Will you be "harvested" before your time? "What? Me be harvested?" you might
rightfully be wondering.
Given recent reports and the incentives involved, it's likely that some
doctors are indeed taking persons' organs from their bodies before death.
The goal of saving lives (in this case, by transplanting organs) is
praiseworthy, but the means to this end involve potentially tragic dilemmas.
Killing innocent people in an attempt to help other people was one form of
Nazi experimentation. The ends do not justify the means.
Before a dead person's organs can be harvested for transplanting, the person
must be dead. Because solid internal organs (such as the kidneys, liver and
heart) deteriorate rapidly after death, transplant doctors want to have an
expeditious diagnosis of death so they can morally remove a dead person's
organs for transplanting.
In most cases, doctors make a diagnosis of brain death before organs are
taken for transplanting. In fact, the diagnosis of brain death was created
to allow expeditious organ harvesting.
Brain death is defined as "irreversible coma with absent brainstem reflexes
(such as reactions of the pupils to light and other 'automatic' reflexes)."
Yet, "irreversible" implies that doctors can predict the future of a patient
in coma; but medical science hasn't reached this degree of perfection. In
newspapers as well as in medical books and journals, I've read about many
patients who seemed to be in a permanent coma but who then woke up days,
months, or even years after doctors incorrectly make the diagnosis of
irreversible coma.
Likewise, "absent brainstem reflexes" simply means that the brainstem isn't
working properly and generating electrical impulses. But this can be due to
what I would call "sleeping" brain cells. Damage to the cells (for example,
from lack of oxygen or nutrients) can make them temporarily too weak to
generate nerve impulses or EEG signals. With reversal of the damaging
condition, the brain cells often heal and resume normal function.
For example, my own mother suffered an oxygen shortage (hypoxia) to her
brain several years ago. Her lungs filled with fluid (pulmonary edema) which
kept the lungs from absorbing oxygen into her blood, resulting in brain
hypoxia. As a result, she was comatose for some days but recovered
completely within two months.
Other diagnostic factors such as "low body temperature (hypothermia),
sedative or paralytic medicines, or the presence of severe metabolic
disorders . . . might confuse the diagnosis of brain death." according to
Doctors Steven Laureys and Joseph J. Fins writing in an editorial in the
January issue of the medical journal Neurology.
"There are substantial differences in practice that may have consequences
for the determination of death and initiation of transplant procedures," Dr.
David M. Greer, at the Massachusetts General Hospital in Boston, and
colleagues conclude in their article "Variability of brain death
determination guidelines in leading US neurologic institutions" in the same
issue of Neurology. "Major differences exist in brain death guidelines among
the leading neurologic hospitals in the United States."
In addition, different doctors weighted these factors differently in making
a brain death diagnosis. Different hospitals also did diagnostic tests
somewhat differently.
"Hospitals vary widely in determining brain death" headlined a Jan. 25
Reuters article. Dr. James L. Berna from Dartmouth Medical School in
Hanover, New Hampshire, described a "disturbing pattern of non-uniformity."
Does this mean an organ harvest could be premature? Other neurologists
certainly think so.
In an internet report on Dr. Greer's findings, neurologist Lawrence Huntoon,
M.D., Ph.D., editor-in-chief of the "Journal of American Physicians and
Surgeons" writes, "In plain, straight talk, the survey indicates a high
likelihood that some patients are being 'harvested' in some hospitals before
they are dead! In hospitals with aggressive transplant programs (hospitals
make a huge amount of money on transplant cases), making sure a patient is
dead before going to the 'harvesting suite' may be viewed as a minor
technicality" (http://www.aapsonline.org/newsoftheday/0010 "Top hospitals
typically disregard brain-death guidelines").
On the same Web site, Neurologist Liz Kamenar commented, "I made detailed
outlines for Brain Death criteria available for the ICU [Intensive Care
Unit] but they weren't followed even by my own colleagues. The criteria are
quite complex and sometimes difficult to do. I was pressured into not 'going
by the book' by the Organ Procurement Team. They thought I was working
against them. They were more concerned about procuring good organs rather
than meeting the criteria for Brain Death."
Doctors Laureys and Fins also write, "doctors need to make all efforts to
make sure there is no consciousness left." Alas, by definition, this is an
impossible task. Consciousness is self-experience; no possible medical
examination or test can diagnose its absence. The "locked-in" state is one
example of this difficulty.
Leaving the guidelines up to each hospital indicates a lack of universal
guidelines, even within America.
Many transplants (such as blood transfusions, bone marrow transplants, adult
stem cell treatments, skin grafts, and living kidney transplants) don't
require the death of the donor; these fruitful medical innovations are not
at issue here.
The ghoulish possibilities inherent in the haste needed for these other
organs disturb me. Dr. Jane Orient's novel "Neomorts"
(http://www.janeorient.com/Neomorts.htm) portrays the tragic and dystopian
results possible.
To make sure your personal wishes are honored, you can establish an Advanced
Health Care Directive (AHCD), and a living will in addition to a Last Will
and Testament.
It's a very good idea to designate an agent for healthcare, to make
decisions on your behalf when you're unconscious or aren't able to do so
yourself. The International Task Force on Euthanasia and Assisted Suicide
(ITF) http://www.internationaltaskforce.org/ has very lucid Advanced Health
Care Directive language adapted the meet the requirements of different
states.
No law or person should demand the life of an innocent person, under any
pretext. Whether a person is unborn, disabled or extremely ill, I believe
life is sacred and is our most fundamental right.
Editor's Note: Robert J. Cihak wrote this week's column.
