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Premature dispatch

Prolonging life for transplant recipients should not hasten death for donors

Issue: "Gulf toil," June 5, 2010

The transplant industry is extremely interested in the definition of death. Transplants now include kidneys, hearts, livers, pancreas, corneas, lungs, and other body parts. Even a face has been transplanted. These transplants allow recipients to continue their lives, lives which may have been marred without a transplant. But the number of needed organs exceeds the number of available organs for transplantation. On this shortage stands the definition of death. Liberalize the definition of death, and increase the number of available organs.

Medically, death occurs when the heart stops and breathing stops. These two parameters defined it for millennia. But with medical technology, applying that definition has become fuzzy and troubling. Death now includes brain death and cardiac death, with cardiac death the most controversial.

Brain death means the body essentially becomes a corpse, even though the heart beats. Not many object to transplants in those circumstances. However, total brain death alone is not easy to assess: Two physicians must declare a person brain dead and strict criteria must be met, including no EEG evidence of brain activity.

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The desire for more transplantable organs has resulted in a new definition of death based on cardiac death, even if the brain has some function. This type of death is more "problematic," as they say, because fresher organs are better organs for transplant and it's hard to get fresh organs if you have to wait for the heart to quit pumping.

Also, cardiac death results in clotted blood in blood vessels. The solution to this dilemma is a solution: If doctors inject a living patient with a solution of blood thinners and a preservative, the blood does not clot. But injecting the solution pretty much guarantees death, again "problematic" as they say.

A heart stopped for five minutes defines cardiac death for transplant in most circumstances. Some places use two minutes of no cardiac function to declare death. In Colorado, some pediatric transplant doctors wait only 75 seconds. In addition, with cardiac death transplant, the patient must die within 30 minutes of stopping mechanical ventilation or the patient is returned to the hospital room and the transplant attempt aborted.

Can one declare death after the heart has stopped for only 75 seconds? Is the heart really dead if it can be restarted in another person?

Abuses are rare, but occur. In one situation, an attending physician who had certified brain death in a patient called an ER doctor to confirm his findings. The ER doctor performed a cursory exam and agreed. The nurse on duty recognized signs of brain activity and called a third doctor who found brain activity that stayed the proposed transplant. One family member told of the transplant doctors calling her twice a day to see if she would consent to use of her child's organs for transplant.

Examples of liberal definitions of death are not hard to find. Many European countries now have an opt-out law instead of an opt-in law, which means organs are deemed available without consent-unless the decedent or the decedent's family specifically denies permission. New York Assemblyman Richard Brodsky recently proposed the same rules for New York state. However, such a law could force patients to be donors against their will. Also, patients fear doctors might not work as hard to save their lives if they are viewed as prospective donors.

I fully recognize the benefit of transplantation and the gift of life enjoyed now by so many transplant recipients. But tenuous life must be protected or more people will see the transplant doctors as vultures circling the patients with serious illness and injuries. Our zeal for prolonging life with transplants should not result in the premature dispatch of the living.

In John 11:25 Jesus tells us, "I am the resurrection and the life. Whoever believes in Me, though he die, yet shall he live." Our blessed hope is in God, who has no confusion about death.
-Matt Anderson is a practicing OB/GYN in Minnesota

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