A research team from the University of Maryland is moving forward with
modified drone testing, hoping to show that donated organs can be
transported safely, and more quickly, between donor and recipient. (Nov.
21)
AP
How should society respond to the increasingly long list of people waiting for organs on a transplant list? You’ve no doubt heard of “black market” organs in foreign countries, but are there other options that should be off the table?
How should society respond to the increasingly long list of people waiting for organs on a transplant list? You’ve no doubt heard of “black market” organs in foreign countries, but are there other options that should be off the table?
If
you were on a transplant list, would it matter to you if the organ was
obtained from a living person who died because of the donation procedure
itself? What if she had volunteered?
Your thoughts on this topic have implications beyond the issue of transplantation.
As
the former co-director of Vanderbilt University’s lung transplant
program and a practicing intensive care unit physician, I see organ
donation an selfless gift to those approaching death on transplant wait
lists.
However, I’m wrestling with the emerging collision between the worlds of transplantation and euthanasia.
Cause of death: organ donation?
At
international medical conferences in 2018 and 2019, I listened as
hundreds of transplant and critical care physicians discussed “donation
after death.” This refers to the rapidly expanding scenario in Canada and some Western European countries whereby
a person dies by euthanasia, with a legalized lethal injection that she
or he requested, and the body is then operated on to retrieve organs
for donation.
At each meeting, the conversation unexpectedly shifted to an emerging question of “death by donation” — in other words,
ending a people’s lives with their informed consent by taking them to
the operating room and, under general anesthesia, opening their chest
and abdomen surgically while they are still alive to remove vital organs
for transplantation into other people.
The big deal here is that death by donation would bypass the long-honored dead donor rule,
which forbids removal of vital organs until the donor is declared dead.
Death by donation would, at present, be considered homicide to end a
life by taking organs.
The mechanics of obtaining
organs after death from either euthanasia or natural cardiac death (both
already legalized in Canada, Belgium and Netherlands) can be suboptimal
for the person receiving the transplant, because damage occurs to
organs by absence of blood flow during the 5 to 10 minutes-long dying
process. This interval is called ischemia time. Death by donation purports
to offer a novel solution. Instead of retrieving organs after death,
organ removal would be done while organs are still being receiving
blood. There would be no ischemia time and organ removal would be the
direct and proximate cause of death.
Unintended, unavoidable consequences
Recently, the New England Journal of Medicine (NEJM) published an article by two Canadian physicians and an ethicist from Harvard Medical School, who contended it might be ethically preferable to ignore the dead donor rule if patients declare they want to die in order to donate their organs.
While
literally “giving yourself” to others might seem commendable at first
glance, let’s discuss three downstream considerations to abandoning the
dead donor rule.
►People with physical and mental
disabilities have expressed that they feel stigmatized and that society
devalues their lives. Would this send them a not-so-subtle message to
get out of the way and do something noble with their healthy organs?
►How quickly would we see expansion whereby those who can’t speak for themselves are included as donors?
►What does it mean for all of us when our healers — physicians — are in a position that directly overrides nearly 2,500 year-long prohibitions against taking life?
Consider the case of Ben Mattlin, who suffers from spinal muscular atrophy. In a 2012 column for
the New York Times, he wrote of the “thin and porous border between
coercion and free choice” for those who feel devalued. On the
subtle erosion of his autonomy, he wrote: “You also can’t truly conceive
of the many subtle forces (to die) — invariably well meaning,
kindhearted, even gentle, yet as persuasive as a tsunami — that emerge
when your physical autonomy is hopelessly compromised.”
Civil
society is measured by how we treat our most vulnerable members.
Euthanasia laws are structured to protect vulnerable populations, but
what are the facts?
Murder by any other name
According to a 2015 article in the NEJM,
of the 3,882 deaths due to physician-assisted suicide or euthanasia in
Flanders, Belgium, in the year 2013 alone, 1,047 (27%) were due to
medication dosages to hasten death without patients’ consent. Such
patients are generally unconscious and may or may not have family
members around.
In 2014, a statement on
end-of-life decisions by the Belgian Society of Intensive Care
Medicine asserts that "shortening the dying process" should
be permissible "with use of medication ... even in absence of
discomfort.” When discussing these facts, two prominent physicians, one
from the Netherlands and another from Harvard, told me that where they
come from, they call that murder.
When physicians
are participating in a procedure designed to take a person’s life, will
patients feel 100% certain that their physician is firmly on the side of
healing? What message does it send about the value of every human life
when physicians endorse the exchange of one life for another? What
affect has it already had on physicians complicit in such death-causing
procedures?
In the 1973 science fiction classic "Soylent Green,"
detective Frank Thorn searches for answers to dying oceans and a
deteriorating human race on overcrowded Earth. He discovers the
high-protein green food produced by the Soylent Corporation is recycled,
euthanized humans. “Soylent Green is people!” he screams.
"Soylent Green" was set in 2022. We are three years away.
E. Wesley Ely, holds
The Grant W. Liddle Chair in Medicine at Vanderbilt University Medical
Center and is the co-director of the Critical Illness, Brain
Dysfunction, and Survivorship (CIBS) Center. He is also associate
director of Aging Research for the Tennessee Valley Veteran’s Affairs
Geriatric Research and Education Clinical Center.
Death by organ donation: Euthanizing patients for their organs gains frightening traction
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