Wednesday, July 18, 2007

Organ Harvesting Before "Brain-Death" Increasingly Common, Concerned Doctors Warn

Warning that changing definition of death will eventually lead to organ harvesting from disabled

From "Organ Harvesting Before "Brain-Death" Increasingly Common, Concerned Doctors Warn" by Gudrun Schultz, posted 3/21/07 at

Organ harvesting from patients before brain-death has been declared as a rapidly increasing trend in U. S. hospitals, the Washington Post reported March 18, alarming doctors and ethicists about the dubious ethics behind the practice.

Instead of waiting until brain function ceases and the patient is declared "brain-dead" by medical officials (itself a questionable practice since there is no universally-accepted definition of brain-death) surgeons have begun following an approach known as "donation after cardiac death." Organs are harvested once the heart has stopped beating and several minutes have passed without the heart spontaneously re-starting.

"The person is not dead yet," said Jerry A. Menikoff, an associate professor
of law, ethics and medicine at the University of Kansas. "They are going to
be dead, but we should be honest and say that we're starting to remove the
organs a few minutes before they meet the legal definition of death."

"Non-beating heart" organ donations have more than doubled since 2003, from 268 to more than 605 in 2006, and the numbers are continuing to rise. The United Network for Organ Sharing and the Joint Commission on Accreditation of Healthcare Organizations now require all hospitals to evaluate the practice and decide whether or not to adopt it.

The Alliance for Human Research Protection issued an alert Sunday warning that the policy is under consideration by hospitals without allowing for public input.

"The race to catch-up to China's policy of live vivisection organ removal from prisoners is underway right here in the US where, the Post reports, the trend is expected to accelerate this year," the AHRP stated.

"So far as we know, our right to informed consent--which means the right to
say, NO--has been abrogated without so much as a public hearing!"

While doctors normally wait five minutes after the heart has stopped before pronouncing death, more and more doctors are shortening the wait period to maximize the quality of the organs. Surgeons at the Children's Hospital in Denver, Colorado wait only 75 seconds after infants' hearts stop beating before removing the heart for transplant, according to the Post. The demand for usable organs is a powerful incentive to push back the ethical boundaries of harvesting policies, say alarmed physicians.

"A lot of us are not particularly happy about cutting that line particularly
close," said Gail A. Van Norman, an anesthesiologist and bioethicist at the
University of Washington in Seattle.

"It's worrisome when you stop thinking of the person who is dying as a patient but rather as a set of organs, and start thinking more about what's best for the patient in the next room waiting for the organs."

While the National Academy of Sciences' Institute of Medicine approved the practice as ethical so long as strict guidelines are followed, opponents say it is difficult to ensure patients are not being killed by over-eager harvesting, particularly in pediatric situations. Van Norman and others said the practice could put pressure on families to stop care prematurely, especially when doctors and nurses are caring for both the potential donor and potential recipient.

David Crippen, a University of Pittsburgh critical-care specialist, told the Post he is concerned the changing definition of death will eventually lead to organ harvesting from the disabled.

"Now that we've established that we're going to take organs from patients
who have a prognosis of death but who do not meet the strict definition of
death, might we become more interested in taking organs from patients who
are not dead at all but who are incapacitated or disabled?"