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Interview with John B. Shea, M.D.

Dr. Shea states that ethical heart transplant is not yet possible because of difficulty of determining certain death

 With the Ontario Legislature entertaining a private members bill to institute presumed consent on organ donation, many questions are being asked on the matter. asked Dr. John B. Shea, an M.D. who has written extensively on the ethics of organ donation, questions submitted by readers…

Q. Is all organ donation morally questionable?  Which organs can be donated ethically?

A. No, non-vital organs may be donated.  The most common living organ donation are kidneys. The body has two kidneys and when one is donated the remaining kidney grows in size and capacity to compensate for the missing organ.

Furthermore a living donor may donate a part of a liver since the organ re-grows.  Also a living donor may donate part of a lung, or part of a pancreas.  While these organs do not re-grow, people are able to function with reduced capacity.

Q. What is the problem with some organ donations?

A. Following real death corneas and bone marrow can still be used.  However, organs such as the heart, lungs, pancreas and kidneys rapidly deteriorate after death and are not usable within a few hours.

The fundamental question is – is the person dead?  It is not ethical to harvest organs from living persons if it will result in their deaths.  That is true even if we don’t know for sure that the person is living or dead, as in the case of some people in coma and on life support.

Thus the answer to the question – is the person dead – is resoundingly that we don’t know in the case of ‘brain death’.

The debate centers on moral uncertainty.  If there is a doubt about the fact that a patient is dead, if it is not factually certain that the patient is not biologically dead. You can’t do anything that would hasten their death.  Analogously, a hunter must not shoot after seeing a bush rustling without being sure that there isn’t a person in the bush.

Q. What is brain death?

‘Brain Death’, is the most common determination of death prior to organ harvesting and involves the cessation of brain activity.  There is no general agreement that ‘brain death’ is in fact death.   The criteria for establishing ‘brain death’ varies from England to the US and through the other countries of Europe.  Moreover, the compliance with those criteria are not consistently applied.

The other criterion that has been applied to pronounce death for the purposes of organ harvesting is the case of non-heart beating organ donors.  Those donors are known not to be brain dead but are usually first in a coma and the doctor decides treatment is futile.

The typical scenario for such organ harvesting is a young person between the age of 5-55 who is in good health, is in intensive care due to an automobile accident and is on a ventilator.  The doctor makes an arbitrary decision that treatment is futile.  They take the patient off the ventilator and if the heart stops beating they sometimes wait a couple of minutes and then remove the organs.  They do not know how long a heart will stop beating and might recover again.

Q. Can there then be a legitimate heart transplant?

A.  The answer is no, since we have no agreement on determination of death soon enough to harvest the heart before its deterioration.
[, 17Feb06 By John-Henry Westen TORONTO, February 17, 2006 (