New organ transplant procedure violates the dead donor rule

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Sharon Kirkey wrote an indepth article for the National Post that was published on October 19 concerning the new organ transplant procedure that is challenging ethical guidelines. Kirkey explains:

The procedure, known as normothermic regional perfusion (NRP) is already legal in some jurisdictions, outlawed in others and has medical ethicists split over whether it invalidates the declaration of death and violates the dead donor rule, which holds that organs should only be taken from dead patients.

Kirkey states that the Canadian transplant community is getting ready to adopt the new procedure. Kirkey explains the development of organ donation.

Organs were once only ever removed from donors declared brain dead, which is defined as the complete and irreversible loss of all brain function. They’re medically and legally dead, but their hearts are still beating. A ventilator keeps oxygen flowing to the heart and other organs until they can be retrieved for transplant.

In 2006, doctors began removing organs from “controlled circulatory death” donors, people who aren’t brain dead but whose prospects for recovery are so grim a decision is made to withdraw life support.

Life support is removed and, after the heart stops and surgeons wait an obligatory five-minute “no touch” period to ensure the heart has permanently ceased beating, organ procurement can begin.

Kirkey explains how traditional organ donation procedures cause the organs to start dying, Kirkey explains:

The difficulty is that the heart and other organs are starved of oxygen and nutrients during the dying process and the mandated waiting period. The heart is especially sensitive to warm ischemia time, time without blood flow and oxygen. Organs can become unsuitable for transplant or take longer to recover once put inside the recipient than they would have “if they’d been getting blood flow the whole time,” said Toronto nephrologist Dr. Jeffrey Schiff, president of the Canadian Society of Transplantation.

Dr Schiff explains, that the same problem does not exist for NPR because the blood continues to flow to the vital organs. Kirkey writes:

With NRP, once death is declared, the major arteries supplying blood to the brain are clamped and tied off. The donor is quickly connected, via cannulas placed inside large blood vessels, to a machine that funnels their blood into a device that adds oxygen and removes carbon dioxide before pumping it back into the body. The goal is to reverse damage to the organs and improve their function.

The obvious problem with NRP is that it may violate the dead donor rule because the person is intentionally allowed to die, then declared dead, and then the body is revived but the blood supply is clamped off from the brain.

When you revive the body for the purpose of organ donation but deny blood to the brain to ensure brain death, then you are intentionally not permitting a person to live, who may have continued to live.

Kirkey explains how the American College of Physicians have asked that NPR be stopped. She writes:

The American College of Physicians, which wants the use of NRP to be paused, argues that by restarting circulation, even artificially, NRP undermines the validity of the definition of circulatory death because “the patient is, in fact, successfully resuscitated.”

Critics also say NRP challenges the dead donor rule, which holds that donors can’t be made dead to obtain their organs and that organ retrieval can’t cause death. By cutting off blood flow to the brain, the doctors’ college argues, “the patient is now dead by brain death criteria — due to actions taken by the physicians procuring the organs.”

Kirkey also interviews Dr Charles Weijer, a professor of medicine and philosophy at Western University who does not oppose NPR but has concerns about whether the technique blocks off all blood to the brain, meaning that it may be possible that the person's brain reanimates while the organ retrieval process is occuring.

An article written by Bioethicist Wesley Smith and published in the Epoch Times on October 17 stated:

This is a terrible mistake. If a patient is resuscitated after cardiac arrest, the person is not dead! Cutting off blood flow to the brain to cause brain death thereafter seems awfully close to reviving the patient and then killing him. This is not only immoral—and arguably illegal as a violation of the DDR—but it also represents another in a long series of violations that have bred so much public distrust in institutions.

I wrote an article on this topic on September 29 which stated:

The new organ donation method ignores the "dead donor rule." What this means is that people who are possibly dying or nearly dead could be essentially killed for their organs. Several factors that are driving this change are that living donors provide healthier organs for transplant; the medical community is rejecting the concept of "do no harm;" and the demand for healthier organs for donation are fulfilled by this procedure.

People who oppose killing will not be able to trust the ethics of organ donation. It is not that I oppose donating organs after death, it is that I cannot be assured that I am dead when the organs are removed.

This technique ignores the dead donor rule and paves the way for euthanasia by organ donation.