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The controversy over whether brain dead is really dead may have just heated up with a peer reviewed article in Spinal Cord ((2008) 46, 396-40. (I don’t have a link.)

The author, a Greek physician named KG Karakatsanis, concludes that declaration of death by neurological criteria is not reliable and may not be dead. The authors’ philosophical reaction with regard to organ donation is worrisome because, it seems to me, it would destroy the dead donor rule that requires vital non-paired organs to only be procured from dead bodies. Karakatsanis writes:

We consider that the interest of the organ transplantation program would be better served by ‘openness and honesty’. The harvesting of vital organs for transplantation—from patients suffering from ‘irreversible apneic coma’ (an identical clinical condition to ‘brain death1)—who had already given their informed consent for this purpose at an unsuspected time-would be socially and morally acceptable in societies which consider that the autonomy of the person justifies such a donation.
Again, we see hints that “choice” justifies everything, even potentially killing for organs. And if it is true for someone with a catastrophic brain injury, who may have decided ahead of time to donate in such a circumstance, why would it not be even more true of a person, say, who has become quadriplegic, is currently competent, believes their life is no longer worth living, and so asks to be euthanized and harvested? By the way, allowing just such scenarios have been proposed in respected bioethics journals.

This is very thin ice. If brain dead isn’t really dead, then only “heart dead” patients should be used as sources of non paired vital organs. If we go the other way, not only will solemn promises made to the public about the ethics of organ donation be broken, but with the shattering of the dead donor rule it would be Katy bar the door.

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