By: Paul A. Byrne, M.D.
You’ve probably seen TV commercials, billboards, and magazine articles encouraging you to give the “gift of life” through vital organ donation. It saves lives. It gives meaning to a wasteful, tragic death. But before you fill out an organ donor card, here are a few things to think about.
Vital organs (from the Latin vitae, meaning “life”) are those organs like the heart, liver, lungs, and pancreas, which are necessary for life. In order to be suitable for transplantation, they need to be removed from the donor before respiration and circulation cease. Otherwise these organs are not suitable, since damage occurs within a brief time after circulation of blood with oxygen stops. Removing vital organs from a living person prior to cessation of circulation and respiration will cause the donor’s death.
Portions of some vital organs can be removed without causing death of the donor, e.g., one of two kidneys, a lobe of a liver, a lobe of a lung. But other vital organs, like the heart, cannot be removed without killing the donor. Both donor and recipient must be fully informed about procedures and risk of death and effect on length of life and health of donor. Organ explantation ought not to cause death or disabling mutilation of the donor.
Since vital organs are not useful for transplantation once the person is truly dead, and taking them before true death causes true death, is it possible to donate vital organs? Organs deteriorate rapidly without oxygen; the heart and liver in 4-5 minutes are so damaged. Thus, there is no way to transplant a heart or whole liver because there is not enough time without circulation to get these organs out. The time without circulation before deterioration of kidneys is about 30 minutes. Thus, it is possible to get kidneys out within this timeframe, but nothing can be done to the donor to initiate or facilitate transplantation prior to true death that might hasten death. Potential donors and potential recipients must be fully and explicitly informed in order to give informed consent or to decline. Kidney function in everyone decreases about 1 percent per year from a maximum at age 20 to about 50 percent of this by age 70. Potential donors and recipients must be fully informed of this.
Pope Benedict XVI taught on November 7, 2008, “Individual vital organs cannot be extracted except ex cadaver” (Pope Benedict used Latin to avoid any question; English: from a dead body). “The principle criteria of respect for the life of the donator must always prevail so that the extraction of organs be performed only in the case of hiss/her true death.” (Cf. Compendium of the Catechism of the Catholic Church, n, 476). This teaching is certainly helpful to Catholics but it is also helpful to everyone as organ transplantation is contemplated.
That’s where “brain death” comes in
Before 1968, a person was dead only when breathing and the heart stopped. In the 1950s and ‘60s when surgeons developed the ability to transplant vital organs, the medical community faced a legal and ethical dilemma: vital organs must be taken from a living body, but removing vital organs will cause death.
In 1968, a committee at Harvard Medical School formulated an alternate definition of death: “brain death.” They decided that when certain criteria are fulfilled (for example, no response, coma, and need for a ventilator to support breathing), the patient can be declared “brain dead.” Even when the heart is pumping and the lungs are oxygenating blood, vital organs could be removed without legal or ethical consequences.
In 1980, the Uniform Determination of Death Act (UDDA) was approved. According to the UDDA, death may be declared when a person has sustained either “irreversible cessation of circulatory and respiratory functions” or “irreversible cessation of all functions of the entire brain, including the brain stem.” Since then all 50 states consider cessation of brain functioning to be death.
Moreover, between 1968 and 1978, more than 30 different sets of criteria for “brain death” were adopted in the United States and elsewhere. Thus, if a hospital has a potential donor, the doctors at the hospital can choose which criteria for determining brain death will best suit its current need.
Read tomorrow for part II of this commentary on organ donation.
The original article has been reprinted with permission and can be found at http://www.renewamerica.com/article/070808. It has been recently updated by the author.
Dr. Paul Byrne has been a practicing physician for 54 years. He is Board Certified in pediatrics and neonatology, and is a Clinical Professor of Pediatrics at the University of Toledo, College of Medicine. He has written numerous articles on life issues in medical and law journals, as well as lay literature on topics including abortion, "brain death," organ transplantation and imposed death.