Before 1968, lack of heartbeat and breath were considered the defining signs of death. In 1968, a new kind of death criteria was introduced, “brain death.” As medicine advanced, so did ways of keeping people alive on respirators and feeding tubes, even if the brain no longer functioned. Throughout the 1970s, the science and legal communities came to define brain death as a complete absence of brain stem reflexes, no evidence of breathing on one’s own, and no sign of consciousness.
A recent article in NewScientist delves into new ethical issues surrounding brain death as it relates to organ donation. Right now, the world’s organ supply is dwindling. Up until now, the vast majority of organs are taken from patients with brain injuries so severe that they are declared brain dead before their bodies are taken off life support. Now, some places are looking to other means to obtain organs.
In most places, if a patient is on life support in an intensive care unit and a doctor recommends switching off the life support, they’d have to wait until the patient’s heart stopped beating, brain activity ceased, and for a doctor to officially declare her “brain-dead.” By that time, her organs would be too damaged to be usable.
In June, Ottawa Hospital in Canada announced its first organ transplant in recent history from a patient who hadn’t been classified as brain-dead, but whose heart had stopped – so-called “donation after cardiac death” (DCD). By switching to this definition of death for transplant purposes, doctors hope to increase the number of healthy organs available and the number of potential donors from which they can be harvested.
If the US adopted the definition, it would increase the supply of organs by up to 20%. But whenever science starts proposing modifications to established norms, it sparks intense debates. In this case, the biggest question is whether doctors will end up sacrificing patient care to save another patient on the organ donor waiting list. Will doctors be more likely to jump the gun and declare someone hopeless when they might have the potential to recover at some point in the future?
And what about the organ donors, themselves, who are clueless about such possibilities? Australia, for instance, is considering having a separate check box on the organ donor form to specifically allow people to consent to one or both forms of organ donation.
Still, the US tends to be more conservative about such matters, so I’m guessing that when the mainstream media picks up this debate, it’s likely to spark all sorts of controversy here.
