The Dead Donor Rule and Organ Transplantation.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

An article written by Robert D. Truog. M.D., and Franklin G. Miller, Ph.D. published in the New England Journal of Medicine 359: 674-675 - August 14, 2008 may turn the concept of brain death and cardiac death upside down for people who respect human life.

Troug and Miller examine the ethics of the application of the dead donor rule. They explain the practise related to Brain Death criteria and Cardiac Death criteria and they determine that in each case the donor is often not actually dead.

Troug and Miller comment on Brain Death by stating:

“The definition of brain death requires the complete absence of all functions of the entire brain, yet many of these patients retain essential neurological function, such as the regulated secretion of hypothalamic hormones. Some have argued that these patients are dead because they are permanently unconscious (which is true), but if this is the justification, then patients in a permanent vegetative state, who breathe spontaneously, should also be diagnosed as dead, a characterization that most regard as implausible. Others have claimed that “brain-dead” patients are dead because their brain damage has led to the “permanent cessation of functioning of the organism as a whole.” Yet evidence shows that if these patients are supported beyond the acute phase of their illness (which is rarely done), they can survive for many years. The uncomfortable conclusion to be drawn from this literature 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.”

Troug and Miller comment on Cardiac Death by stating:

“The cardiac definition of death requires the irreversible cessation of cardiac function. Whereas the common understanding of “irreversible” is “impossible to reverse,” in this context irreversibility is interpreted as the result of choice not to reverse. This interpretation creates the paradox that the hearts of patients who have been declared dead on the basis of the irreversible loss of cardiac function have in fact been transplanted and have successfully functioned in the chest of another. Again, although it may be ethical to remove vital organs from these patients, we believe that the reason it is ethical cannot convincingly be that the donors are dead.”

Troug and Miller conclude that the Dead Donor Rule needs to be abandoned and replaced by “requirements for organ donation in terms of valid informed consent under limited conditions of devastating neurologic injury.” They suggest that this new criteria: “optimally respects the desires of those who wish to donate organs, and has the potential to maximize the number and quality of organs available to those in need.”

Please note that I am only commenting on the statements within the article.

This article directly challenges the current accepted notions in relation to brain death criteria and cardiac death criteria, and it does this from a secular, pro-organ donation point of view.

Troug and Miller are suggesting that organ donation is ethical, not because the donors are dead but rather because they believe that directly and intentionally causing the death of a person for the reason of obtaining organs for transplant is ethical when consent in some way is obtained or known and when the person is unlikely to neurologically recover.

This is the same ideology that is proclaimed by Princeton Universities, Peter Singer and this is the same ideology that justifies euthanasia and assisted suicide.

Link to the article:
http://content.nejm.org/cgi/content/full/359/7/674?query=TOC