April 22, 2024

The fuzzy frontier of death

Why protocols for organ donation could change

Since trends normally begin in the New York
, 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

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

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


Michael Cook
brain death
donation after cardiac death
organ donation