CBC: Is it fair to assume you are generally supportive of organ donation and transplantation?
Smith: Yes. Using cadaveric tissues to help the living is a wonderfulthing. We just have to be careful that our desire to help ill peoplewith organ transplant does not supersede our ethical obligation tovalue the lives of the cognitively devastated or imminently dying, orto treat them as fully human persons. In other words, we must nevertreat people as mere organ systems.
CBC: But, it is also your concern that people be killed or their death hastened for the purpose of harvesting their organs?
Smith: That is a real concern. For several years some of the most respectedbioethicists and transplant doctors working at the most prestigiousmedical institutions and universities have urged that death beredefined to include a diagnosis of persistent vegetative state forthe purpose of expanding the potential organ donor pool. Some, evenadvocate doing away altogether with the “dead donor rule,” whichrequires patients who donate vital organs to be dead before theirorgans are procured. If these advocates get their way, people likeTerri Schiavo could well face being killed for their organs. I wishto stress that this is NOT being done at the present moment.
CBC: Are you familiar with the presumed consent ‘solution’ to the organ shortage and can you comment on this idea?
Smith: I am familiar and note that it is done in some countries in Europe.But to presume consent and require patients to say no ahead oftime–instead of yes ahead of time or require family consent–would beto claim that the human body is, in a sense, owned by the state. Idon’t think the American people would countenance this idea and I fearit would destroy confidence in organ procurement. It could alsoimpact the care of the very ill or catastrophically injured since theycould be looked upon more as available organ systems rather thanliving patients.
CBC: What are some safeguards that need to be put into place to instill public confidence in the organ donation system?
Smith: I think we need to create binding national standards that would haveto be complied with before “death by neurological criteria” werepermitted to be declared (a way of diagnosing the cessation of lifecommonly known as “brain death). This would mean that all necessarytests were done to determine that the whole brain and each of itsconstituent parts were not functioning in any way as a brain. Somepeople reject brain death as a utilitarian fiction. I am not there,yet. We might wish to revisit the issue to make sure that properethics are being followed. But if we do, beware of those who saybrain death is a fraud, not to prevent the killing of living peoplebut to expand current practices to patients who are catastrophicallydisabled by brain injury.
CBC: Any final comments you have for our readers?
Smith: I worry that there is too much paranoia among some communities. Somefear that physicians are too ready to declare death in order to garnerorgans. But the overwhelming majority of doctors involved in organprocurement and transplantation are ethical professionals who onlyseek to palliate suffering and heal patients. We have to be carefulnot to make organ transplant professionals enemies by personallyattacking them. Our job, rather, is to ensure that proper ethicscontinue to prevail.
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