be necessary as a safeguard against the unethical removal of vital organs from vulnerable patients (Robert D. Troug M.D.). The two types of death that fall under this category are brain death and cardiac death. Brain death is the criteria used most often to determine death. Pontifical Academy of Science studied the question of death and concluded that neurological criteria is the most appropriate criteria for determining the death of a person (Dubois). All fifty U.S. states use this criteria legally to determine death of a patient. I am an organ and tissue donor, and I agree that brain death is an ethical criterion for organ removal. Two people who support the ethical side of this debate are James M. Dubois a professor and department chair of health care ethics at Saint Louis University and Pope John Paul II. Pope John Paul II stated that it is ethical for a trained health care worker to use neurological criteria to determine death, and it is ethical to transplant organs from such a patient (Dubois). The Catholic Church has been a long-time supporter of organ transplantation. The Catechism of the Catholic Church stated that organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity (Dubois). Patients on the verge of death from organ failure usually live at least another ten years after an organ transplantation. Death use to be declared when someone was cold, blue, and stiff. Organs cannot be used for transplantation after they have shut down. In 1968 an ad hoc committee at Harvard Medical School suggested revising the definition of death in a way that would make some patients with devastating neurologic injury suitable for organ transplantation under the dead donor rule, requiring the complete absence of all functions of the entire brain (Robert D. Troug M.D.). One exception to this rule is cardiac death, patients who are not brain-dead but who are undergoing an orchestrated withdrawal of life support are pronounced dead two to five minutes after the onset of asystole (no cardiac electric activity or flat line) and the organs are expeditiously removed for transplantation. According to Robert D. Troug M.D. and Franklin G. Miller Ph.D.
If the critiques of the current methods of diagnosing death are correct, surgeons are already legally removing vital organs from patients before death.
In modern ICU, ethically justified decisions and actions of physicians are already the proximate cause of death for many patients¬¬— for instance, when mechanical ventilation is withdrawn. Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered. With proper safeguards, no patient will die from vital organ donation who would not otherwise die as a result of the withdrawal of life support. Finally, surveys suggest that issues related to respect for valid consent and the degree of neurologic injury may be more important to the public than concerns about whether the patient is already dead at the time the organs are
removed.
In a survey of 2000 people that were randomly selected and asked about their attitude toward organ donation 63% of the people were in favor of organ donation with presumed consent law (a deceased individual is classified as a potential donor in absence of explicit opposition to donation before death) using the dead donor rule (Science Direct). Not everyone in the Catholic Church agrees with Pope John Paul II, some members have contested whether brain death is an adequate criteria for determining death.
This is largely based on facts and confusion on what is actually brain dead and what is a persistent vegetative state (the patient still has brain activity but is not able to wake up). Many people object that transplantation surgeons cannot legally or ethically remove vital organs from patients before death, since doing so will cause their death (Robert D. Troug M.D.). In 2009, Paul Byrne, MD. A former president of the Catholic Medical Association, a neonatologist at St. Charles Mercy Hospital in Oregon, Ohio, and a long-time opponent of brain-death criteria, published a letter on the Web site Renew America arguing God’s law (Dubois). Paul Byrne said “the transplantation of unpaired vital organs, an act which causes the death of the ‘donor’ and violates the fifth commandment of the divine Decalogue, ‘Thou shalt not kill’ (Dt. 5:17)” (Dubois). According to what Paul Byrne and his colleagues believe, that we need to be absolutely certain that death has occurred, we would have no organs healthy enough to be able to transplant. An organ must be taken from a living person for it to be suitable for transplantation. At the close of 2007, 183,222 people were recorded in available OPTN data as living with a functioning transplanted organ (R.A. Wolfe. E.C. Roys). In 2007 alone 27,586 organs were transplanted with 21,279 of
those coming from “deceased donors” (R.A. Wolfe. E.C. Roys). Those people would not have survived without the sacrifice of someone else donating their organs. The problem that people have with whether it is ethical or not comes from the fact that doctors have made mistakes and misdiagnosed brain death. Just this year Lamar Odem a famous basketball player was pronounced brain dead, not even 72 hours later he was said to have recovered. Zack Dunlap from Oklahoma was declared dead, the transplant team was ready to remove his organs until he moved. When he woke up he told the doctors he could hear them discuss his “brain death.” But he could not move to tell them he was alive (Byrne). Paul A. Byrne said:
Patients who have been declared brain dead for the purposes of organ transplants are not truly dead because there has not been complete cessation of all of the functions of the brain, including the brain stem. In reality, when organs are harvested from a brain dead patient, they are being taken from a living body. Organs from a body that is completely dead are not useful for transplantation. Therefore, a patient's right to live is violated by the declaration of brain death and doctors who harvest organs from a brain dead person are committing homicide.
The reliance that some put on the dead donor rule has a greater potential to undermine trust in the transplantation enterprise, in another words the medical profession has been getting around the definition of death to make sure the conditions for transplantation are more favorable. Less strict criterion that does not fulfill any of the “brain death” criteria has been issued in the 10 years after the Harvard Criteria was set in 1978 (Byrne). It used to be that you would wait 10 minutes after a patient was taken off life support with no pulse to declare the patient deceased, now that has been reduced to 1.25 min. Byrne feels that no matter how noble someone might want to be by donating their organs to save someone else, suicide or homicide to save another is not morally acceptable since brain death is not really true death. Even though both sides have valid arguments, I still stand behind those that agree that brain death is ethically acceptable criteria for organ removal. We have to put our trust and faith in those doctors who decide whether we are “dead” or if we have a chance to recover. Determining death in the context of organ donation is challenging and will likely remain controversial for the simple reason that death must be determined quickly lest all transplantable organs die according to the Catholic Church (Dubois). One good approach to this controversial subject would be to emphasize the importance of getting valid informed consent from organ donation from patients or surrogates before the need arises ex. do-not-resuscitate order. The living donor needs to let their family and health care professionals know what they wish to be done in emergency situations. We had over 96,874 patients on the waiting list for organ donation in 2007 and I am sure that number has grown in the last several years. When we die our body does not go with us and that includes all our vital organs, if they can be used to save someone else’s life then I say let someone else get a little more time with their love ones.