What you don't know can kill you!
August 8, 2007
Paul A. Byrne, M.D.
You've probably seen TV commercials, billboards, and magazine articles encouraging you to give the "gift of life" through vital organ donation. It saves lives. It gives meaning to a wasteful, tragic death. But before you fill out an organ donor card, here are a few things to think about.Vital organs (from the Latin vitae, meaning life) are those organs like the heart, liver, lungs, and pancreas that are necessary for life. In order to be suitable for transplant, they need to be removed from the donor before respiration and circulation cease. Otherwise, these organs are not suitable, since damage occurs within a brief time after circulation of blood with oxygen stops. Removing vital organs from a living person prior to cessation of circulation and respiration will cause the donor's death.
Portions of some vital organs can be removed without causing death of the donor — for example, one of two kidneys, a lobe of a liver, a lobe of a lung. But other vital organs, like the heart, cannot be removed without killing the donor.
Since vital organs are not useful once the person is dead, and since taking them causes death, how is vital organ donation possible?
That's where "brain death" comes in.
Before 1968, a person was dead only when his or her breathing and heart stopped. In the 1950s and 60s, when surgeons developed the ability to transplant vital organs, the medical community faced a legal and ethical dilemma: vital organs must be taken from a living body, but removing vital organs will cause death.
In 1968, a committee at Harvard Medical School formulated an alternate definition of death: "brain death." They decided that when certain criteria are fulfilled (for example no response, coma, and need for a ventilator to support breathing), the patient can be declared "brain dead." Even when the heart is pumping and the lungs are oxygenating blood, the committee decided that vital organs could be removed without legal or ethical consequences.In 1980, the Uniform Determination of Death Act, or UDDA, was approved by Congress. According to the UDDA, death may be declared when a person has sustained either "irreversible cessation of circulatory and respiratory functions" or "irreversible cessation of all functions of the entire brain, including the brain stem." Since then, all 50 states consider cessation of brain functioning as death.
Moreover, between 1968 and 1978, more than thirty different sets of criteria for "brain death" were adopted in the United States and elsewhere. Thus, if a hospital has a potential donor, the doctors at the hospital can choose which criteria for determining brain death will best suit its current need.
Dead or "Brain Dead?" What's the Difference?
If you were to compare a dead body with someone declared "brain dead," you would find that the dead body is pale, cold, stiff, and unresponsive. There is no heartbeat, no body functions, no breathing, and no movement. Someone declared "brain dead" is warm and flexible. There is a beating heart, normal color, temperature, and blood pressure. Most functions continue, including digestion, excretion, and maintenance of fluid balance with normal urine output. There will often be response to surgical incisions. In a long enough period of observation, someone declared "brain dead" will show healing and growth, and will go through puberty if they are a child.
There have been numerous instances of young pregnant women with head injuries declared "brain dead," yet with careful medical management they are able to carry the child to birth. In the longest recorded instance, the child was carried for 107 days.
In other cases, during the excision of vital organs, doctors find they need to use anesthesia and other drugs to control muscle spasms, blood pressure and heart rate changes, and other bodily protective mechanisms common in living patients.
Hospitals allow "brain-dead" patients to occupy a bed; insurance companies cover expenses as they do for other living patients. If the patients' organs are suitable for transplantation, any transfer of the patients to another hospital is covered by insurance. If they are used for teaching purposes or vital organ donation, they (the "brain-dead" patients) receive life support procedures, blood transfusions, antibiotics and other medications, or anything else necessary to maintain their organs in a healthy state. Insurance also covers all this.Interestingly, in cases of suspected homicide, attorneys hesitate to file charges until the patient is truly dead, even if the patient has been declared "brain dead." But in the meantime, if someone else would act to "finish the job," this "new aggressor" could possibly be held or prosecuted for murder, since the patient is alive, but legally "brain dead." Other discussions with legal experts suggest that since the victim is legally dead, the case for murder by the second assailant would not be tenable since the victim is already legally dead. However, the second assailant could be liable for intent to mutilate the "corpse," which in some jurisdictions is the property of the victim's family.
Legally "Brain-dead" patients are considered corpses or cadavers, and are called such by organ retrieval networks. The corpses can be used for teaching, for trying out new procedures, and for vital organ harvesting. Yet these same "corpses" are carrying unborn children to successful delivery. Certainly this is extraordinary behavior by a "cadaver!"
It appears that "dead" is not the same as "brain dead." So if "brain dead" persons aren't dead, what are they?
More Moral Dilemmas Created By The Existing Flawed Definition Of Death
Sometimes a potential organ donor does not meet the criteria for "brain death," but has sustained certain injuries or has an illness suggesting that death will occur soon. Such cases brought about the development of "non heart-beating donation" (NHBD), more recently labeled donation by cardiac death (DCD) — in which treatments considered extraordinary means, such as mechanical ventilation, are discontinued and certain drugs are used to lower the blood pressure and cause the patient to be pulseless. As soon as circulation stops, death is declared, and after a few minutes, which vary in different institutions, the body could still be resuscitated to restore cardiac and respiratory activity. This cannot be accomplished in the remains of someone who is truly dead.
It seems clear that in certain cases, we are playing games with human lives for utilitarian gain. So glaring is the reality of this issue that there are those who now argue that doctors should not be burdened with determination of death criteria, since the good of organ donation outweighs the harm (killing) done to the donor. Scary, isn't it?
Government InvolvementThe federal government is deeply involved in transplant programs for reasons that are unclear. A federal mandate issued in 1998 states that physicians, nurses, pastors, and other health care workers may not speak to a family of a potential organ donor without first obtaining approval from the regional organ retrieval system. If there is the possibility of vital organs available for transplant, a trained "designated requester" visits with the family first, even if the family adamantly opposes organ donation. If someone at the hospital speaks to the family first, the hospital risks losing its accreditation and possibly federal funding.
Why the "designated requester"? Studies show that these people have greater success obtaining permission for organ donation. They're trained to sell the concept, using emotionally-laden phrases such as "gift of life," "your loved one's heart will live on in someone else," and other similar platitudes, all empty of true meaning.
Where Does the Money Go?
The donation and transplant industry costs billions of dollars a year, according to several sources (including a 1996 series by Forbes Magazine). But it's difficult to obtain financial data. One thing is clear: donor families do not receive any monetary benefit from their "gift of life."
Something to Think About
Based on what you've just read, take a moment to ponder the following:
- Why can health insurance cover intensive care costs on "brain dead" patients?
- Why do "brain dead" patients often receive intravenous fluids, antibiotics, ventilator care, and other life support measures?
- Why is it wrong to tell families their "brain-dead" loved one is dead?
Why do "brain-dead" organ donors often receive anesthesia and other drugs to stop natural physical responses when they're undergoing vital organ harvesting?- How can "brain dead" patients have normal body functions, including vital signs, if they're dead?
- How can a "brain-dead" pregnant mother deliver a normal, healthy infant?
- Why does a ventilator work on someone declared a "brain-dead" person, but not on a corpse?
- Why is it wrong to carry out burial or cremation of a "brain-dead" person?
- Are "brain-dead" persons truly dead?
- Are they alive?
Dr. Paul A. Byrne, a Neonatologist, is Director of Neonatology and Director of Pediatrics at St. Charles Mercy Hospital in Oregon, Ohio, is Clinical Professor of Pediatrics University of Toledo College of Medicine, Board Certified in Pediatrics and Neonatal-Perinatal Medicine, Member of Fellowship of Catholic Scholars.Dr. Byrne is past-President of the Catholic Medical Association (USA), formerly Clinical Professor of Pediatrics at Creighton University School of Medicine in Omaha, NE, and at St. Louis University School of Medicine in St. Louis, MO. He is author and producer of the film "Continuum of Life" and author of the books "Life, Life Support and Death," "Beyond Brain Death," and "Brain Death Is Not Death."
Dr. Byrne has presented testimony on "life issues" to eight state legislatures beginning in 1967. He opposed Dr. Kevorkian on the television program "Cross-Fire." He has been interviewed on Good Morning America, public television in Japan and participated in the British Broadcasting Corporation Documentary "Are the Donors Really Dead?" Dr. Byrne has authored articles against euthanasia, abortion, and "brain death" in medical journals, law literature and lay press.
Paul was married to Shirley for forty-eight years until she entered her eternal reward on Christmas 2005. They are the proud parents of twelve children and grandparents of twenty-six grandchildren.
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12 comments:
PG-
I am reeling from this post.
So you have given us the down side to organ transplanting but is there a solution that does not actually render a living "brain dead" person -actually dead (ready for cremation)?
Or should we do away with heart, lung, pancreas(sp?) donations all together?
Karin, you are not dead until you are biologically dead. Since removal of vital organs is what ultimately kills you, how can it be moral to be a donor of vital organs? Brain dead people are still biologically living, their heart is pumping blood, they have a pulse, and they are warm to the touch. Organ donation is a big industry. Needless to say, I'm not an organ donor.
PG-
I am an organ donor (reconsidering this after this post though).
I understand the difference between brain dead & dead-dead (biological), but my question is do we do away with organ donation of "vital organs" and leave other organ donations intact? Or do we do away with the whole concept of organ donation?
As to organ donations being "moral"...
2296
Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good that is sought for the recipient. Organ donation after death is a noble and meritorous act and is to be encouraged as an expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible directly to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons
http://www.usccb.org/catechism/text/pt3sect2chpt2art5.htm#2301
Karin, the key phrase in that CCC quote is "after death." If removing your organs is what kills you, then it's not after death, is it? You can donate other non vital organs after death, like corneas for example. That fits within the moral description of the CCC.
Agree PG.
But then we come back to the same question, do we do away with organ transplants in general or do we totally re-vamp the program?
Karin, I think that vital organ donation will only be moral when and if medical science finds a way to retrieve the vital organs without the act causing the death of the donor. With all the technology we have available to us, it is a possibility. It is immoral to just keep redefining death so that we can harvest organs from live patients.
Wow. Thanks for this. I did not know this at all. I'm an organ donor. Silly me, I thought you were dead-dead before they took the organs, not psuedo-dead.
I do not know of any patient that I have ever taken care of in the CCU that was declared "brain dead" and then was allowed to just wallow away on life support.
When two physicians have declared that the patient is "brain-dead," the patient either goes through the procedure to become an organ donor (after talking with the family, etc) OR the patient is taken off life support and the rest of the body is allowed to die.
A diagnosis of brain death is only arrived at after numerous tests. No one likes having to declare anyone brain dead.
Make no mistake. Brain dead IS dead.
The number of errors (factual, omission, and other) in this post is astonishing.
Brain death is death. The brain is what makes us who we are...it controls all thought, intellect, reasoning, etc. Without the brain, there is no "there" there.
Brain death and its sequelae are an established fact of medicine. Once the brain has died, the rest of the body follows quickly, absent significant critical care intervention. The "survival rate" from true brain death is exactly zero.
Dr. Byrne suggests that there are two "eras" of death understanding: pre- and post-1968. In fact, our understanding of death (and the related science of resuscitation) has evolved since the days of Hippocrates. There was not a "sudden change" in 1968, but rather a slow evolution of our understanding of death. Modern medicine (primarily the ventilator) made it necessary for us to further refine our understanding of death since since the advent of mechanical ventilation in th 1950s and 1960s respiratory failure could not be relied upon as proof of death.
There are well-established criteria for brain death, involving the absence of cranial nerve function, the absence of respiratory effort (note, not "insufficient respiratory effort" but the complete absence thereof), as well as confirmatory testing such a cerebral blood flow studies, four-vessel cerebral angiograms, etc. Dr. Byrne's allegation that there are "more than thirty different sets of criteria" is simply false.
Dr. Byrne describes (without citation) responses to surgery in the brain dead cadaver. These are spinal reflexes, reliant only on the reflex arc and having nothing to do with the brain or brain stem. He also describes the young pregnant women who have been carefully maintained to allow for the birth of the child, but fails to mention that the survival rate of these women is as I decribe above: zero.
Some hospitals do allow a brain dead patient to occupy a bed, and some insurance companies do cover expenses. these, however, are the distinct exception to the rule, and are usually the results of mistakes (in judgment or practice) by either or both parties. I am personally familiar with days' worth of hospital bills for brain dead patients being refused for the period after the declaration of brain death. Brain death is death; insurance companies won't pay for care rendered on a dead patient if they're aware of it.
In non-heartbeating donation (more commonly known as donation after cardiac death), the decision to withdraw support from a patient with no hope for recovery is made independent of and prior to the decision to donate organs. No medications are administered to hasten death; the patient receives the same comfort care medications as any other patient from whom support is withdrawn.
The "federal mandate" addressed by Dr. Byrne was put in place to ensure that all families were given the option to donate if the patient was medically suitable to do so. Prior to that mandate, there was a hodgepodge of practices across the country, ranging from asking every family (regardless of suitability) to never asking at all because of caregiver beliefs and feelings, even though this is, by law, a family decision. Despite Dr. Byrne's allegations, trained requesters are trained to insure (among other things) that the donor's family understands that death has occurred. Quite frequently, the first time the families understand this is when the trained requester explains it; the physicians have either skated around the issue or flat-out misrepresented the condition of the patient.
Like all aspects of health care, organ donation and transplantation involves some expense. While donor families do not receive financial compensation for donated gifts, many have described the satisfaction they receive from knowing they were able to help save the lives of others.
Dr. Byrne's expertise is in the area of pediatrics and neonatology. It is not clear how he achieved supposed expertise in the field of death, resuscitation and/or organ donation. But brain death as well as organ donation and transplantation are well-established medical practices, and arguments against them are reminiscent of (and as well-grounded scientifically) the old arguments that the earth is flat.
For the non Catholics who are commenting here and clearly have an agenda to push (like their jobs), there are a few moral implications you are overlooking. When does the soul leave the body? At the moment of the ever changing definition of brain death, (it varies from country to country) or when biological death occurs?
Considering it clearly is the removal of vital organs that kills the patient and causes biological death, and the Catholic Church has always held that the soul leaves the body at the moment of biological death, then there is a moral implication involved in organ donation for those who hold a religious view of the soul and eternity.
Dr Byrne has done an excellent job exposing all the questionable factors of organ donation that are clearly being pushed on the public by people with either don't understand or are pushing their own agenda.
Very Good,PG! Doctors Mengelet and Singer are always lurking in the background,the culture of death always cloaks itself as a helper and a friend even as it diminishes our Humanness!
Note that a good book to read is "Eugenics" by G.K. Chesterton, it addresses the justifications of those enemies of truth and faith and ....Life !
I just lost a very dear dear friend last week. I talked to her on the phone just 3 weeks before her death!!!
It was so unexpected and it happened in very very suspicious circumstances, after I spoke to her husband and got more details (and I'm still waiting for more, I told him to get a copy of her medical file!!), I FEEL and I KNOW that she has been a victim of the medical system!!!! Starting with the paramedics who didn't want to listen to her husband that she never drank and so they took her (unconscious!) first to a hospital where they "treat" addicts, only to call him back 20 minutes later (probably after they CHECKED in their van and saw that she was sober!!!) to send him to another hospital where they were taking her (without letting him come with them and be with his wife in those moments!!!).
Then at the hospital, her husband was getting a different "diagnosis" every day: stroke, seizure, aneurysm, "something genetic", everybody was very very eluding, nobody really took the time to talk to him... She was still in a coma (!) when they called him to "discuss" further steps and noone showed up; the next day they let him wait for 2 hours and then another doctor (a woman this time!) came and told him how she was "brain dead" and they wanted her organs!!!!!!!!!!!
He was so totally lost that they manipulated him into signing the papers and that's the day when I finally got hold of him on the phone - I had been trying to reach my friend every other day (can you imagine how guilty I feel because I didn't call EVERY DAY, EVERY HOUR?????). So I was on the way to work when I got him on the phone and asked for my friend and he told me first that... she had had a stroke... he told me it had happened on a Sunday, after she had been complaining of a very very bad headache and had been taking some strong pills (even if I always WARNED her against suppressing symptoms and making everything worse!!!!! She always said she couldn't deal with pain!!!!!); she was sitting at the table when she just collapsed and her head hit the table... she then regained consciousness for a few minutes, he put her in bed and then she collapsed again and then he called the paramedics... After he told me this, I said "OK, she's had a stroke, so she is in the hospital, right? How is she now?", then he told me... stammering... that they switched off the devices keeping her alive... and that they took her organs!!!!!!!!!!!!!!!! Of course, they kept her in a coma for so long to check her thoroughly and -since they wanted her organs- it's obvious that she was healthy!!!! But my friend and her husband were living on welfare in a very poor neighborhood (I was sending her €50 a month to help her), so of course she didn't have a top medical insurance, it wasn't worth it to keep her alive any longer, but she was good enough to make tens of thousands of euros with her organs!!!!!!!!!!!
WHY didn't I get hold of her husband on the phone earlier to inform him what "brain death" really means and about the dangers of this organ "donation" which in reality is a criminal BUSINESS???? There is no scientifically accepted definition of "brain death", it's just a consensus which was created to give the medical system green light to take organs from whomever they please (or by manipulating the poor surviving members of the family into consenting "to do something good" with the organs, "don't let her [brain!!] death be in vain"). It's a medical fraud and a CRIME what they did to her!!!!
I am NUMB with pain, I've been crying for hours every day and I still cannot realize and accept that she is gone!!!!!! Like a candle that someone blew out!!! My dear dear friend who was only 45 and whom I've known and loved for 32 years spent this Christmas butchered in the morgue of Bremen!!!
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