Saturday, July 07, 2007

The dilemma of organ donation

Edit -August 31, 2008 - before you sign an organ donor card, please also see these more recent posts on the dilemma of organ donation.

A young handicapped man with little ability to pay for medical expenses is murdered for his organs by a doctor who kept administering lethal doses of morphine and Ativan. Sound far fetched? It happened in California, and the doctor who administered the lethal dose of drugs was actually working for a California organ-harvesting corporation. When the twenty six year old didn't die from the overdoses, he was left without life support until he died nine hours later.

The push for social acceptance of euthanasia and a high demand for organs creates situations where the donor is no longer viewed and cared for as a patient, but seen as the means to supply life to the patient waiting for organs. With no universally-accepted medical definition of brain-death, the door is wide open for abuse of organ donation. In China, prisoners are killed for their organs after a match is found, and in Canada and the US, "non-beating heart" organ donations have the ethical implication of doctors decreasing the wait time after cardiac asystole in order to harvest "better" organs.

The Catholic Church considers organ donation an act of charity and love. Pope John Paul II calls organ donation an act of everyday heroism in the 1995 encyclical Evangelium Vitae:
"A particularly praiseworthy example of such gestures is the donation of organs, performed in an ethically acceptable manner, with a view to offering a chance of health and even life itself to the sick who sometimes have no hope." (Evangelium Vitae, n. 86).

The Ethical and Religious Directives for Catholic Health Care Services states that “Catholic health care institutions should encourage and provide the means whereby those who wish to do so may arrange for the donation of their organs and bodily tissue, for ethically legitimate purposes, so that they may be used for donation and research after death.” Directive No. 64: “Such organs should not be removed until it has been medically determined that the patient has died. (my emphasis). In order to prevent any conflict of interest, the physician who determines death should not be a member of the transplant team.”

It used to be fairly easy to determine when death had occurred. Now, with the high demand for organ donation and the relatively low supply of donors, calling a death has become an ethical issue when the patient is also an organ donor. Patients who are organ donors are kept alive until the removal of their vital organs causes their death.

Removing life support before death has occurred for the sake of harvesting higher quaility organs is a moral dilemma that keeps me from being an organ donor. That, and the very real moral question of when exactly does the soul leave the body? The Catholic Church has always held that the soul leaves the body at the moment of biological death, and with organ donation, biological death occurs when the transplant team removes the vital organs.


Anonymous said...

I am one of those that is marked as an "organ donor" on my D.L.
If and when I die, if I have any organs that are still healthy and of use to someone that is. At this point I am leaning towards resinding my "organ donation" status and changing it to "donating to science", that way I know I wont be murdered for organs but will be allowed to die a dignified death!

Shig said...

You are confusing two different approaches to organ donation. One is brain death. This is absolutely provable-you can test for it, you can see it on imaging scans. It is irreversible and widely accepted around the world. Just because someone remains on a ventilator with a heart beat does not mean they aren't dead. In fact, since the heart can be restarted with shocks and CPR, loss of heart beat should not be considered death. Death occurs, even after cardiac death, after the brain is denied oxygen for 10 minutes.

Donation after cardiac death is the way organs were initially recovered, in the "old days"-a person died, there family was asked for consent and kidneys were quickly recovered. I have been involved in DCD cases and the case in California, if true, is a gross violation of the standards, moral and legal, set forth. That patient was not brain dead.

I don't know what the Catholic Church's position is on removing the ventilator of non brain dead patients. I do work with Catholic hospitals where families decide to let nature take it's course when all medical interventions are useless by "pulling the plug" and letting the patient die. If organ donation was going to be a part of such a scenario, it would not be asked for until AFTER the family made that decision. Organ donation should not factor into a family's decision to withdraw care.

Please don't use this one, isolated case to turn people against organ donation. I have seen the people who have been helped by receiving an organ. Such an altruistic gift from a stranger is a miracle of life to these people and those who give the gift of life are surely blessed by God.

jim klasz said...

This one isolated case where they caught the perpetrator remains a fear,and frankly there are no safeguards built into the system to prevent "harvester Physicians" or Body Snatchers if you prefer from working with the critically ill.As the handicapped person's very humanity has been called into question by Peter Singer and his cohort,the vanguard of the culture of death we may expect to see more of this reaping of the expendable for the survival of the rich....oops...healthy.
Already we have seen the results of surrogate motherhood the exploitation of the poor woman's womb with, of course the consent out of her ignorance and poverty.Then of course we have stem cells of those things called fetuses,once known as unborn children.
So I agree with Paramedic Girl that we are again faced with a dilemma of our own devising where the very redefinition of Humanness the worth of a life has become problematic;whose is worth more? Today the aforesaid Doctor is a criminal,tommorow that same act might well be regarded as bringing about a greater good.
Hence,We are again on the slippery ethical slope and unfortunately it is unlikely that the Magisterium will prevail in the short term.

paramedicgirl said...

tc, there is no universally accepted definition of brain death, hence the moral dilemma of doctors shortening the wait time to retrieve higher quality organs for the patient in the next room, so to speak. I believe now the required wait time is just 5 minutes, and in some cases it is being shortened beyond that in contravention of the 5 minute rule.

As long as the patient is using his vital organs to sustain life, he isn't really dead. It's the removal of the vital organs that causes his biological death. It's a moral dilemma I'm not quite comfortable with.

And there have been documented cases of people waking up from comas both short and long term, where the family had considered removing life support and donating the organs. What if that had been you? Or a loved one?

Frank Fenn said...

well, i don't know the church's stance on organ donation. but let me tell you, if any of mine are good then when i die, if someone needs a life saving transplant, they are welcome to mine if they are good.

hint, i smoke. so nuff said. yes, i will quit before the surgery date!

Anonymous said...


Last I heard were you not quitting? What happened?
You do know that smoking stunts your growth, right!?! (Please note that I say this with a grin, as I too am a smoker)

Anonymous said...

I have chosen not to be an organ donor,and part of the reason is the ethical dilemna discussed in this post. Also, for those of you who think this incident in California is an isolated case, give your head a shake- they caught this Doctor. How many go unreported?

Anonymous said...

This is NOT an isolated case. DCD organ donation has gone up approx. 250% from 2003-2006. People are being deceived and their loved are being killed. Yes, it's obvious there is a BIG push for organs. The "business" is very profitable for the government, hospitals and OPOs (organ procurement organizations). The United States Health & Human Services Transplantation Division is giving out grant money to hospitals, OPO's and now EMS! Trauma patients DON'T get emergent treatment (surgery) anymore - There were changes made to United States Federal Code for trauma and EMS in 2004. OPO's know when a patient is on their way "in" to ER - some trauma hospital's have OPO people that are stationed right at the hospital! The HHS/OPO/Hospital/EMS all work together from the very beginning and the patient and family NEVER know what is going on - they are left in THE DARK - while the rest gang-up against the patient in what they call their HUDDLE! Now the United States Government and states are working on PRESUMED CONSENT - everyones "in" unless they opt out - but the opt out part will NEVER work. What can the American People do? Research, gain knowledge and put good, honest, caring people in governmental office. God give us strength.