Dying for donations

More and more these days, there are disturbing articles out there both in mainstream media and medical journals about the problems surrounding organ donation, among other bioethical issues, and people are very confused. That’s lethal confusion, when you or your loved on winds up in a hospital at the mercy of someone who sees the benefit of hastening death to harvest organs. 

A new article I just saw recalled something like it in the biomedical news recently, and these issues have to come out of the specialty journals and into the mainstream debate. Like this one, on unethical diagnoses and treatment of dying patients.

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else’s benefit.

Then the author points out a report that attacks the deception involved in the ‘non-heartbeating death’ diagnosis, with three researchers…

arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent. Such honesty about NHBD should be welcomed. However, NHBD violates a fundamental end of medicine, nonmaleficience, “do no harm.” Physicians should not be harming or killing patients, even if it is for the benefit of others. Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

This kind of wrestling with life issues is going on in peer-review journals.

But it makes its way to the public in stories like this one in WaPo, and we sure need to be paying attention to them.

After a long fight with a degenerative disease, Ruben Navarro appeared close to death. So the hospital caring for him alerted the local transplant network, which rushed a team to the medical center to try to salvage the 25-year-old’s organs.

But as Navarro hung on, tension mounted in the operating room of Sierra Vista Regional Medical Center in San Luis Obispo, Calif. With time slipping away, one of the transplant surgeons ordered repeated doses of the narcotic morphine and the sedative Ativan, jokingly calling the drugs “candy,” according to police reports. Navarro eventually died, but too late for his organs to be useful.

Horrified nurses complained, prompting multiple investigations. In July, prosecutors charged Hootan Roozrokh with trying to hasten Navarro’s death, marking the first time a surgeon has faced criminal charges in a transplant case.

So there you are, Pandora’s Box cracked open.

For some doctors, nurses and medical ethicists, it represents their worst fear — the extreme end of a spectrum of practices that have been raising alarm in hospital wards, emergency rooms and intensive care units around the country.

“This is what we’ve been worrying about,” said Michael A. DeVita, a University of Pittsburgh critical care specialist. “If you promote organ donation too much, people lose sight that it’s a dying patient there. It’s not just a source of organs. It’s a person.”