Here we go again! The push to transform the most ill and disabled living human bodies into so many organ farms continues among some bioethicists and within organ transplant ethical discourse. Now, an article in the American Journal of Bioethics, written by organ surgeon and medical professor Paul E Morrissey, urges that patients who are going to have life support removed and then become organ donors after death, instead have their kidneys harvested while still alive. From the Abstract:
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor’s death, this approach satisfies the dead donor rule. The donor family’s wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
Allow me to translate: The author is discussing organ procurement from what is known as ”non heart-beating cadaver donors,” under what I call “heart death” ethical protocols. Done properly, I support the approach. But the temptation to cut corners is very strong.
Here’s how the system is supposed to work. When a decision is made to remove life support and allow organ donation, the patient is moved to a surgical suite. The medical team—which is kept strictly separate from the organ retrieval team, and which is not supposed to make patient care decisions based on organ donation—attends to the patient awaiting cardiac arrest after removal of life support. If the patient breathes on his or her own and doesn’t expire, life support is restored and the patient returned to the ward for further treatment decisions. At that point, he or she is no longer eligible to be a donor under the protocol.
Morrissey would destroy the current protocol under the sophistic premise that removing the kidneys wouldn’t actually cause death. That’s too clever by half. First, the trauma of the surgery could at least sometimes be the cause of death. But beyond that, sometimes these patients live after removal of life support. Look at Karen Ann Quinlan. Even though she wasn’t going to be an organ donor, when life support was removed as happens in organ donation circumstances, she lived for about 10 years. Take away both of a patient’s kidneys and that patient will die.
More importantly, Morrissey’s benighted idea would destroy medical ethics by treating the living patients as organ farms rather than persons. Under current protocols, the treatment of the patient is supposed to be the same regardless of whether organs will be procured after death. That is why even providing a non therapeutic administration of an organ preserving drug is controversial.
But bringing the organ team in while the patient was still alive would shatter the brick wall that separates patient care from cadaver organ procurement like an 8.2 on the Richter Scale earthquake. It would turn patients into things. And in the doing, it would destroy not only medical ethics—the proper care of the individual patient—but trust in the organ donation system generally.
I know that there is an organ shortage. But breaking solemn promises made to the public about organ transplant ethics will make things worse, not better, and further the ongoing transformation of the most defenseless and vulnerable human beings into exploitable natural resources.