Vital Organ Donation II

May 25, 2011 09:00 AM

Paul A. Byrne, M.D.

Part II (continued from yesterday)

Dead or “brain dead?” What’s the difference?

If you were to compare a dead body with a “brain dead” body, you would find that the dead body is pale, cold, stiff, and unresponsive. There is no heartbeat, no body functions, no breathing, and no movement. A “brain dead” body is warm and flexible. There is a beating heart, normal color, temperature, and blood pressure. Most functions continue, including digestion, excretion and maintenance of fluid balance with normal urinary output. The body will often respond to surgical incisions. In a long enough period of observation, someone declared “brain dead” will show healing and growth, and will go through puberty if they are a child.

There have been numerous instances of pregnant women with head injuries declared “brain dead,” yet with careful medical management they have been able to carry the child to birth. In the longest recorded instance, the child was carried for 107 days.

In other cases, during the excision of vital organs, doctors find they need to use anesthesia and other drugs to control muscle spasms, blood pressure and heart rate changes, and other bodily protective mechanisms common in live patients.

Hospitals allow “brain-dead” patients to occupy a bed; insurance companies cover expenses as they do for other living patients. If the patients’ organs are suitable for donation, any transfer of the patient to another hospital is covered by insurance. If they are used for teaching purposes or vital organ donation, they (the “brain-dead” patients) receive life support procedures, antibiotics and other drugs, or anything else necessary to maintain their organs in a healthy state. Insurance also covers this.

Interestingly, in cases of suspected homicide, attorneys hesitate to file charges until the patient is truly dead, even if the patient has been declared “brain dead.” But in the meantime, if someone else would act to “finish the job,” this “new aggressor” could possibly be held or prosecuted for murder, since the patient is alive, but legally “brain dead.” Other discussion with legal experts suggest that since the victim is legally dead, the case for murder by the second assailant would not be tenable since the victim is already legally dead. However, the second assailant could be liable for intent to mutilate the “corpse,” which in some jurisdictions is the property of the victim’s family.

Legally “brain dead” patients are considered corpses or cadavers, and are called such by organ retrieval networks. The corpses can be used for teaching, for trying out new procedures, and for vital organ harvesting. Yet these same “corpses” are carrying preborn children to successful delivery. Certainly this is extraordinary behavior by a “cadaver”!

It appears that “dead” is not the same as “brain dead.” So if “brain dead” persons aren’t dead, what are they?

More moral dilemmas created by the existing flawed neurological criteria for death

Sometimes a potential organ donor does not meet the criteria for “brain death,” but has sustained certain injuries or has an illness suggesting that death will occur soon. Such cases brought about the development of “Non-heart-beating (so-called) donation” (NHBD) and more recently labeled Donation by Cardiac Death (DCD) in which treatments considered extraordinary means, such as mechanical ventilation, are discontinued and certain drugs are used to lower the blood pressure and cause the patient to be pulseless. As soon as the patient is pulseless (not necessarily without heartbeat), death is declared, and after 5, 2 or 1.75 minutes, which varies in different institutions, the body could still be resuscitated to restore cardiac and respiratory activity. This cannot be accomplished in the remains of someone who is truly dead. 

It seems clear that in certain cases we are playing games with human lives for utilitarian gain. So glaring is the reality of this issue that there are those who now argue that doctors should not be burdened with determination of death criteria, since the good of organ donation outweighs the harm (killing) done to the donor. Scary, isn’t it?

Government involvement

The federal government is deeply involved in transplant programs for reasons that are unclear. A federal mandate issued in 1998 states that physicians, nurses, pastors, and other health care workers may not speak to a family of a potential organ donor without first obtaining approval from the regional organ procurement organization (OPO). If there is the possibility of vital organs available for transplant, a trained “designated requester” visits with the family first, even if the family adamantly opposes organ donation. If someone at the hospital speaks to the family first, the hospital risks losing its accreditation and/or federal funding.

Why the “designated requester”? Studies show that these people have greater success obtaining permission for organ donation. They’re trained to sell the concept, using emotionally-laden phrases such as “gift of life,” “your loved one’s heart will live on in someone else,” and other similar platitudes, all empty of any true meaning.

Where does the money go?

The donation and transplant industry costs billions of dollars a year, according to several sources (e.g., a 1996 series by Forbes magazine.) But it’s difficult to obtain financial data. One thing is clear: donor families do not receive any monetary benefit from their “gift of life.”

Something to think about

Based on what you’ve just read, take a moment to ponder the following:
Why can health insurance cover intensive care costs on “brain dead” patients?
Why do “brain dead” patients often receive intravenous fluids, antibiotics, ventilator care, and other life support measures?
Why is it wrong to tell families their “brain-dead” loved one is dead?
Why do “brain-dead” organ donors often receive anesthesia and other drugs to stop natural physical responses when they’re undergoing vital organ harvesting?
How can “brain dead” patients have normal body functions, including vital signs, if they are truly dead?How can a “brain-dead” pregnant mother deliver a normal, healthy infant?
Why does a ventilator work on a “brain-dead” person, but not on a cadaver?
Why is it wrong to carry out burial or cremation of a “brain-dead” person?
Are “brain-dead” persons really dead?
Are they alive?

But it is not up to us to decide who does not have the right to live . . . and who must die!

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 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.

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