Skip to comments.Killing for Organs: Taking Neurologically Devastated Patients' Kidneys Before Death
Posted on 04/10/2010 12:47:46 PM PDT by wagglebee
As I have repeatedly reported here and elsewhere, some bioethicists and others in the transplant community seek permission to harvest patients organs before they are dead. The latest example is in the Winter 2010 edition of Lahey Clinical Journal of Medical Ethics, in which Brown University transplant surgeon, Dr. Paul Morrissey, argues that to obtain more usable kidneys, organs should be taken from neurologically devastated patients without first withdrawing life support and waiting for death by cardiac arrest. From the article Kidney Donation From Brain-Injured Patients Before a Declaration of Death:
My proposed model uncouples organ donation from the donors death. The process begins as before with they identification of an individual with good renal function and with severe, irreversible brain injury with no hope for purposeful or prolonged existence. The family decides to withdraw care with the expectation of the patients imminent death. A DNR order is written. With the consent of the donor family, the patient is transported to the operating room for kidney recovery. Both kidneys are recovered in a controlled surgical procedure with vascular control, equivalent to bilateral nephrectomy in a neurologically intact patient. General anesthesia and standard analgesic care are administered, as would be given to a trauma victim with severe head injury undergoing surgery. The patient returns to the intensive care unit and end-of-life care is instituted, in a more relaxed time period without the requisite rush to the operating room following asystole. This protocol enables the family to grieve and spend time with the decedent after death.
Currently, a donor must first be declared dead, either by neurological criteria (brain death)not the kind discussed hereor after removal of life support and cardiac arrest. This proposal would reverse the order, first take the kidneys, and then remove the life support, under the pretense of obeying the dead donor rule as the actual death could come after the kidneys were removed. But this sophistry: The patient couldnt possibly live without kidneys, and many would die during the surgery.
Morrissey says these patients will die if life support is removed anyway. Indeed, he claims:
With what certainty do we know that cardiopulmonary death will ensue following the withdrawal of life-sustaining therapy? To date, no patient entered into consideration for DCD has been reported to have prolonged cardiac function or entered a persistent vegetative state. Cases of prolonged cardiac function after extubation beyond even 24 hours are exceedingly rare.
So in essence, whats the harm? Theres plenty: Consent or no consent, there is harm in treating a patient like an objectboth to the specific individual and society. Besides, plenty of patients considered for the heart death protocol didnt become donors precisely because they didnt die within an hour as expected. Moreover, according to a study published last year in the Journal of Intensive Care Medicine, as reported here:
There is a misconception that withdrawal of ventilatory and hemodynamic support will result in immediate or imminent death in the ICU. A survey of withdrawal of mechanical ventilation in the critically ill adults at 15 ICUs found that 21 of 166 patients (13%) survived to ICU discharge after withdrawal of life support.
Dr. Morrissey might respond by differentiating his proposal from the patients in this study, since he would select only the most imminently dying from devastating head injuries. Perhaps, but as this blog has abundantly demonstrated, standards slip. Besides, it is certainly conceivable that at least some patients whose kidneys were removed could possibly have otherwise survived withdrawal of mechanical ventilation.
Dr. Morrisseys proposal would indeed, be killing for organs, even if the heart stopped after removing the organs. Moreover, once we walked through that door, the practice would only expand as a matter of simple logic. To maintain the peoples trust in transplant medicine and to prevent human beings from being used as mere harvestable resource, such proposals should be rejected at every turn.
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With apologies to Gene Wilder and the cast: “Is it fresh?” “It is very fresh, Master.”
So much for the hippocratic oath.
The problem is when they stop asking for permission.
If they paid even a modest sum they would have more organs than they could handle.
What we have now is them saving money by letting people on waiting lists die.
welcome to the future of all healthcare.
Liberal Brown University says that if someone’s brain has been disconnected from their nervous system it is a-okay to harvest their parts for the good of society. Let the harvesting of progressive democrats commence!
Dr. Mengele I presume? History....history...history....God save the Republic.
It is reprehensible stories like this that have made me adamantly AGAINST donating my organs or those of my family members. No only had those wretched transplant ghouls best not even ask me to donate a family member’s organs but they had best not even look like they are walking in my direction. It would take SEVERAL members of the hospital’s security staff to pull me off those damned grave robbers. Vile, disgusting creatures all.
This produces a visceral hatred of the subject of donation that I cannot intellectual explain. I do NOT trust the medical staff of hospitals that would view me and mine not as patients, but as ‘potential’ donors.
...with no hope for purposeful or prolonged existence.
Notice the use of the word "or" instead of "and". Not that I would agree if he had used "and", but it does reveal a certain mindset.
Exactly! Organ transplantation is one of the greatest advances in medical history, but the disrespect that many in the medical community show toward the living is ruining it.
And what the hell does “purposeful” even mean? I can list hundreds of politicians whose continued purpose is entirely detrimental.
Eventually, if the organ takers get too greedy, I can imagine a prophylaxis. A one time injection of a weakened pathogen that will insure that organs will never be used.
What the optimum “false positive” would be is uncertain, but once in your system, it would make normal, healthy organs seem to be unacceptable. Then, along with your identification, make sure that it is clearly marked, not that you don’t *want* to be an organ donor, but that you *cannot* be an organ donor. Under *any* circumstances.
It is a simple case of persuasion. Doctors are very capable of disregarding your desires and opinions vs. what they want. But they are far less able to ignore or disregard objective warnings known to medicine.
He should make this clear by simply stating this would only apply to the brain dead.
I’m very much in favor of organ transplantation but I’ll never be a donor until they allow the sale of organs so my family would get something out of it when i’m done.
One problem now is of whom they ask permission. I have observed the very real situation of permission for donation after cardiac death, the withdrawal of life support in preparation for organ donation, being granted by children. Frequently there is a large inheritance at stake. The entire transplant industry stinks to the core.
Organ harvesters do more stripping than poll dancers. People, wake up. The procedure is heinous. The brain has to be alive for the heart to beat. Heinous, heinous, heinous.
HCA got nothing for their enthusiasm and extreme poor taste. Not one eyeball!