Redefining death

For decades, bioethics expert Nancy Valko has been the most dilligent and vigilant participant I know in the biomedical field in defending all stages of life, and analyzing the thorny issues that threaten life. Here’s just one reason why you should reconsider the organ donor check on the back of your driver’s license. There’s a better way to do the same thing, with less risk to you down the road.

That story is about a woman who lay in intensive care for nearly a month after an accident.

One specialist declared her case hopeless, and recommended switching off life support. Had that happened, first her heart would have stopped, and several minutes later her brain activity would have ceased. Yet although Janet was a card-carrying organ donor, in many countries her organs wouldn’t be used. This is because doctors would normally wait to confirm that she was brain-dead (see “Redefining death”). In the time it takes to do that her organs would have been irreparably damaged.

For this reason, organs for transplant usually come from patients with brain injuries so severe that brain death is determined before the life support that keeps their hearts and lungs functioning is removed, enabling their organs to be kept in good condition until the moment they are harvested. Such organs are in critically short supply.

Now, however, this situation is changing. In June, Ottawa Hospital in Canada announced its first organ transplant in recent history from a patient who hadn’t been classified as brain-dead, but whose heart had stopped – so-called “donation after cardiac death” (DCD). By switching to this definition of death for transplant purposes, doctors hope to increase the number of healthy organs available and the number of potential donors from which they can be harvested.

How chillingly convenient. Definitely puts this on the slippery slope.

For example, the Australian Health Ethics Committee (AHEC) is considering recommending legislation to enable more DCDs, as part of a drive to turnaround Australia’s flagging organ donation rates. A similar shift is taking place in the US, where a limited number of DCDs already take place. There, the number of DCD kidney transplants has increased fivefold since 1995 to over 500 in 2004, and numbers are expected to increase sharply over the next decade.

The driving force behind this change is the worldwide shortage of organs (see “The crisis in organ donation”). Last week, doctors at the World Transplant Congress in Boston, Massachusetts, heard how the pool of available organs in the US could increase by up to 20 per cent if DCD was adopted more widely – enough to treat many of the estimated 6000 people in the US who die each year while on organ waiting lists. In the UK, strong government support has helped swell numbers of DCDs more than sixfold in the last 15 years, to 120 in 2005.

So is the medical profession all on board this sea change in bio-medicine? No.

In light of this, it is all the more surprising to discover that the medical community is divided about the ethics of DCD. What’s more, donor-card holders, far from consenting to the new practices, are blissfully unaware of the seismic shift in organ collection procedures.

“Doctors are very pragmatic,” says Christopher Doig, a critical care specialist at Canada’s Foothills Hospital in Calgary, Alberta. “But there is something inherently bothersome about changing the way we are going to determine death so that we can increase the numbers of organs for donation.”

For many doctors, harvesting organs only after brain death draws a clear line in the sand, removing any conflict between patient care and the interests of organ recipients. Often too, the decision to withdraw life support is a subjective one. In the case of Janet, a second specialist advised against ending life support, and after almost a year in hospital, she is now wheelchair-bound but happy to be alive. One concern is that if DCD becomes routine, doctors caring for critically ill people may have their judgement swayed by the needs of those on transplant waiting lists.

Nurse Nancy Valko has seen ‘miracles’ happen, and she’s seen a lot of abuse and unethical treatment. Her campaign of information is aimed not only at the medical community, but the unsuspecting public who are but a heartbeat away from these decisions. Says Valko:

The alliance of the “right to die” with organ donation is very dangerous in itself but the one of the worst aspects is that the public is encouraged to sign organ donor cards (or accept “presumed consent” laws) without this kind of crucial information.

Learn more about the subject from Valko’s many articles available at www.wf-f.org. Go to the “WFF Board and Staff” link on the right side, and then scroll down to Nancy Valko’s name. The Women for Faith & Family site is loaded with good resources. Okay, full disclosure here. Yes, I’m on the board. But it’s those other members who load that site with the wealth of information you find there.