The fuzzy frontier of death

Since trends normally begin in the New York Times, an article about organ donation on December 16 may signal a move towards redefining death to maximize the number of available organs. Darshak Sanghavi, the chief of pediatric cardiology at the University of Massachusetts Medical School, and Slate’s health care columnist, highlights the shortage of organs – 18 people die every day because they can’t get an organ – and the "inherently arbitrary" moment of death.

The thrust of Dr Sanghavi’s excellent overview of the ethical dilemmas in organ donation is that the protocols governing donation after cardiac death (DCD) need to be loosened. He contends that there are too few brain-dead organ donors to shorten the ever-lengthening waiting list. DCD donors, on the other hand, are far more numerous.

On the whole, DCD has had a slow uptake in American hospitals since it was endorsed by the Institute of Medicine in 1997. This body established that exactly 5 minutes should elapse after the heart stops beating before death can be declared and organs removed.

DCD has helped to increase supply. "Within a decade," writes Dr Sanghavi, "the number of such donors increased tenfold; they now account for 8 percent of organ transplants nationwide, up to 20 percent in certain areas."

But the pressure on transplant surgeons to procure more organs is relentless. So the standard protocols are being questioned. Why 5 minutes? By and large, doctors stick to the protocols, if only to avoid suspicion of body-snatching. However, Denver paediatric surgeons have set up a controversial 75-second protocol so that they can do heart transplants for infants.

Indeed, why not take this logic one step further and remove organs before death, if the patient is going to die anyway? Dr Sanghavi spoke to two couples who would have authorised the removal of hearts from their brain-damaged children before they were declared dead.

Dr Sanghavi wants the debate to begin now. "Though no religious organizations or right-to-life groups have yet mounted any opposition to DCD, including the Denver protocol, it is important to change practices in deliberate steps that give decision makers clear rules of action and establish gradual consensus." ~ New York Times Magazine, Dec 16


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