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 wonderful thing. We just have to be careful that our desire to help ill people with organ transplant does not supersede our ethical obligation to value the lives of the cognitively devastated or imminently dying, or to treat them as fully human persons. In other words, we must never treat 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 respected bioethicists and transplant doctors working at the most prestigious medical institutions and universities have urged that death be redefined to include a diagnosis of persistent vegetative state for the purpose of expanding the potential organ donor pool. Some, even advocate doing away altogether with the “dead donor rule,” which requires patients who donate vital organs to be dead before their organs are procured. If these advocates get their way, people like Terri Schiavo could well face being killed for their organs. I wish to 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 of time–instead of yes ahead of time or require family consent–would be to claim that the human body is, in a sense, owned by the state. I don’t think the American people would countenance this idea and I fear it would destroy confidence in organ procurement. It could also impact the care of the very ill or catastrophically injured since they could be looked upon more as available organ systems rather than living 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 have to be complied with before “death by neurological criteria” were permitted to be declared (a way of diagnosing the cessation of life commonly known as “brain death). This would mean that all necessary tests were done to determine that the whole brain and each of its constituent parts were not functioning in any way as a brain. Some people reject brain death as a utilitarian fiction. I am not there, yet. We might wish to revisit the issue to make sure that proper ethics are being followed. But if we do, beware of those who say brain death is a fraud, not to prevent the killing of living people but to expand current practices to patients who are catastrophically disabled by brain injury.
CBC: Any final comments you have for our readers?
Smith: I worry that there is too much paranoia among some communities. Some fear that physicians are too ready to declare death in order to garner organs. But the overwhelming majority of doctors involved in organ procurement and transplantation are ethical professionals who only seek to palliate suffering and heal patients. We have to be careful not to make organ transplant professionals enemies by personally attacking them. Our job, rather, is to ensure that proper ethics continue to prevail.
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