Friday, February 16, 2007

Irresponsible Headline: "Organ Harvesting Begins Before Brain Death"

The headline on this story is irresponsible because it implies that organs are being harvested before the donor is really dead. Not so. This organ procurement protocol, known as "non heart beating cadaver donor" removes organs from people who died from irreversible cardio/pulmonary arrest. (For ease of discussion, let's call this "heart death.")

The problem, I think, arises from the ubiquitous use of the often misunderstood term "brain death," a popular description for "death by neurological criteria." DNC does not require that every cell in the brain be dead, but rather, that the brain has irreversibly ceased functioning, both in whole and in each and every constituent part. (The term is also sometimes misused as a description of persistent vegetative state.) As one neurologist once described it to me, the experience of brain death (properly diagnosed) is akin to a headless body being animated by machine. (As I have written previously, some bioethicists claim brain death is not really dead, not to prevent organs from being procured from living people, but as an argument to gain permission to expand the pool of harvestable people to patients diagnosed with persistent vegetative state. But let's not get into that here.)

And here's a kicker: If brain death isn't really dead--as some pro lifers also claim--then the only ethical way to permit vital organ procurement would be through the protocol mentioned in the story. Life support for the patient would be removed, there would be an immediate cessation of breathing ("brain dead" patients can't breathe because their brains don't send the requisite signal for a breath to be taken), followed immediately by cardiac arrest. (This is also the protocol for non brain dead organ donors today.) A necessary waiting period after the heart stops beating comes next--which I don't believe should be shorter than 5 minutes--and then organ removal from the dead body. (It is true, that some brain cells may still be alive at this point, but that is also true in "brain death" procurements.)

This is not to say, of course, that the protocol I just described could not have serious ethical problems. Indeed, I discuss these concerns at some length in Culture of Death. But I do believe that if it is done correctly, using donors who died from heart death is totally appropriate and morally upright.

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