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Jewish World Review Feb. 22, 2008 / 16 Adar I 5768 Organs harvested before their time By Drs. Michael A. Glueck & Robert J. Cihak http://www.JewishWorldReview.com | 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. Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here. Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here. Archives © 2007,

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