TRANSPLANTS

When should organs be donated?

Are patients on life support dead?

In Summary

• Brain death is seen to validate procuring of vital organs such as the heart from patients who are nearly dying but are not yet dead.

• After withdrawing life support, the physician is supposed to 'wait for the patient to die' before procuring organs and really, can a heart that has stopped beating be used for transplantation?

To clearly understand deceased organ donation, it is imperative to understand the definition of death and its effect on whether a deceased person can indeed be a donor or not. Not all deceased persons are legally or medically fit to be organ donors.

Traditionally death was said to occur when an individual experienced a cardio-respiratory failure, that is, when they ceased to breath or when their hearts stopped beating. It included using basic cardiopulmonary standards including; feeling the pulse, listening for breathing, holding a mirror before the nose to test for condensation and looking to see if the pupils were fixed.

However, with the rise of modern medicine, technology could perform vital bodily functions such as breathing through a ventilator machine. Because of this, the connection between cessation and vital functions began to loosen and the traditional standards of determining death could no longer suffice.

As a result, there was need to broaden both legal and clinical definition of death to recognise the irreversible loss of brain function as a way of determining death. This meant that brain dead patients would be treated as legally dead and this came to the aid of those who had concerns with the use of people without brain function for organ donation.

Nevertheless, to avoid causing death by procuring vital organs, doctors are guided by the Dead Donor Rule (DDR) when procuring organs from brain dead patients. The DDR does not allow recovery of vital organs until the patient has been declared dead after withdrawal of life support.

Brain death is however not without controversies, even though a person who is brain dead is legally and clinically dead, their hearts are kept beating and their blood still flows to their organs through an artificial respiratory machine and so they still appear as though they are alive. As it is, brain death is seen to validate procuring of vital organs such as the heart from patients who are nearly dying but are not yet dead.

This raises questions such as; are patients who are on life support dead? And should their vital organs such as the heart and lungs be procured? What would be the cause of their death—organ donation or withdrawal of life support? It is true that with the withdrawal of life support, the patient would be dead but then again, what is the situation before the machine is turned off? Isn’t the patient already well within the definition of death?

If this is the case, turning off the life support machine is not to be questioned because this act would not really kill a patient who is already dead. This was actually a decision held by the New Jersey Supreme Court when it was first confronted by the question of the definition of death in the case of Karen Ann Quinlan.

In deciding whether or not to withdraw life support machine, the judges held that withdrawal of life support does not cause a patient’s death rather it allows the patient to die and it is the disease that causes the death of the patient and not the physician who withdraws the life support machine. 

Nevertheless, to avoid causing death by procuring vital organs, doctors are guided by the Dead Donor Rule (DDR) when procuring organs from brain dead patients. The DDR does not allow recovery of vital organs until the patient has been declared dead after withdrawal of life support.

Well, we can’t really say that the DDR has not prevented premature organ procurement (early grave robbing) but at the same time we can’t say for sure that the rule has not contributed to the shortage of organs for donation.

Yet, DDR is neither a statute nor a regulation, rather it is an ethical prohibition put in place to prevent physicians from causing the death of patients. This is argued to be the reason why the world is still being faced with shortage of organs for donation, even after broadening the definition of death to match modern medicine advancement.

 

Reason being, even after withdrawing life support, the physician is supposed to 'wait for the patient to die' before procuring organs and really, can a heart that has stopped beating be used for transplantation?

Well, we can’t really say that the DDR has not prevented premature organ procurement (early grave robbing) but at the same time we can’t say for sure that the rule has not contributed to the shortage of organs for donation.

What we can say irrefutably is that there ought to be definite legal, medical, and ethical guidelines to essentially explain the very thin line between life and death; one that will guide the procuring of deceased organs for donation as a way of countering the global shortage of organs for donation.

Advocate of the High Court