NRL News

Brain death? New transplant protocol blurs the line between life and death.

by | Sep 30, 2022

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

An article by Randy Dotinga, that was published on September 28 by Medpage Today examines a new “brain death” protocol that blurs the line between life and death. Dotinga explains:

With little attention or debate, transplant surgeons across the country are experimenting with a kind of partial resurrection: They’re allowing terminal patients to die, then restarting their hearts while clamping off blood flow to their brains. The procedure allows the surgeons to inspect and remove organs from warm bodies with heartbeats.

Transplant surgeons and several bioethicists argue that the procedure is appropriate and crucial to boosting the number of organs that are available for transplant. But critics — including other bioethicists and the nation’s second-largest physician organization — warn that surgeons are trampling the line between life and death.

Dotinga interviewed Wes Ely, MD, MPH, a critical care physician and transplant pulmonologist at Vanderbilt University, who told MedPage Today:

“We’re so hungry for organs right now that we are pushing all the limits,”

“I just want us to be super-cautious. We need to press the pause button on this and have some more conversations so that we can set up boundaries and stay in the right lane. The dignity of the human who donates organs should never be sacrificed.”

Dotinga states that The American College of Physicians (ACP), which represents primary care doctors, warned in a 2021 statement that the procedure raises:

“profound ethical questions regarding determination of death, respect for patients, and the ethical obligation to do what is best.”

Dotinga explains that hospitals in Nebraska, Arizona and New York are currently doing clinical trials on this procedure. Amy Fiedler, MD, a cardiac and transplant surgeon at the University of California San Francisco, who has performed this procedure several times, told MedPage Today:

“It’s expanding rapidly,”

“Every time I talk to colleagues, they want to talk about how to build an NRP program and get it started.”

Dotinga explains that since organ donation began more than 1 million organ donations have been done in America and in 2021 more than 40,000 organ donations in America. He explains how organ donation is done and why the new procedure changes everything:

In the organ-retrieval procedures that are most well-known, patients are declared brain dead but they remain on life support: Their hearts beat, their lungs breathe. Surgeons remove organs for transplantation, and then the life support system is turned off.

But there’s another category of organ donor: A patient who cannot survive without life support, but is not brain dead — someone with severe brain injury, for instance, who has no chance of recovery.

In the past, transplant surgeons wouldn’t remove organs until the hearts of these patients stopped for good. Now, transplant surgeons have changed the game. 

Matthew DeCamp, MD, PhD, a bioethicist at the University of Colorado and a consultant to ACP, was lead author of a 2022 commentary in the journal Chest opposing the procedure. Dotinga reports:

“You’re reversing the conditions under which death is declared and taking active steps to ensure the progression to brain death,” he told MedPage Today. “The person is declared dead, and the subsequent actions invalidate that declaration.”

DeCamp said this process bumps into the dead donor rule, an ethical standard within transplant medicine that says the process of retrieving an organ cannot kill a donor. However, the withdrawal of life support with consent, essentially facilitating a death, is allowed.

“The dead donor rule is ethically foundational to organ transplantation. It’s the idea that medicine looks out for the best interests of the patients — do no harm — and acts cannot be taken that would cause death,” DeCamp said. “Resuscitating the patient and reversing those conditions engages with the ethics of the dead donor rule.”

He added: “Imagine you’re an outside observer watching this procedure take place. You’d be unable to distinguish whether it was proceeding to organ transplantation or the resuscitation of the patient.”

The new organ donation method ignores the “dead donor rule.” What this means is that people who are possibly dying or nearly dead could be essentially killed for their organs. Several factors that are driving this change are that living donors provide healthier organs for transplant, the medical community is rejecting the concept of “do no harm,” and the demand for healthier organs for donation are fulfilled by this procedure.

Editor’s note. This appeared at Mr. Schadenberg’s blog and is reposted with permission.

People who oppose killing may be forced to oppose organ donation.

Categories: Brain Death