You might want to think twice before checking off the organ donor box the next time you renew your driver’s license.
Three physicians from Northwell Health in New York — cardiologist Sandeep Jauhar and heart failure and transplant directors Snehal Patel and Deane Smith — collaborated on a rather thought-provoking op-ed published in The New York Times last week. (The essay can be viewed here.)
They propose an intriguing solution to address the shortage of donor organs available to patients in urgent need: simply expand the definition of death.
The doctors explain that “there are only two reasons a person can be declared dead: Either the heart has stopped or the brain has ceased to function, even if the heart is still beating.”
A person may serve as an organ donor only after being declared dead. (Until then, transplant surgeons are not allowed even to interact with a dying patient.)Most donor organs today are obtained after brain death, defined by most state laws as a condition of permanent unconsciousness with no spontaneous breathing, no response to pain and no primitive reflexes — in other words, devastation of the whole brain. Organs obtained this way are often relatively healthy, because brain-dead patients can continue to circulate blood and oxygen.
The physicians note that “brain death is rare.” For example, in New York State, “there are on average fewer than 500 cases suitable for organ procurement and transplantation each year.”
Far more often, people die because their heart has permanently stopped beating, which is known as circulatory death. However, precisely because the blood has stopped circulating, organs from people who die this way are often damaged and unsuited for transplantation.The need for donor organs is urgent. An estimated 15 people die in this country every day waiting for a transplant. We need to figure out how to obtain more healthy organs from donors while maintaining strict ethical standards.
Then, they cut to the chase: “We need to broaden the definition of death.” [Emphasis added.]
Consider how things currently work. In the procedure known as donation after circulatory death, a typical donor is in an irreversible coma from, say, a drug overdose or a massive cerebral hemorrhage, and the heart is beating only because of life support. The donor is still not legally brain-dead; he or she might have, say, a gag reflex or other primitive functions.In such cases, with the blessing of the family, a donor is brought into an operating room and life support is carefully withdrawn. If, as is expected, the removal of life support results in stoppage of the heart, surgeons will wait long enough to determine that the stoppage is permanent — to be confident of death — but not so long that vital organs get damaged. This period is typically about five minutes. Then the surgeons remove the organs.But even a few minutes of a stopped heart often results in damage to the organs. This deprives potential recipients of healthy organs and thwarts the wishes of donors to have their organs used to help others.
The doctors describe a fairly new method that is widely used in Europe called “normothermic regional perfusion,” which can “improve the efficacy of donation after circulatory death.”
Doctors take an irreversibly comatose donor off life support long enough to determine that the heart has stopped beating permanently — but then the donor is placed on a machine that circulates oxygen-rich blood through the body to preserve organ function.Donor organs obtained through this procedure … tend to be much healthier.
Use of this method has sparked considerable ethical debate within the medical community.
The trio briefly considers the possibility that a patient might be declared irreversibly comatose prematurely, and acknowledges that, while rare, it has indeed happened and “it is a catastrophe.”
Still, they argue that the definition of brain death must be broadened “to include irreversibly comatose patients on life support.” This would result in “more organs available for transplantation.”
Finally, the doctors cite a committee of physicians and ethicists at Harvard that was tasked with formulating a definition of brain death in 1968, the same basic definition most states use today. In their initial report, the committee wrote that “there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.”
The doctors note that “this frank assessment was edited out of the final report because of a reviewer’s objection. But it is one that should guide death and organ policy today.”
Needless to say, this op-ed stirred considerable debate among readers. Here are some of their reactions:
Elizabeth writes commentary for Legal Insurrection and The Washington Examiner. She is an academy fellow at The Heritage Foundation. Please follow Elizabeth on X or LinkedIn.
CLICK HERE FOR FULL VERSION OF THIS STORY