By Wesley J. Smith, J.D., Special Consultant to the CBC
This report is unduly provocative in my view. Some ICU physicians in Canada are urging a moratorium on “heart death” organ procurement because, they say, some of the patients might not actually be dead. From the story:
A group of ICU doctors is calling for a moratorium on harvesting transplant organs from people whose hearts have stopped but are not yet brain dead, reviving controversy around a process that is becoming increasingly important to the transplant system. Family members are essentially being misled into believing patients are dead when they may not be, and in some rare cases people’s hearts could actually start beating again after being silent for the required two to five minutes, the physicians say. In most instances it may still be appropriate to remove organs — if the family consents — but relatives need to be better informed about their loved one’s state, said Dr. Ari Joffe, an intensive-care specialist at Stollery Children’s Hospital in Edmonton who signed a letter urging the moratorium.
“I think that we’re being less than entirely honest about when the patient is truly dead,” he said in an interview. “We’re not trying to deny the parent the choice to donate … The point we’re making is ‘what if they’re almost dead and we’re not sure if they’re dead, and it’s not at the point of irreversibility yet?’ ”
He’s right about one thing: The issue is irreversibility. From my research for Culture of Death, I think two minutes from cardiac arrest to procurement may well be too short (although every neurologist I spoke with said no way could the patient feel it). Five minutes seems right. But if, as the story reports, there have been cases of spontaneous resuscitation cases after seven minutes, it might be necessary to move the time between cardiac arrest and procurement to that point to maintain proper ethics. But I don’t think it is fair to say that some patients were not actually dead. (It isn’t like harvesting people who are unconscious — killing for organs — which, as we have discussed here, some organ ethicists want license to do.)
But this criticism of current practices, I think, is right on the money:
Dr. Chip Doig, a University of Calgary critical care professor who is skeptical about the DCD concept, noted that death is declared anywhere from 75 seconds to 10 minutes after the heart stops, depending on the jurisdiction. “Dead in Cleveland should be the same as dead in Calgary and dead in Brussels,” he said.
Absolutely. We need conformity — both as to the criteria for declaring death, and the ethical protocols of organ procurement.
I really dug into this issue for Culture of Death (and since). My conclusion remains that planning organ procurement after expected cardiac arrest upon the removal of life support is a legitimate and ethical in concept. Getting the time right is important, both ethically and to maintain the people’s confidence in the system. We have to tread a careful path, both maintaining the dead donor rule against the many threats being made against it, while at the same time, making sure that donors who have died can be so declared at the earliest proper moment to protect organ viability. Or to put it another way, we don’t want to throw the baby out with the bathwater. Other lives are also at stake.
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