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Organ donation and the definition of death

The following editorial appeared in the May 23, 2003 edition of the St. Louis Review, the newspaper of the Archdiocese of St. Louis. It is reprinted here with the kind permission of the St. Louis Review.

Organ donation is quickly becoming a very troublesome affair. In theory, it's a wonderful act of charity. In practice, it just might be your worst nightmare.

There are some 80,000 persons in the United States today awaiting a vital organ from a donor in order that they might live. It is widely held that the donation of organs after death is a noble and meritorious act. The "Catechism of the Catholic Church" makes clear that organ donation is to be encouraged as an expression of solidarity (No. 2296). Pope John Paul II has said this on numerous occasions.

The desirability for exercising charity and encouraging organ donation in solidarity with one another, however, cannot obliterate the "dead donor rule" where vital organs are concerned. Procuring organs for donation should not cause the donor's death.

The donation of an organ to save another's life does not make killing the donor morally admissible. In the words of the Pope, "There is a real possibility that the life whose continuation is made unsustainable by the removal of a vital organ might be that of a living person, and the respect due to human life absolutely prohibits the direct and positive sacrifice of that life."

Most of us would see the dead donor rule as simple, clear and morally mandated. But, there is a problem. When is a life over? How does one determine death? Again, many people have come to accept the definition of death based upon so-called "brain death," or the irreversible cessation of all brain and nervous system function. The Pope has condoned the reasonable use of the criteria associated with this definition as a way of establishing death. However, there are no established criteria for death in authentic magisterial teaching. That is something left to the scientists.

Uncertainty about the moment of death has resulted in a hotly debated organ donation protocol known as Non-Heart-Beating Organ Donation (NHBD). Transplant services operating in the St. Louis region and around the country have adopted NHBD as a means of procuring organs from patients who are not brain dead by any set of criteria. Rather, in this procedure, the pronouncement of death is based upon the cessation of circulatory and respiratory function for 2 to 5 minutes after being removed from a ventilator. This "death watch" could take place in the operating room as the patient is prepared to become a donor with the transplant team in wait nearby.

In NHBD procedures, the determination to remove the patient from the ventilator is founded upon the medical team's prognosis that the patient is hopeless even though brain function continues. It is even possible that the patient could experience recovery of circulatory and respiratory function, consciousness, and, moreover, significant recovery if enough care was given. However, because of the protocol, some patients will never have this opportunity.

In NHBD some patients will be pronounced dead because their hearts did not begin to beat on their own or they were not given CPR within the 2 to 5 minutes determined by the protocol. A do not resuscitate order or a living will to that effect will prevent the CPR, of course. But because there is no sure bet that the patient's heart will stop after removal from the machine, the "death watch" begins -- a process that is aborted after 60 minutes if, indeed, the blood pressure and pulse continue. This means, of course, that the patient who was abandoned to death an hour earlier by the attending physician was, in fact, quite alive.

According to the protocol, in this scenario the patient will be returned to the room to die "naturally" with no treatment given. What will the team tell the family when the patient finally does die? Hours or days after the patient had been declared dead and then returned to the room, the family will learn that the organs will probably be of no use for donation purposes.

The NHBD protocol is cruel and dangerous and does not meet standards of respect for human life. Even the action of removal of the ventilator from a patient destined to become a donor could constitute a grave injustice against human life if the intention in doing so is to cause or hasten death. All hospitals should impose an immediate moratorium upon the procedure until such time as clearer, objective moral standards of determination of death are enacted. The conscience rights of all medical personnel who object to these procedures should be respected and protected.

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