Organ Donors Beware!

If you’re an organ donor, you may want to reconsider your decision after reading about five people who are alive today because someone accidentally noticed at the last moment that they were not really dead.  These are all 2008 cases:  Raleane Kuperschmidt, 65, of Minnesota, Zack Dunlap, 21, of Oklahoma, Val Thomas, 59, of West Virginia, a 45 year-old Parisian whose name was not published by French media, and Kevin Mark. 25, of Wyoming.  All were just seconds away from having their organs removed while they were still alive.  All have recovered and are grateful some family member did what their doctors should have done: made absolutely certain they were dead.

Zack, for instance, was saved by a cousin, Dan, who was also a nurse.  Not convinced that Zack was really dead, he ran a pocketknife over his foot and was startled when his “dead” cousin jerked his foot back.  He also dug his fingernail under one of Zack’s nails and behold, the “corpse” pulled his arm away!

The doctors who were about to extract his heart could, of course, have performed these same simple “operations” to make sure he was dead.  Instead, they were apparently more concerned about following approved protocols, watching the readings on their sophisticated equipment and the second hand on the clock to make sure they waited the recommended time, instead of watching the patient who had entrusted his life to them.  After all, you wouldn’t expect a protocol full of medical mumbo-jumbo to include the suggestion of running a knife down a patient’s foot.  How unprofessional that would be!

A recent article in The New England Journal of Medicine explains why such cases are not rare.  Drs. Robert Troug and Franklin Miller, after examining three cases of heart transplantation from infants who were pronounced dead on the basis of cardiac criteria, admitted that “The uncomfortable conclusion to be drawn…is that, although it may be perfectly ethical to remove vital organs for transplantation from patients who satisfy the diagnostic criteria of brain death, the reason it is ethical cannot be that we are convinced they are really dead.”

Let’s rephrase that last line better.  They’re saying that what doctors are doing today in hospitals all over the world MAY be ethical, not because the patients are actually dead but rather because they meet newer definitions of death agreed upon by various medical groups.

Before the development of modern critical care, people were considered dead when they were cold, blue, and stiff.  Unfortunately, organs from such traditional cadavers cannot be used for transplantation.  But now that new definitions of circulatory (cardiac) death and brain death (permanent cessation of functioning of the organism as a whole) have been accepted by the medical profession, organ transplantation has become mainstream, not to mention lucrative.

As Dr. Bernat of Dartmouth Medical School says, “researchers have begun to design ‘innovative’ protocols that aim to improve the function of transplants and expand the donor pool. These protocols test the conceptual limits of donation after circulatory death — by permitting invasive intervention in living organ donors or by altering the tests required to determine death.”

Get it?  The aim of these new protocols is not to prevent people like Dunlap from being killed before they are dead.  Just the opposite!  Their aim is to increase the supply of Dunlaps to meet the growing demand for more organs.    

Here are two types of invasive intervention being used: One, the administration of intravenous heparin or vasodilators, not to benefit the donor patient but only to improve the function of transplantable organs.  Two, instituting extracorporeal membrane oxygenation (ECMO) in the donor after the declaration of death.  As Dr. Bernat observed coolly, “This permits much more invasive intervention, including the insertion of arterial catheters before death.”

The dead donor rule states that a donor must be dead before vital organs are procured. Death statutes require the irreversible cessation of circulation and respiration or the irreversible cessation of brain functions.  However, John Shea M.D., a Canadian physician, points out that patients diagnosed as "brain dead" often continue to exhibit brain functions.  In "Organ Donation: The Inconvenient Truth" he points out that the criteria for brain death "test only for the absence of some specific brain reflexes.  Functions of the brain that are not considered are temperature control, blood pressure, cardiac rate and salt and water balance.  When a patient is declared brain dead, these functions are not only still present, but also frequently active."

Shea also notes that the very definition of "brain death" is vague and inconsistent: "There is no consensus on diagnostic criteria for brain death. They are the subject of intense international debate. Various sets of neurological criteria for the diagnosis of brain death are used.  A diagnosis of death by neurological criteria is theory, not scientific fact.  Also, irreversibility of neurological function is a prognosis, not a medically observable fact."

Commenting on the five cases mentioned above, Dr. Paul Byrne, neonatologist and Clinical Professor of Pediatrics, observed that, "While these stories are reported as something miraculous, what occurred is not supernatural at all…Zack was always living - his heart was always beating, there was always blood pressure, he was always very much alive."

Over the years Dr. Byrne has collected information about numerous cases where patients labeled brain dead have "returned from the dead."  The reason being, he says, “That brain death is never really death."

That being the case, we’re talking about euthanasia first, then organ transplanting.  Those three Denver infants, only hours old, were euthanised at the request of their parents so their organs could be donated.   

Zack's story should be taken as a warning about the insufficiency of the brain death criteria.  How many other organ donors are there who were not so lucky?  "Brain death was concocted,” says Byrne.  “It was made up in order to get organs.  It was never based on science."

Look at the back of your driver’s license.  You’ll notice that it’s now assumed that everyone wants to be a donor.  The state just wants to know which organs and tissue.  Not if, but which.  There’s no box to check if you don’t want any part of the program.  You’re warned that it’s a legal document, so you had better write NONE in that space if you don’t want your organs harvested before you’re dead.  And make sure a witness signs, too.

A new law passed by the Illinois General Assembly went into effect on January 1, 2007.  It reads, in part, “When there is a suitable candidate for organ donation and a donation or consent to donate has not yet been given, procedures to preserve the decedent's body for possible organ and tissue donation may be implemented under the authorization of the applicable organ procurement agency, at its own expense, prior to making a donation request pursuant to Section 5-25.”

While thinking about all this, keep in mind what J. A. Barondess of the New York Academy of Medicine wrote in his book, Medicine against Society: Lessons from the Third Reich: “The engagement of German biomedicine in the design and execution of Nazi programs of racial cleansing was extensive and was organized by physicians and other professional leaders.  In its active involvement and acquiescence, the German medical profession, one of the most sophisticated and respected medical enterprises in the world, dishonored itself and raised profound and persisting questions about the nature, strength, and relevance of the medical ethos and the relationship between medicine and the policies and programs of the state.”

Is history repeating itself here in America in a more subtle (and therefore more dangerous) way?

Sincerely,

Published in the November 19, 2008 Issue of Carroll County's Prairie Advocate News

Related Information:

Recovery After "Brain Death":
"Brain Dead" Man Saved from Organ Harvesting:  "Brain Death is Never Really Death"
Doctors Who Almost Dissected Living Patient Show "Brain Death" is Not Reliable
Woman Diagnosed as "Brain Dead" Walks and Talks after Awakening
Woman's Waking After Brain Death Raises Many Questions About Organ Donation
Comatose Patient Glad Parents Didn't Listen to Doctors' Euthanasia Suggestion   More...

Vatican Newspaper: Brain Death and thus Organ Donation Must be Reconsidered