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by Julie Grimstad
The campaign to persuade people to donate their organs is impossible to ignore. Billboards plead, "Give the Gift of Life." Newspapers and magazines run story after story about grieving families who have been comforted by donating a loved one's organs and the new lease on life these acts of generosity have given grateful recipients. News programs spotlight the shortage of transplantable organs and the thousands of people who die awaiting transplants. When we apply for a driver's license, we are confronted with the "opportunity" to check "Yes" to organ donation. Likewise, when we prepare advance directives.
This zeal to save as many lives as possible through organ transplantation is certainly understandable. However, while we are bombarded with appeals to our emotions, the facts we need in order to make genuinely informed and moral decisions are notably absent. We must use our heads as well as our hearts when we answer questions about organ donation for ourselves or for loved ones. There are certain truths we need to know.
Firstly, the charitable donation of one of a person's two healthy kidneys or a lobe of his liver is morally permissible. This is true because the removal of one kidney or part of a liver would not normally result in harm or death to the donor. However, for such donations, there is no need to sign anything ahead of time. The donor is healthy, conscious and able to consent for himself at the time.
Secondly, let's look at some cold, hard facts.
Before organ transplantation became possible, physicians took the time needed to determine death in order not to treat the living as dead. Today, death is often hastily declared, not for the patient's welfare, but in order to ensure that the desired organs are alive. Removal ("harvesting") of the heart, lungs, liver, pancreas and kidneys must be done before they begin to deteriorate due to cessation of blood circulation. Vital organs are useless if organ harvesters wait the time necessary to determine that a person is certainly dead.
Judging a person "dead" when he is still alive is not an unimportant mistake.
In the past, a physician pronounced death when there was no breathing, no heartbeat, and no response to stimulation. Today, a person can be judged "brain dead" while his heart is still beating, and his circulation and respiration are normal. In fact, a "brain dead" organ donor may react violently to the stimulation of being cut into to remove his organs. Surgeons have come to rely on a paralyzing drug to keep the donor's body from squirming and grimacing. However, even though movement is suppressed, the donor's blood pressure and heart rate increase, and his heart continues beating until the surgeon stops it just before removing it.
There are many different sets of criteria for determining "brain death." A physician is free to use any set of criteria. Thus, a patient could be pronounced dead by one set, when use of another set would determine that he is still alive. It is also important to know that the medical community is divided about whether "brain death" is actual death. As Dr. Stuart Youngner wrote in a letter to the editor of the New England Journal of Medicine, 11/17/1994: "The signs of life in brain dead patients...are very real and cannot be discounted in human terms, even if we have done so in public policy."
While questions about "brain death" are still being debated, it is apparent that the number of organs from people declared "brain dead" will never be enough to meet the demand. Therefore, new sources of organs are being sought. Nancy Valko, RN, is one person who has been sounding the alarm about the latest source: patients who are not "brain dead" but are on ventilators and considered "hopeless." In a paper presented in July 2002 at the Center for Bioethics and Human Dignity Conference, Trinity University of Illinois, she stated:
In these patients, the ventilator is withdrawn and organs are quickly taken when cardiac death rather than brain death is pronounced. This is known as non-heart-beating organ donation. At the present time, about half of all organ procurement organizations have been involved in at least one NHBD procedure, even though most people are unaware of this new method of obtaining organs.
People have been led to believe that organs will be taken only after "all efforts to save your life have been exhausted." This is not necessarily so. Valko told about "one of the first and few public discussions of NHBD in the media." In April 1997, CBSÕs 60 Minutes aired a segment that began with the case of a woman who had been shot in the head. She was not "brain dead," but was judged to be fatally injured and a perfect candidate for NHBD. However, the medical examiner who conducted a later autopsy said that he believed the wound was survivable. Narrator Mike Wallace questioned NHBD policies that would allow taking organs from persons who could be, in WallaceÕs words, "not quite dead." (For more information, read "Ethical Implications of Non-Heart-Beating Organ Donation" by Nancy Valko, RN, Voices, the publication of Women for Faith and Family, Fall 2002.)
In our society, criticism of organ transplantation policies has become taboo. It is somehow perceived as impolite to voice our misgivings. When we do so, we seem unsympathetic to those who need organ transplants to live. We might even hurt the feelings of people who have donated the organs of loved ones or have received transplants. But, the bottom line is, when you agree to be an organ donor, you may be giving transplant surgeons permission to terminate your life.
As in any other issue involving moral principles, we must be sure that a good end does not justify any and every means. Even if it is done to save the life of another, to cut out a vital organ prior to being absolutely certain that the donor is actually dead does not respect the unique dignity of the human person.
Julie Grimstad is the primary writer and editor of Euthanasia: Imposed Death. She is the executive director of Life is Worth Living, Inc., whose members are dedicated to the authentic restoration of respect for human life. Julie co-founded and served as the director of the Center for the Rights of the Terminally Ill from 1985 to 2003. A patient advocate, public speaker and writer, she is recognized for her long-standing focus on end-of-life issues. She resides in Stevens Point, WI. Julie may be contacted by email at lifeisworthliving@sbcglobal.net.
