Treatment Concerns - Definitions / Living Wills / Palliative Care / Terminal or Excessive Sedation / Organ Donation / DCD or NHBD / Hospice / POLST / DNR

Stop Harvesting Organs after ‘Cardiac Death,’ Say MDs (2010)

A group of doctors have called on the medical community to cease harvesting organs from patients whose hearts have stopped pulsating, saying that doctors are misleading families to believe that the patient has died when in fact their loved one is still alive.

The story was featured in 2010 on the cover of Canada’s National Post.

“A longstanding tenet of ethical organ donation [is] that the nonliving donor must be irreversibly dead at the time of donation,” explain the eight paediatric intensive care specialists, writing in Pediatric Critical Care Medicine.

The doctors say that the public’s “underlying assumption” when they agree to donate organs is that “they are giving permission to have their organs removed after they are dead.”

But the authors observe that “death” has been redefined in the last few decades to meet the demand for more organs. They say organs were originally taken from “cadaveric donors who died in the conventional way, irreversibly losing all electrical and mechanical activity from the heart (circulation) and all brain function, despite medical efforts to save them.”

But “this method of organ procurement created a problem for organ transplantation.” “If the patient died in the conventional way then, at the time of irreversibility, so did most organs.”

The notion of “brain death” was created in 1981 in order to harvest more organs, they say. Then in 1991 the Pittsburgh Protocol was developed to allow doctors to harvest the organs of adults after a person’s heart has stopped for a certain period.

The Protocol involves removing the person from life support for 30 to 60 minutes. If the patient’s heart continues to beat after that time, they are returned to the ICU, but if it stops for a prescribed period (around 2 minutes, though ranging from 75 seconds to 10 minutes depending on the jurisdiction), the organs are harvested.

“No efforts are made to assess the patient’s brain function at the time of organ removal,” the authors explain. “The claim is that circulation has irreversibly stopped after 2 mins of observation.”

But this ignores the many reports of the “Lazarus phenomenon,” where a patient’s heart starts again 5 to 10 minutes after CPR is performed. Such instances suggest that “the heart function and circulation may not be irreversibly stopped in DCD [‘Donation after Cardiac Death’] patients at the time of organ procurement.”

The authors also point out that doctors’ desire to prolong lives through organ transplants can “foster physician and institutional bias” for the cardiac death criteria.

While opposing the notion of “cardiac death”, the authors accept organ harvesting following “brain death”. Opponents of “brain death” point out that organs can only be harvested when the organ’s functioning continues, meaning that the donor is still showing signs of life.

They say that if the person is truly dead, the unpaired vital organs cannot be transplanted. In particular, “brain death” has allowed heart transplants, but the heart is only useful if it is still beating in the donor.

Akin to the “Lazarus phenomenon” noted by the authors, there have been numerous instances of patients recovering following a declaration of “brain death”.

The National Post interviewed Dr. Ari Joffe, the sole Canadian author of the controversial document, from Stollery Children’s Hospital in Calgary. “I think that we’re being less than entirely honest about when the patient is truly dead,” he said. “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?’”

See related coverage:

Melbourne Doctor: Most Donors Still Alive when Organs are Removed

New England Journal of Medicine: ‘Brain Death’ is not Death

Doctors Who Almost Dissected Living Patient Confess Ignorance about Actual Moment of Death

Doctor Says about “Brain Dead” Man Saved from Organ Harvesting – “Brain Death is Never Really Death”

Denver Coroner Rules “Homicide” in Organ-Donor Case

Russian Surgeons Removing Organs Saying Patients Almost Dead Anyway
[15 Sept 2010, Patrick B. Craine, CALGARY, Alberta, ; ALL Pro-LIfe Today, 16 Sept2010]