At times, it seems as though I’m one of just a few voices in medicine expressing concerns about the organ transplant industry. So, I was pleased to come across a very insightful article recently in The Journal of Medicine and Philosophy about the industry’s troubling ethics (or lack thereof).
The crux of the problem stems from how we determine the exact point in time at which a person is declared dead. The transplant industry wants to set that point in time as early as possible—allowing them to remove organs while they’re most viable.
But the only way to know for certain if a person has truly died is to wait for all brain function to completely and irreversibly cease. And sometimes, that takes a while.
In fact, up until 100 years ago, bells and other devices were installed in or outside of coffins in case a misdiagnosed and prematurely buried person suddenly “woke up” from the dead, so to speak. And it happened all the time.
Big difference between being legally dead and being “brain dead”
According to today’s forensic medical standards, “death” only occurs after complete and irreversible cessation of breathing and blood circulation. At that point, clear post-mortem signs begin to appear, including bluish discoloration, coldness, and stiffness, which leads to algor, livor, and rigor mortis. (I studied these changes and published a book called Post-Mortem Change in Human and Animal Remains: A Systematic Analysis.)
But transplant teams want to take organs while they’re still receiving blood, oxygen, and nutrients from the normal circulation. Which means they don’t wait for the complete and irreversible cessation of breathing and circulation.
In fact, organ transplants today can happen as soon as a patient is declared “brain dead.”
The problem is…
The process of declaring a patient “brain dead” relies on vague, outdated criteria established 50 years ago by a Harvard University committee.
And in the 50 years since the Harvard committee established those broad guidelines, we’ve seen significant advancements in the treatment, restoration, and rehabilitation of patients who, at one point, had been declared brain dead. But the criteria for declaring a patient “brain dead,” unfortunately, hasn’t changed to reflect these advancements.
There’s too much grey area in the definition of “brain death”
A person can be declared “brain dead” when their heart is still beating—which the brainstem controls.
But that stipulation makes no sense. How can someone be legally “brain dead” when their brain is still telling their heart to beat?
We would never bury a “brain dead” person with a still-beating heart (except in a grisly and macabre tale from Edgar Allen Poe). So, why are we allowing their vital organs to be removed with a still-beating heart…a normal pulse, blood pressure, normal color, normal temperature, and other normal vital signs of life?
Surgeons administer paralyzing drugs to “brain dead” patients to prevent muscular movements during organ harvesting. And when the body is cut open, the heart rate increases and blood pressure skyrockets as a normal physiologic reaction to the pain!
The brain stem controls these normal reactions. But according to a legal definition of “brain death,” no part of the brain should still be functioning…including the brain stem.
Plus, I’ve come across cases where children who were declared “brain dead” continued to grow. There are also many documented cases of pregnant women declared “brain dead” carrying to term and delivering normal, healthy babies.
Last, and most alarmingly, there are a growing number of cases where people who had been declared “brain dead” suddenly wake up and recover. We are conveniently told that the diagnosis was “wrong,” when in reality, the standard of “brain death” is simply rife with contradictions. And it allows for way too much grey area—allowing for transplant physicians to move the needle.
Resist the pressure to become a donor until these serious issues are addressed
As I suggested earlier, the only way to tell whether a person is genuinely “dead”—or even completely “brain dead”—is to wait around and see if they wake up. Yet, doctors can’t simply wait around to see if a “brain dead” patient wakes up…because they’ll lose out on organ donations.
Well, one thing’s for certain…once they do remove their organs, the patient won’t ever wake up!
I remember Pope John Paul II stated that organ donation is an act of charity. But he also cautioned, “Nor can we remain silent in the face of other, more furtive, but no less serious and real forms of euthanasia. These could occur when, in order to increase the availability of organs for transplant, organs are removed without respecting adequate and objective criteria which verify the death of the donor.”
In the end, we must seriously question the validity of declaring a person “brain dead.” Particularly when that person is slated to become an organ donor. Or when a brain death determination is expediently made to justify stopping all life-support.
So, until we clarify and strengthen the criterion used to declare a person dead, or even “brain dead,” I must advise against signing up to become an organ donor. There’s just too much at stake.
“Are Brain Dead Individuals Dead? Grounds for Reasonable Doubt.” Journal of Medicine and Philosophy, 2016; 41 (3): 329-350. doi.org/10.1093/jmp/jhw003