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Vague Criterion of "Brain Death" Leaves Potential Donors Clueless that They Donate While Alive

 ORGAN DONATION — Vague Criterion of "Brain Death" has Blinded Potential Donors to the fact that their organs are often harvested while they are still alive

Shock: Oxford Neonatologist Says Time Has Come to Consider “Mandatory Organ Donation”
Also suggests that “donor death” criteria for organ donation should be abandoned
 According to Dr. Julian Savulescu, the Uehiro Chair of Practical Ethics at the University of Oxford, and neonatologist and Oxford graduate student Dominic Wilkinson, bold steps may have to be taken to increase the supply of organs for transplant.  This, they say in a co-authored article published today, could be accomplished by removing one simple impediment – the requirement of donor "death." In a separate article, published last week, Wilkinson suggested an even more radical plan – mandatory organ donation.

"We could abandon the dead donor rule," wrote the pair in today’s article, published on Oxford’s Centre of Practical Ethics’ website. "We could for example, allow organs to be taken from people who are not brain dead, but who have suffered such severe injury that they would be permanently unconscious, like Terry Schiavo, who would be allowed to die anyway by removal of their medical treatment."

Romanian-Australian professor Savulescu's most recent statements are entirely of a piece with his outspoken advocacy of the most controversial forms of human manipulation, including genetic screening, cloning, human/plant or human/beast hybrids, and the use of performance enhancing drugs for athletes. Savulescu, a proponent of the most radical form of utilitarian ethics, told the Sydney Morning Herald in August that when he was a young doctor he was a “believer,” until he encountered an unsettling image of death in the form of a corpse. 

"That, for me, just made the meaninglessness of death extremely vivid," he said.  "You think there's something beautiful and peaceful about death. There's not. People's mouths are sewn together." 

He then left medicine to complete a Ph.D. on "good reasons to die," reported the Herald.

Savulescu and his protégé, graduate student Dominic Wilkinson, published the article in response to the concerns raised by Australian Dr. James Tibballs that under the current “brain death” criteria, most donors will actually surrender their organs while they are still alive. (http://www.lifesitenews.com/ldn/2008/oct/08102105.html)

In doing so the Oxford scholars have joined the small but influential chorus of organ donation proponents who have downplayed the doctor's statements, complaining they would stem the flow of organs from donors, who may begin to think twice about signing that donor card.

Wilkinson also published a solo article on October 20, in which he not only suggested the removal of the death criteria for organ donation, but also the criteria of consent.

One solution to the perceived dearth of donated organs, Wilkinson says, is to simply give patients the option to donate their organs before death.  Another alternative: remove the superfluous requirement of choice. "We may come to think that the benefit of organ donation is so great that we should reject the current charade of informed consent for organ donation," wrote Wilkinson. 

“After all, at present thousands of patients per year die for want of an available organ. Yet every day potentially life-saving organs are buried or burned because their owners did not make their wishes clear during life, because their families could not come to terms with the idea of donation, or because doctors failed to approach families to ask them for permission.

"Consent is relevant to what happens to us while we are alive. But once we are dead, our organs cannot benefit us, while they could save the lives of up to 6 others. Perhaps it is time to contemplate mandatory organ donation after death?" 

Wilkinson says that he agrees with Tibballs that the precise moment of death is a "fiction," and calls upon the medical community to "change the moment of death" and "move the definitional point of death slightly earlier into the dying process to account for his [Tibballs'] worries."

In the more recent article, the one co-authored with Savulescu, the authors claim that Tibballs' concern that patients are being dissected alive are irrelevant.  "Whether or not this is true," they write, "there is no dispute on one issue: organs are not being taken from people who would have lived if their organs had not been taken."

Not all agree with this statement, however.  An increasing number of doctors and bioethicists, including Tibballs, are becoming alarmed at evidence pointing to the routine evisceration of patients that might have recovered. LSN has in the past reported numerous cases in which organ donors were found to be alive only moments before dissection, often making a complete recovery.  (http://www.lifesitenews.com/ldn/2008/mar/08032709.html; http://www.lifesitenews.com/ldn/2008/jun/08061308.html)

Savulescu and Wilkinson, however, also take into consideration this objection by suggesting that people who have merely "a low chance of any meaningful recovery" could still be eligible for organ removal.

Conservative bioethicist Wesley J. Smith responded to Wilkinson’s original article, saying, "I believe and hope that this remains a minority view."

"But the fact that it is considered a matter of respectable discourse is cause for concern."

To read the original articles see:

Death Fiction and Taking Organs from the Living
http://www.practicalethicsnews.com/practicalethics/2008/10/death-fiction-a.html#more

The Paradox of Organ Donation Consent
http://www.practicalethicsnews.com/practicalethics/2008/10/the-paradox-of.html

See related LifeSiteNews.com coverage:

Melbourne Doctor: Most Donors Still Alive when Organs are Removed
http://www.lifesitenews.com/ldn/2008/oct/08102105.html

New England Journal of Medicine: 'Brain Death' is not Death
http://www.lifesitenews.com/ldn/2008/aug/08081406.html

Doctors Who Almost Dissected Living Patient Confess Ignorance about Actual Moment of Death
http://www.lifesitenews.com/ldn/2008/jun/08061308.html

Doctor Says about "Brain Dead" Man Saved from Organ Harvesting – "Brain Death is Never Really Death"
http://www.lifesitenews.com/ldn/2008/mar/08032709.html

Denver Coroner Rules "Homicide" in Organ-Donor Case
http://www.lifesitenews.com/ldn/2004/oct/04101208.html

Russian Surgeons Removing Organs Saying Patients Almost Dead Anyway
http://www.lifesitenews.com/ldn/2003/sep/03090906.html
[24Oct08,Kathleen Gilbert,OXFORD, UK, www.LifeSiteNews.com]

Melbourne Doctor: Most Donors Still Alive when Organs are Removed. A prominent Melbourne doctor has written that, contrary to popular belief, most organ donations take place before the donor is actually dead.

He argues that the vague criterion of "brain death" has blinded potential donors to the fact that their organs are often harvested
while they are still alive.

Pediatric intensive care specialist

Dr. James Tibballs published his controversial views in the Journal of Law and Medicine earlier this month, calling upon medical institutions to review their organ harvesting guidelines to ensure that donors know that they may be volunteering to surrender their life on the operating table.

Tibballs points out that current medical practices usually contravene the law, which state that a donor must display irreversible cessation of all functions of their brain or of blood circulation in order to be eligible for the surgery. Australian doctors, however, usually wait only two minutes after a heart has stopped beating before giving the green light for harvesting, said the pediatric specialist.

But Tibballs says two minutes is inadequate time to determine whether the loss of circulation is "irreversible." The two minutes criterion was established purely for utilitarian reasons, he says – because waiting longer could threaten the viability of donated organs.

"It could be troubling for the public to realise that doctors looking out for organ donors are also the ones formulating guidelines on how to declare death for organ transplantation," observed Tibballs.

"For this reason, there should be members of the community and people with legal backgrounds on the committee that create these clinical guidelines used to declare someone dead."

Organ donor groups have criticized Tibballs' article, expressing concern that it may cause donors or potential donors to reconsider their commitment.

"This could be very damaging to public confidence of brain death diagnosis, because a lot of people might say, 'we don't believe in this any more,' and as a consequence, people might die on waiting lists," said Bill Silvester, the medical director of LifeGift.

Dr Gerry O'Callaghan also dismissed Tibballs' ideas, claiming that donors should be confident that a brain death diagnosis always means true death. "There is no possibility that they would be conscious, that they would have the capacity to feel pain, that they have the capacity for independent life," he said.

However, although Tibballs' opponents stress that his opinions are in the minority, there has been growing concern about aggressive organ harvesting policies that fail to ensure that the patient is actually dead.

LSN has reported several recent cases in which patients deemed "brain dead" resuscitated only moments before their organs were to be removed. Such cases have brought more evidence to the table showing that the highly contested definition of "brain death," and the later idea of "cardiac death," do not eliminate the possibility that donors may yet recover from seeming lifelessness.

LSN published the story in June of a French man who, after suffering cardiac arrest for at least ninety minutes, was being prepared for organ removal when doctors noticed the patient breathing, his pupils dilating, and the patient reacted to pain. Within weeks, the patient that had been considered "brain dead" was walking and talking. (http://www.lifesitenews.com/ldn/2008/jun/08061308.html)

In another example, earlier this year 21-year-old Zack Dunlap was spared from dissection when a relative saw him react to touch minutes before he was scheduled to have his organs removed. Zack was originally deemed eligible to donate his organs when doctors could detect no blood flow to his brain. He later said, however, that he could hear the doctors pronouncing him dead as he lay seemingly unconscious. (http://www.lifesitenews.com/ldn/2008/mar/08032709.html)

In his article "Organ Donation: The Inconvenient Truth," LSN medical advisor Dr. John Shea reveals the disturbing similarity between these "miraculous" cases and other organ donors whose surgeries were successful:

"Some form of anesthesia is needed to prevent the donor from moving during removal of the organs. The donor's blood pressure may rise during surgical removal. Similar changes take place during ordinary surgical procedures only if the depth of anesthesia is inadequate. Body movement and a rise in blood pressure are due to the skin incision and surgical procedure if the donor is not anesthetized.

"Is it not reasonable to consider that the donor may feel pain? In some cases, drugs to paralyze muscle contraction are given to prevent the donor from moving during removal of the organs. Yet, sometimes no anesthesia is administered to the donor. Movement by the donor is distressing to doctors and nurses. Perhaps this is another reason why anesthesia and drugs to paralyze the muscles are usually given."

Dr. Paul Byrne, an expert in organ donation and neonatologist, has continuously fought against policies and practices that put donors at extreme risk for being pronounced dead prematurely in order to lay hold of their organs.

"Brain death was concocted, it was made up in order to get organs. It was never based on science," Dr. Byrne told LSN.

Last month, LSN reported that the Vatican is currently reconsidering its stance on organ donation. Vatican medical advisors are in a heated debate over the ethical standing of brain death and organ donation, which may or may not be resolved before the Vatican conference promoting organ donation scheduled for November. (http://www.lifesitenews.com/ldn/2008/sep/08090513.html)

Related:New England Journal of Medicine: 'Brain Death' is not Deathhttp://www.lifesitenews.com/ldn/2008/aug/08081406.html

Doctors Who Almost Dissected Living Patient Confess Ignorance about Actual Moment of Deathhttp://www.lifesitenews.com/ldn/2008/jun/08061308.html

Doctor Says about "Brain Dead" Man Saved from Organ Harvesting – "Brain Death is Never Really Death"
http://www.lifesitenews.com/ldn/2008/mar/08032709.html

Denver Coroner Rules "Homicide" in Organ-Donor Case
http://www.lifesitenews.com/ldn/2004/oct/04101208.html

Russian Surgeons Removing Organs Saying Patients Almost Dead Anyway
http://www.lifesitenews.com/ldn/2003/sep/03090906.html
[21oCT08, Kathleen Gilbert,MELBOURNE, Australia, WWW.LifeSiteNews.com]