Many Australian organ donors are not really dead, claims a Sydney doctors in a controversial article. Writing in the latest issue of the Journal of Law and Medicine, Dr James Tibballs, of Royal Children's Hospital, in Melbourne, says that “organ donation is presently commonly carried out on persons not actually dead but rather in the process of dying or ‘not completely dead but dead enough’”.

These sensational allegation were angrily denied by other doctors. Professor Geoffrey Dobb, chair of the Australian and New Zealand Intensive Care Society's committee on organ and tissue donation, told The Age that that brain dead patients were really dead. "I strongly emphasise that this view is an extreme minority point of view," Professor Dobb said. Other doctors said that Dr Tibballs’s argument was irresponsible because it would deter donors. "We know that every organ donor potentially saves or greatly enhances the lives of up to six other people, so even the loss of a single donor or someone who wished to be a donor is a major loss to the community as a whole," said Professor Dobb.

What may have sparked Dr Tibballs’s foray into international controversy was an incident in Sydney two years ago, when relatives of an elderly man disputed a hospital’s decision to remove life support. Dr Tibballs concluded that many members of the public do not understand the medical definition of death and a significant minority feel that relatives were still alive when organ donation occurred.

Australian doctors – and doctors around the world – are removing organs even though there is no certainty about donor death, contends Dr Tibballs. He observes that “From a pragmatic point of view, it is evident that the dead donor rule cannot be fulfilled – it is impossible to be certain that all function of the brain has ceased irreversibly or that the circulation has ceased irreversibly as required” under Australian law.

The problem is that the clinical guidelines used to diagnose brain death cannot conclusively prove irreversible cessation of all brain function. The notion of brain death was introduced into Australian law in 1977 as a "convenient fiction" to allow the development of organ transplantation.

The other criterion for death, cardiac death, or the absence of blood circulation, is usually done when the heart fails to restart itself for two minutes -- not after proven "irreversible cessation" of its functioning. The rule was set at two-minutes to ensure that the organs could be harvested in time, he says.

Dr Tibballs’s remarks come at time when the dead donor rule is being criticised from two directions. Some doctors and ethicists say that most donors are not dead and that therefore almost no organ donation is ethically possible. Others argue that only living people are good sources of organs, so the dead donor rule should be abolished. The dispute even featured in a recent issue of The Economist. Essentially the problem hinges on determining exactly what death is; it is not a matter of 21st Century body-snatching. But this is a philosophical problem on which it is not easy to reach a consensus. ~ The Age, Oct 20; Journal of Law and Medicine