Why Is Death Important

Why is the definition of death an important question for the issue of donation and transplantation?
The definition of death is an important question for the issue of donation and transplantation for several reasons, but most importantly, because doctors may only harvest organs after a person has died because otherwise they are going against the medical principle of Primum non nocere meaning “first, do no harm”. This means that doctors must wait until a person is fully dead before removing organs as otherwise they would be inflicting harm on a patient, not removing organs from a corpse. Therefore this medical principle of Primum non noncere requires doctors to know when a person is dead. Therefore the definition of death is an important question
for the issue of donation and transplantation, as without definition it becomes very unclear on when a doctor is to remove the organs from the donor.
Many definitions of death have been evident throughout time.
Up until 1968 the fourth edition of Black’s Law Dictionary defined death as “…Total stoppage of the circulation of the blood, and a cessation of the animal and vital functions consequent thereupon, such as respiration, pulsation, etc.” This definition is commonly known as ‘body death’, whereby a person’s body could be seen to no longer function, resulting in death. However, this definition poses problems, one of which is highlighted by Glanville Williams who discusses a hypothetical case that poses legal difficulties due to the ‘body death’ definition of death. The case explores the issue surrounding whether it is murder to stab a body that had stopped beating but could have been revived. The problem it poses is that technically the man simply had an illegal interface with a corpse, not murder, which if the definition of death was different, the case would have seen the man been accused with murder. This problem with the definition of ‘Body death’ is a problem for the issue of donation and transplantation because it can justify doctors giving up on patients too early, because they know the organs could be donated, therefore saving more people that were dying, as evident in the Pittsburgh Protocol (1993), which is undoubtedly wrong, if the person still has a chance of returning to full functionality, for the doctor to declare a person ‘body dead’ and therefore
‘dead’.
Since medical advances have led to ‘body dead’ no longer being a valid definition of death becoming more evident throughout the 20th century, many groups have tried to define death, notably the “Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death”, who brought about the commonly known phrase of ‘brain dead’. Brain Death, know advanced to become ‘Brain Stem Death’ to fully confirm that the brain-stem, without which basic human functioning is impossible, is damaged, therefore consciousness may never be recovered, is the more commonly defined version of death. However, the ‘brain-stem dead’ definition of death also holds problems as it is difficult to declare someone who’s body is still functioning under life support is dead, if functions like circulation are still evident, such as the functioning of PVS (Persistent Vegetative State), which under the ‘brain-stem dead’ definition of death, many patients would be considered dead. This definition therefore poses an issue to donation and transplantation as in many cases of PVS, a recovery has been made by the patients, which is why Christina Odone, a Journalist for the Daily Telegraph, stated on “The Big Questions” (BBC 19/02/12) that she wouldn’t carry a donor card, as she believed that “miracles can happen” and therefore because of ‘brain-stem death’ definition, organs may be taken prematurely, and before a person has had a full chance at life.
Another reason why the definition of death is an important question for the issue of donation and transplantation, is that under different definitions, the procedure of Elective Ventilation is accepted or prohibited, making a substantial difference to the chance of success of the transplant to save another’s life.
Elective Ventilation is the procedure of putting a dying person on life support to keep their organs preserved for longer, in short, prolonging a donor’s inevitable death, in order to increase the chances of success of transplantation, as all organs deteriorate the longer they are out of a body, and some organs such as the heart, can be substantially damaged in the time between removal and transplantation. This poses a problem for donation and transplantation as under ‘body death’ the donor is still alive, as their heart is still beating, which to many, implies the doctor is killing the patient by taking away life support in order to donate, therefore not upholding the principle of Primum non nocere. This whole issue raises the question previously raised by Jonathan Glover of whether we believe ‘being alive is intrinsically valuable’ or whether ‘being conscious is intrinsically valuable’ as under the latter, Elective Ventilation is acceptable, allowing a higher chance of saving life, unlike the first, an opinion held by many religions under the premise of “sanctity of life”. Therefore the definition of death is an important question for the issue of donation and
transplantation, as depending on the definition, Elective Ventilation is either acceptable or prohibited.
In conclusion, the reason the definition of death is an important question for the issue of donation and transplantation is because, depending on the answer, doctors may follow very different procedures concerning their patients and trying to uphold Primum non nocere. Jonathan Glover proposes the answer is a ‘double-test’ solution, whereby the donor must be declared both ‘body dead’ and ‘brain-stem dead’, leaving no ambiguity as to whether a person is dead or not. This view is also held by many countries and acknowledged by medical-dictionary.thefreedictionary.com/death to be the definition of death, requiring “The heartbeat, brain activity and breathing” to all have ceased. However, in the UK, no actual definition of death is acknowledged leaving it up to the doctor of each individual case to best decide, although many guidelines are available to them, leaving the problems of donation and transplantation to each individual doctor. Therefore the definition of death is an important question for the issue of donation and transplantation as it is often difficult for doctor to be able to make a full decision on death seeing as many different factors are involved, and doctors want to make sure that a successful transplant is possible, but also that they are not violating Primum non nocere by ending the life of a patient prematurely.