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OrganFacts.net

The truth behind
organ donation
& transplants

The truth behind organ donation & transplants


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… The truth behind organ donation & organ transplants

OPPOSE
ORGAN
DONATION

Dr David W Evans

Dr David W Evans , Retired Consultant in Cardiology, says: “Human organ transplantation is Wrong because it necessitates the abuse of the dying or harming the healthy. Doctors should not be involved in such things… I don’t know how any doctor can operate on his patient not for his good but knowingly to do him harm.” [more]

OPPOSE
ORGAN
DONATION

Dr David J Hill

Dr David J Hill , Retired consultant anaesthetist, says: “The Diagnosis of Death for Transplant Purposes has no international consensus and in the UK… depends upon testing only a few cubic centimetres of tissue in the brainstem for loss of function… Live organs can only come from living bodies. ” [more]

OPPOSE
ORGAN
DONATION

Dr Paul A Byrne

Dr Paul A Byrne , neonatalogist and pediatrician, says: “In order to be suitable for transplant, (heart, liver, lungs, kidneys and pancreas) need to be removed from the donor before respiration and circulation cease. Otherwise, these organs are not suitable, since damage to the organs occurs within a brief time after circulation of blood with oxygen stops.” [more]

OPPOSE
ORGAN
DONATION

Dr John B Shea

Dr John B Shea , retired diagnostic radiologist & Fellow of Royal College of Physicians & Surgeons of Canada, says: “Many physicians have serious and well-considered concerns about morality of human organ transplantation … the general public has not been properly informed about what really happens when organs are retrieved.” [more]

OPPOSE
ORGAN
DONATION

Bereaved mother

Bereaved mother (Bernice Jones) says: “ Brain death is not death” and “organ donation is very deceptive”. “Families are led to believe that their loved ones are dead, but in fact they are alive. You must be alive to be a vital organ donor.” [more]

OPPOSE
ORGAN
DONATION

Nurse Ellen B Linde

Nurse Ellen B Linde , senior graduate teaching assistant, University of Scranton, says: “Some, believing that removing vital organs is what kills the patient, view organ donation… as an act of killing… not all nurses are comfortable with a value system driven primarily by the needs of transplant recipients rather than by the needs of the potential donor.” [more]

OPPOSE
ORGAN
DONATION

Earl E. Appleby Jr

Earl E. Appleby Jr , Director, Citizens United Resisting Euthanasia, says: “Anyone unwise enough to have signed an organ donor card also has legitimate cause for concern. Would you trust a doctor who regards your body “not as an organism in need of healing but as a container of biological useful materials” … That’s exactly what organ donors do. ” [more]

OPPOSE
ORGAN
DONATION

Michael Potts

Michael Potts , medical ethicist, says: “Any action that directly causes the death of a patient, even if it is for the good of others, opposes the goal of medicine not to harm that individual patient… It is precisely whether transplantation kills the donor that is the key issue that cuts to the heart of the goals of medicine.” [more]

Brain death is not death

By Dr David W Evans

There were never sound scientific or philosophical grounds for a redefinition of death based on the loss of testable brain function while the body remains alive (1). Pressure for a viable heart for transplantation nevertheless resulted in a diagnosis of death on some such basis in Cape Town (2), in 1967. There followed “a euphoric, uncontrolled epidemic of heart transplantation around the world” (3). This, together with demand for other organs which, to be viable in recipients, required that they be perfused until their removal, necessitated “the production of a set of legal and philosophical justifications” (2) for procedures which would otherwise be seen as assault. The story of how the Harvard Brain Death Committee produced, in 1968, a facilitating redefinition of death based on “irreversible coma” with “no discernible central nervous system activity” makes interesting reading (4). The ease with which their novel redefinition of death became incorporated into American law, and subsequently accepted in many other countries, gave food for thought. It seemed to resist attacks upon its inconsistencies and contradictions because of its utility - indeed its perceived necessity to some transplant practices. That is, until last year. Fittingly, the paper formally admitting that the concept of brain death - as this new form of death became widely known - “fails to correspond to any coherent biological or philosophical understanding of death” came from the Harvard Medical School too (5).

Dr David Evans

While the philosophical arguments about concepts of death may be for others, the possibility of diagnosing - with the necessary certainty - the “irreversible cessation of all functions of the entire brain, including the brain stem”, while the rest of the body remains alive, has always been the concern of the doctor. That “whole brain” definition was the requirement stipulated in the quaintly named Uniform Determination of Death Act (1981) if death were to be certified on other than the universally accepted cardiorespiratory basis. The Harvard tests - essentially of brainstem mediated reflexes and ventilator dependence, with or without EEG, in patients whose coma was believed irremediable - clearly lacked the power to make that diagnosis. The many protocols in use worldwide failed similarly. Indeed, their very number (6) proclaimed the fact that the syndromes they diagnosed could not be one and the same entity (7). And prominent among the variations was the apnoea test, which might lead to the misdiagnosis of respiratory centre failure if inadequately stimulating. If stringent, it might prove lethal (8).

Truog and Robinson acknowledge that many patients currently diagnosed “brain dead” do not, as a matter of fact, meet the American legal requirements governing that practice. They say that many of them retain demonstrable brain function - and that this knowledge, which should be uncomfortable to those certifying death on the basis that there is none, is set aside on the premise that it is not “significant”. That practice is reminiscent of the stance assumed by those who foisted “brain death” upon us here in the UK in 1979. They simply promulgated a set of prognostic criteria, first published in 1976, with a directive that they were to be used thenceforth as criteria for the diagnosis of death (9) . The illogicality of that change of use was pointed out in 1980 (10). The diagnosis (of “brain death”) was crucially dependent upon the absence of specified brainstem reflexes. Other persisting brainstem function, such as blood pressure control, was to be ignored. EEG activity was not to be sought. If demonstrated, it was to be set aside as of no “significance”. Such was the pretence to knowledge of our marvellous brain’s function which did not, and still does not, exist.

The term “brain death” was formally abandoned, in this country, in 1995 (11). But comatose, ventilator-dependent patients are still being certified “dead” for transplant purposes using similar tests. These are now held to diagnose the irreversible loss of the capacity for consciousness, although no sound scientific evidence has been advanced to support that claim. Nor, since these patients are not exposed to the anoxic drive stimulus, do they have the power to diagnose the irreversible loss of the capacity to breathe. That being so, the merits and demerits of the new conceptual basis for certifying these patients dead should be of no practical concern to the doctors who care for them. Where requests for the organs of such patients are concerned, Truog and Robinson (like others (12), (13)) propose the abandonment of all obfuscation about their status in the dying process. They suggest that people should be allowed to donate their organs when they become “neurologically devastated or imminently dying”, without first being declared dead. This refreshing call to face the facts has implications for the validity of the “consent” given by those led to believe that their offer of organs will not be taken up until after their death. But it may be that more will be prepared to register as prospective donors on the proposed new basis if it is fully and frankly explained - and the necessary legislation enacted after open debate.

David W Evans
Retired Physician (sometime Consultant Cardiologist at Papworth Hospital)
27 Gough Way, Cambridge, CB3 9LN - and Queens’ College, CB3 9ET
(DWEvansMD@tinyworld.co.uk)

Competing interests : None



References

1. Beyond Brain Death : the Case Against Brain Based Criteria for Human Death. Eds. Potts M, Byrne PA, Nilges RG. Kluwer Academic Publishers, Dordrecht, 2000

2. Hoffenberg R. Christiaan Barnard : his first transplants and their impact on concepts of death. BMJ 2001;323:1478-80 (and see bmj.com ‘Rapid responses’ to this article)

3. Smith T. Clinical freedom. BMJ 1987;295:1583

4. Singer P. Is the sanctity of life ethics terminally ill? In: Brain Death, Ed. Machado C. Elsevier Science B.V. 1995, 231-243

5. Truog RD, Robinson WM. Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med 2003;31:2391-96

6. Wijdicks EFM. Brain death worldwide : accepted fact but no global consensus in diagnostic criteria. NEUROLOGY 2002; 58:20-25

7. Evans DW. ‘Open letter to Professor Wijdicks’, bmj.com ‘Rapid responses’ 11 Dec 2002

8. Coimbra CG. Implications of ischemic penumbra for the diagnosis of brain death. Braz J Med Biol Res 1999;32:1479-87

9. Conference of Medical Royal Colleges and their Faculties in the UK. Memorandum on the diagnosis of death. BMJ 1979;I:332

10. Evans DW, Lum LC. Brain death. Lancet 1980 (November 8th):1022

11. Working Group convened by the Royal College of Physicians and endorsed by the Conference of Medical Royal Colleges and their Faculties in the United Kingdom. Criteria for the diagnosis of brain stem death. J Roy Coll Physns Lond 1995;29:381-2

12. Kerridge IH, Saul P, Lowe M, McPhee J, Williams D. Death, dying and donation : organ transplantation and the diagnosis of death. J Med Ethics 2002;28:89-94

13. Woodcock TE. New act regulating human organ transplantation could facilitate organ donation. BMJ 2002;324:1099


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