Organ Donation and Questions Regarding the Determination of Death
by Staff
September 18, 2008
PHILADELPHIA, (christiansunite.com) -- Recently, several articles were published in the New England Journal of Medicine which address the issue of organ donation. One article was particularly interesting written by Robert Truog and Franklin Miller titled "The Dead Donor Rule and Organ Transplantation," (NEJM Vol. 359 (7). The authors argue that the so called Dead Donor Rule should be abandoned by claiming that traditional determinations of death are inadequate in terms of providing good evidence for death. In the case of brain death criteria, some claim that there are patients who give evidence of system wide functioning even with a total absence of brain functioning. In the case of cardio-pulmonary criteria, death is declared if the patient suffers the "irreversible" loss of cardio- pulmonary functioning. However, the authors argue that in the case of non-heart-beating donation if the heart can be restarted in the recipient's body, then the heart did not satisfy the 'irreversible' criterion. The only way around this problem, they assert, is to define 'irreversible' with reference to a decision not to attempt resuscitation on the donor.Death, however, is a property of the patient and is not based on the decisions of an external party. The authors assert that both brain death and non-heart beating criteria fail to capture our intuitive notion of death; hence, the moral grounds for extracting organs from these donors cannot be patient death as understood by these two criteria. In the authors' judgments we already are killing patients to extract their organs. If this practice is permissible, then why should we not expand the practice to include those who are in a persistent vegetative state or those who are terminally ill? They state that with proper safeguards on consent, these patients may elect to donate their organs, and such donation would in effect kill them. Summarizing this argument they say, "Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate" (p. 675).
Though Truog and Miller offer some interesting reflections, their argument includes several errors. The first and most grave error is simply that they recommend abandoning the Dead Donor Rule. The Dead Donor Rule is essential to assure that living humans are treated with the full dignity they deserve as members, albeit very sick members, of the human family, and to assure that they are not instrumentalized for their "spare parts" or "commercializable" resources. The second error is that the term 'irreversible' is taken to mean either 'unable to be reversed by technological means,' or a decision not to resuscitate has been made. Both are erroneous because our notion of death has to be tied to the condition of the patient. [See Reflections on Non-Heart-Beating Donation and Brain Death at www.ncbcenter.org]
A third error is conflating, in the case of non-heart- beating donation, the actions of withdrawing life support with extracting vital organs. Both end in the death of the patient. The error is in supposing that moral actions are classified strictly with reference to their end results or outcomes. Imagine for a moment that a physician removes disproportionate life support treatment from a patient consistent with the patient's wishes. In this case the physician performs an act of altruism. Altruism is characterized by complying with the patient's reasoned wish, with the effect that the patient will die. Imagine further that instead the physician chooses to administer a lethal injection which kills the patient. In this case the end result is the same as in the first, but the physician chose to kill the patient with the effect of ending his suffering. The object of choice in the first case is 'respect for the patient's morally legitimate wish,' while the object of choice in the second case is 'to cause the death of the patient.' The end result is the same in each, but radically different moral actions are performed.
