July 3, 2022

Most organ donors not dead, says controversial article

“Not completely dead but dead enough”

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