Tuesday, September 02, 2008

More on Harvesting Human Organs

I have posted harvesting organs when brain functions is still present. Maurice has an interesting blog named Bioethics Discussion Blog in which he wrote a response to my comments.

The moment of death for legal purposes has always been pronounced by a person who has the legal responsibility and capacity to pronounce death. It should be the same (and is the same) whether organs are to be procured or not. The pronouncement of death of a patient in whom no attempt will be made for cardio-vascular-pulmonary resuscitation should occur when it is known by clinical experience that full return of non-assisted cardio-vacular-pulmonary system function spontaneously is unlikely or if it should occur the period of anoxia of the brain would be long enough to cause brain function to meet brain death criteria. The pronouncement of death can also be made in a patient who may still have cardio-vascular system function but meets the clinical criteria for brain death. The pronouncement of death, if not by neurologic criteria, was made not because the heart was "dead" but because of the permanent pathophysiologic failure of the cardio-vascular-pulmonary system, no longer providing oxygen or other substances to the brain and the other body organs and with no intention to attempt artificial resusitation. I believe it should be clarified that The Dead Donor Rule (that the patient should be dead at the time the organs are removed) is satisfied by a legal pronouncement of death, There is no other way to define death since it is known that the cells throughout the human body don't all die at the same instant. There is nothing inconsistent with the Dead Donor Rule that the donated heart has resumed beating in the recipient. This event is not pertinent to the pronouncement of death of the donor since it was the entire cardio-vascular-pulmonary physiologic system that "died" and not the heart..

Patients have the ethical and legal right to voluntarily withdraw unwanted life support and the legal right to give permission for their organs to be removed for donation when the patient is pronounced dead. I would disagree that "doctors are allowing patients to die so that organ harvesting can take place" since the physicians, supported by the law and ethics, are following the requests of the patient. As long as society maintains strict attention regarding the validity of these patient permissions, the act of organ procurement for transplant is an ethical and humanistic procedure. ..Maurice.

Please see here for further comments and discussion.

In addition, he has included the following link to the New England Journal of Medicine Video Round Table discussion of the issue regarding organ donation after cardiac death with Atul Gawande as moderator and discussants, ethicists George Annas, Arthur Caplan and Robert Truog.


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