Organ Donation Debate Over Definition Of Death

When is an organ donor dead?

A published report today is raising the ethical debate about the sometimes aggressive procurement of organs intended for those in need.

The controversy has arisen as doctors from Denver Children’s Hospital detail for the first time how and when they perform the procedure. 

In the case of severely brain-damaged infants, usually resulting from oxygen deprivation at birth, in less than two minutes after the infant is taken off life support their hearts stop beating and the viable organ is taken and restarted in the chest of another infant. 

The New England Journal of Medicine description raises questions from critics as to whether hearts should be taken from infants who are not brain-dead, just severely brain-damaged. 

The general standard of organ procurement is to wait until death - defined as complete and irreversible cessation of brain function or heart and lung function.  The fact that the heart can be restarted in another infant’s chest shows the cessation was not irreversible.

Hospitals are required to follow protocols defining the role of the doctor and the organ procurers. But since the 1970s, in an effort to retrieve more organs, transplant surgeons and organ banks have been pursuing DCD (donation after cardiac death).

In this case, the donor is not technically brain-dead, but may have irreversible brain damage. The organs are likely to be more viable if recovered right after the heart has stopped beating.

Bioethicists are debating whether the Denver example, part of a federally funded research project, is tantamount to murder.

"The whole issue is whether the infants from whom the hearts were taken were dead. It seems very clear to me that they were not," he said. "I think it's illegal, and if it's illegal, what we're talking about is the physicians causing the death of the three patients, and that would be homicide. It's immoral. I think it should be stopped," said Robert M. Veatch, a Georgetown University bioethicist to the Washington Post. 

Denver Children’s Hospital has waited as little as 75 seconds after life support is removed to take an organ, but in rare cases a heart can begin beating again after it has stopped.  In the two cases involving a 75 second wait, an ethics panel monitoring the cases gave their okay.

In all types of procurements, the family must consent to the donation.

Three babies received the hearts in the Denver report. Six months later all three babies were alive, an outcome not always seen with standard organ procurement.  

"This bold experiment is pushing the boundaries and raising many questions," said James L. Bernat, a Dartmouth medical professor tells the Washington Post. He wrote one of the commentaries to the journal, which has posted all reactions on its Web site with a videotaped debate among three prominent bioethicists.

One ethicist suggests that instead of trying to define death, the people with the terminal illness or brain injuries, or their family members should be allowed to decide whether the organ donation should take place.

One California transplant surgeon is facing criminal charges for a DCD procedure in 2006. He is charged with hastening a man’s death so his organs could be harvested. #