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The Inconvenient Truth About Organ Donations
Truthfulness in transplantation: non-heart-beating organ donation: Commentary Abstract


The Inconvenient Truth About Organ Donations: Physician sounds alarm about unethical or at least highly questionable practices of organ transplant industry

There has been growing concern over the past several years about increasingly aggressive measures undertaken to harvest human organs from dying patients.

Dr. John, Shea, a Toronto physician who has specialized in researching the issue, has just completed a report, Organ Donation: The Inconvenient Truth, that sounds an alarm about the unethical or at least highly questionable practices of the organ transplant industry.

Dr. Shea reports on the modern and still very unsettled definition of "brain death" used by many organ transplant physicians to justify declaring organ donors dead and therefore fair game for immediate organ harvesting .  

Shea points out, "There is no consensus on diagnostic criteria for brain death. They are the subject of intense international debate. Various sets of neurological criteria for the diagnosis of brain death are used. A person could be diagnosed as brain dead if one set is used and not be diagnosed as brain dead if another is used." It depends on what hospital or which doctor is involved in a particular case. 

In fact, says Shea, "A diagnosis of death by neurological criteria is theory, not scientific fact. Also, irreversibility of neurological function is a prognosis, not a medically observable fact."  

The coldly utilitarian goal of promoting the acceptance of brain death, says Shea, "is to move to a society where people see organ donation as a social responsibility and where donating organs would be accepted as a normal part of dying." In fact, he says, the specific wishes of a donor opposed to having his organs removed would be bypassed by putting skilled pressure on surviving family members to approve the organ removal.
The apnea test, or removal of a ventilator, that is often used to determine brain death, says Dr. Shea, is the thing that often ends up killing the patient. "The test", he reports, "significantly impairs the possibility of recovery and can lead to the death of the patient through a heart attack or irreversible brain damage."
Shea reveals there are some preventive measures taken by organ removal teams that bring in to serious question whether their donor body, kept functioning through artificial means to preserve the organs, is really, fully dead.
"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."
Since the definition of brain death was invented in the late 1960s "as a means for the moral validation of the retrieval of human organs for transplant", says Shea, the demand for organs has increasingly exceeded supply and so a new definitions of death had to be created to help meet the demand. The concept of "cardiac death" was developed but this also has serious ethical challenges and test measures that also kill a possibly still alive patient.
Another "ominous and disturbing development" is the recent recruitment of palliative caregivers by the organ harvesting industry. "Those care givers" says Shea, "In effect… are to be the agents of a soft-sell program to make the family 'feel comfortable and supported during this extremely difficult time.'"
Shea covers the changing Vatican debate on these end of life issues and the need for more definitive and better informed direction from the Church on the issues. An Italian researcher is quoted stating, "The concern of many is that the Vatican has not taken the appropriate position when doubts exist about the end of human life."
Organ donation: The inconvenient truth contains many references to support its statements and is a timely paper on the human transplant trend that is fast becoming ethically out-of-control. Many political jurisdictions are considering radical legislative measures, such as presumed consent, without being fully aware of the major ethical dilemmas related to organ transplants. Most are not aware, for instance, that organs are often taken from persons who are likely, in many ways, still alive.
To view the complete article, Organ donation: The inconvenient truth: ; HTML version ; pdf version
See related: More Hospitals/Governments Push For Organ Transplants 5 Minutes or Less After Heart Stops
Organ Transplant Doctor Investigated in Non-Heart Beating Donation Case
Surgical Preparation For Organ Donation For Non-Brain Dead Patients?: Australia
UK Chief Medical Officer Pushes for Automatic Organ Donation
Ontario NDP Introduces Organ Donor Bill Which Presumes Consent of all Dying
Deaths now Automatically Reported to Organ Donation Program
Organ Donation after Cardiac Death a Danger to Critical Patients ~ Medical Professor
[By Steve Jalsevac, September 19, 2007 (]


Truthfulness in transplantation: non-heart-beating organ donation: Commentary Abstract

The current practice of organ transplantation has been criticized on several fronts.
The philosophical and scientific foundations for brain death criteria have been crumbling.

In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit. < br />

Verheijde, Rady, and McGregor attack the deception involved in NHBD, arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent.

Such honesty about NHBD should be welcomed.

However, NHBD violates a fundamental end of medicine, non-maleficience, "do no harm."

Physicians should not be harming or killing patients, even if it is for the benefit of others.

Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

[24 August 2007, Philosophy, Ethics, and Humanities in Medicine 2007, 2:17     doi:10.1186/1747-5341-2-17,, Michael Potts. The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.]