dead donor rule

I welcome Lawrence Masek’s response to my criticism of his journal article. I am sorry he didn’t appreciate my perspective, but I take nothing back.

Let’s start with a matter of little importance. Masek claimed I said his article would curl your toes. No, I wrote that I cover articles published in the professional journals because “some” of them would. Whether your digits react to his effort thusly is a matter for you to decide.

As to the substance of his rebuttal, Masek claims at great length that the dead donor rule, which forbids killing for organs, would also prohibit many common interventions in clinical medicine as “suicide.” He writes:

Permitting lethal organ procurement would enable patients to commit suicide by donating their vital organs, but the same is true of permitting lethal palliation and the refusal of life support.

This is verifiably untrue. Dying from a side effect of an ethical medical treatment like palliation is not suicide any more than a patient dying during heart surgery is euthanasia.

The “dead donor rule” (DDR) is a legal and ethical mandate that requires vital organ donors to be truly dead before their body parts are procured. A corollary to the rule holds that people cannot be killed for their organs. The DDR promotes trust in the system and protects the vulnerable — but is flexible enough to permit living donations of one kidney and parts of a liver from altruistic donors. Utilitarian bioethicists have long argued against the DDR and its corollary based on the notion that killing those who are dying or want to donate will relieve the suffering of people who want to live and need an organ. And here we go again. The Journal of Medical Ethics Read More ›

The “dead donor rule” is the cement that binds the public’s trust in organ transplant medicine. Under the DDR (other than in living donations, such as of one kidney) organs cannot be procured unless donors, in the words of the Munchkins, are not merely dead but really most sincerely dead.

There are two means of declaring death. Let’s call the first “heart death,” that is an irreversible cessation of all cardio/pulmonary function. The other is popularly known as “brain death,” (death declared by neurological criteria) in which function in the whole brain and each of its constituent parts have irreversibly ceased. The key word in both means of declaring death is “irreversible.”

But something appears to have gone badly off the rails in the field of procuring organs after heart death. A long New York Times expose found cases of patients who were clearly alive when organ procurement began. At the same time, a very disturbing report by the Department of Health and Human Services contained similar findings.

First, the NYT. From “A Push for More Organ Transplants Is Putting Donors at Risk”:

Last spring at a small Alabama hospital, a team of transplant surgeons prepared to cut into Misty Hawkins.…Days earlier, she had been a vibrant 42-year-old with a playful sense of humor and a love for the Thunder Beach Motorcycle Rally. But after Ms. Hawkins choked while eating and fell into a coma, her mother decided to take her off life support and donate her organs. She was removed from a ventilator and, after 103 minutes, declared dead.

A surgeon made an incision in her chest and sawed through her breastbone. That’s when the doctors discovered her heart was beating. She appeared to be breathing. They were slicing into Ms. Hawkins while she was alive.

The horror! Why are such awful things happening?