Brain-Death Protocol for Voluntary Execution
followed by Organ Donation


SYNOPSIS:

    The following suggested procedures for achieving brain-death
in a prisoner being executed
who has volunteered to donate his or her organs after execution
will be modified, expanded, & adapted as needed
by various legal and medical systems around the world.
And this original essay will be modified over the years.

    What are the best practices and procedures for executing the prisoner
in order to preserve his or her organs for immediate transplant?
How should brain-death be achieved and certified?
What safeguards should be fulfilled at each step in the process?

OUTLINE:

1.  AT LEAST ONE YEAR OF ADVANCE PLANNING.

2.  MEDICAL TESTING BY THE TRANSPLANT-TEAM
            WITHIN PRISON WALLS.

3.  BRAIN-DEATH IS THE IDEAL METHOD OF EXECUTION.

4.  AN INDEPENDENT PHYSICIAN
            CERTIFIES THAT THE PRISONER IS DEAD.

5.  THE BODY BECOMES THE PROPERTY
            OF THE MEDICAL INSTITUTION
            THAT HAS AGREED IN ADVANCE
            TO ACCEPT THE DONATED ORGANS.

6.  NEWS MEDIA WILL WANT TO KNOW WHO GOT THE ORGANS.





Brain-Death Protocol for Voluntary Execution
followed by Organ Donation

by James Leonard Park

    The prisoner has volunteered to be executed.
Only about 1 prisoner in 1,000 will freely select this method of meeting death.
And elaborate safeguards will be needed to make absolutely certain
that the prisoner is really making a free choice for execution
and is not being coerced, manipulated, or rewarded in any way.
Another essay asks this question:
"Can a Prisoner Ever Make a Free Choice?"
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/FREE-PRI.html
This essay includes 10 safeguards, which call for the opinions of others
about the voluntariness of the prisoner's choice of execution.

    And because 'voluntary execution' seems such a paradox,
it receives a full explanation here:
"Voluntary Execution: Better than Capital Punishment?":
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/CY-VX.html.




1.  AT LEAST ONE YEAR OF ADVANCE PLANNING.

    In order to assure that the prisoner is choosing a voluntary execution,
this decision must be re-affirmed at least once per month
over a period of 12 months or more.
The prisoner can prove that he or she is freely choosing execution
by various methods of writing, speaking, & recording the decision
for a wide variety of persons not connected with the prison system.

    The prisoner should retain the right to rescind or postpone
the decision for voluntary execution
up until the last moment of consciousness.
This freedom to change the plan for death will make it obvious
that the prisoner was not under pressure to accept execution.
The witnesses at the execution will observe
the last re-affirmation of the choice to die at this time.

    If the prisoner is offering his or her organs for transplant after execution,
then the cooperating transplant-team will be allowed to do any testing
beginning at some time at least six months
into the period for proving that the decision for death is really voluntary
and that the prisoner continues to be determined
to follow this course toward voluntary execution.

    Thus, the transplant-team will not become involved with prisoners
who change their minds about voluntary execution early in the process.
If prisoners initially determined to accept voluntary execution
(perhaps followed by organ donation)
later decide that they would like to live a bit longer in prison,
they can cancel their plans or postpone the date of voluntary execution.

    But the prisoners who continue to re-affirm their plans
for voluntary execution followed by organ donation
will cooperate fully with all of the necessary medical testing
to make sure their organs will be viable after execution
and to determine their tissue and blood types
in order to match them with the best recipients of their donated organs.

    Because of problems and objections that will necessarily arise
concerning the first voluntary executions followed by organ donation,
the planning period will probably be more than one year.
But each additional month of planning and preparation
will provide further proof that this plan for saving lives
can be a valid and meaningful way for a prisoner to choose death.




2.  MEDICAL TESTING BY THE TRANSPLANT-TEAM
            WITHIN PRISON WALLS.


    Beginning about 6 months into the planning process
which is also at least 6 months before the date of execution
the most appropriate members of the transplant-team
will be permitted to visit, examine, question, & test the donating prisoner.

    Six months advance planning will make the organ-donations
more successful than any others performed by the same transplant-team.
Usually they work with organs that become available on very short notice.
(Accident victims do not know their dates of death in advance.)

    All expenses of this medical testing by the transplant-team
will be borne by the transplant institution and not by the prison system.
These costs will fall within the organ-procurement parts of their budgets.
Ultimately all of these costs will be part of the total cost of the transplants.
And these expenses will be paid by
whatever health-care systems are paying for the transplants.
The only additional cost to the prison system
will be whatever additional security might be needed
for allowing visits by medical personnel
and all the communication that will be necessary
to coordinate the planning for organ-transplantation after execution.

    Such advance cooperation among
the transplant-team, the prisoner, & the prison system
will give everyone involved ample opportunity
to re-consider their thinking about the whole process
of voluntary execution followed by organ donation.
Some of the medical personnel might decide not to participate
because they do not want to know the donor as a person
before they see the brain-dead body on the operating table.

    Such advance planning and coordination
(embracing several months of time)
will allow everyone involved to reconsider their plans.
The prisoner must re-affirm his or her decision
to choose voluntary execution and organ donation
at least six more times during this second half
of the one-year count-down to the day of execution.

    And the fact of the continuing cooperation with the transplant-team
should be dramatic proof to distant skeptics
that this prisoner really wants to donate his of her organs after execution.
The doctors examining the prisoner and testing his or her organs
will be able to testify that as far as they could tell
the donor was not being manipulated or coerced in any way.

     If the transplant-team discovers any medical conditions in the prisoner
that must be addressed before organs can be transplanted,
these can be corrected during the remaining months before execution.
For example, the prisoner might have some infectious disease,
which can be completely cured before execution.
This will allow the doctors to affirm that the organs are free of disease
with a higher degree of certainty than is usually possible
when an organ-donor dies without any advance planning.

    Some potential recipients of the organs to be donated
might decline to receive these specific organs
because they came from an executed criminal.
Others in the waiting pool of patients needing organs
will happily step into this gap
because having continued life is more important to them
than the identify of the donor.

    In the normal, emergency situations of organ-donation,
no one has the luxury of such time for reflection.
The transplant-team will continue to accept ordinary donations
during all of the months of preparation for this special donation.
And they will have ample opportunity to compare the procedures
they normally use for obtaining, preserving, & transplanting organs
to the special circumstances of a donation from an executed prisoner.
Those members of the transplant-team who have qualms
about accepting organs obtained from an executed prisoner
will not be forced to participate.
They can be assigned to other duties at the transplant center
whenever the prisoner-donor is being evaluated
and when this particular dead-donor comes into their institution.




3.  BRAIN-DEATH IS THE IDEAL METHOD OF EXECUTION.

    Brain-death is now well-established as a definition of death.
When the human brain has no oxygen for a few minutes, it dies.
Brain-death is declared after elaborate testing
to make certain that this brain will never resume its normal functions.
And when brain-death has been certified by a physician
who has used all the appropriate tests,
then all others should agree that this executed prisoner is now dead.

    The specific tests for the cessation of brain functions
will not be included here since they are too technical for most of us.
Also, they are subject to continual revisions.
The Internet provides plenty of (constantly updated)
information under this search-term: "brain death protocol".

    Slight modifications of the standard methods for determining brain-death
will likely be made for the situation of intentionally-creating brain-death
as a means of executing a willing prisoner
with the additional plan to donate organs after execution.

    For example, when brain-death is achieved by the executioner
rather than accidentally resulting from an auto crash,
the doctor who must declare brain-death
will know the exact mechanism by which this brain died.
The elaborate testing sometimes needed to rule-out
conditions easily confused with brain-death
will not be needed in the case of voluntary execution.
This brain did not suffer accidental drowning, freeing, or drug-overdose.
The duration of oxygen-deprivation, for example, will be known precisely
because it was achieved by controlled conditions in the prison.

    Also, because this was a planned execution, not an accidental death,
the usual delay for re-testing will probably not be necessary. 
Instead of attempting to restore the functions of this brain,
the medical people will be cooperating in a process
intended to terminate all functions of this brain.
(And, as said before, doctors and nurses who have doubts
about accepting organs from executed prisoners
will not be required to participate.)

    However, perhaps the first few executions by brain-death
will have to be prolonged in order to assure all distant skeptics
that the prisoner is absolutely and permanently dead.
Because 'life-support' systems will be used to preserve the organs,
there will less need to rush to the operating room.
When the organ-donor was a victim of an accident,
the organs must be harvested immediately
because the damaged body even with 'life-support' systems
will not be able to maintain the organs indefinitely.
The body of the executed prisoner might be kept inside the prison walls
for 24 hours after the execution just to assure skeptics
that the prisoner is really dead and can never be revived.

    The 'life-support' systems provided by the transplant-team
will keep the organs alive within the body of the brain-dead donor.
And these 'life-support' systems will continue to operate
while the body is moved to the transplant center,
where the specific patients chosen to receive these organs
have been prepared in advance.




4.  AN INDEPENDENT PHYSICIAN
            CERTIFIES THAT THE PRISONER IS DEAD.


    Even in executions achieved by any others means,
the prisoner's death must be declared by a physician.
Normally it is obvious to all observers and witnesses
that the prisoner is dead and that he or she died by execution.
But it is nevertheless required that the prison doctor
(or some other licensed physician employed for this purpose)
examine the body in detail to make certain that death has occurred.

    In the case of brain-death achieved by a new method of execution,
it will be especially important for an independent physician to certify death.
In this case, the regular prison doctor might not be sufficient
because most doctors are not trained
in the specific tests needed to certify brain-death.
Therefore, in the case of brain-death as a method of execution,
a specialist in determining brain-death might be needed.

    Everyone must be convinced that the prisoner has been executed.
The warden of the prison will record the date and time of the execution.
The news media will be informed of the exact time of death.




5.  THE BODY BECOMES THE PROPERTY
            OF THE MEDICAL INSTITUTION

            THAT HAS AGREED IN ADVANCE
            TO ACCEPT THE DONATED ORGANS.


    At first it might seem like a minor detail,
but the legal possession of the body of the executed prisoner
symbolizes in one concrete way the transition from life to death.
The prisoner has sacrificed his or her life in an organized way
in order that others might benefit from his or her death.
All future costs for maintaining this body fall within
the medical care of those who will receive the donated organs.
The prison system pays nothing after the execution of the prisoner.

    While still connected to the all necessary 'life-support' systems,
the body of the executed prisoner will be moved to the transplant center.
This can be done in an orderly and dignified way.
It will not be an emergency transportation of a brain-dead donor,
which usually must be accomplished at great speed
because the organs are dying within the body of the donor.

    The organs of the executed donor will be relatively easy to preserve
because the medical people who will be taking care of the donor's body
will know the exact cause of death
and any other particular facts about this donor
that might be relevant to what will happen to the organs
after the donor's body reaches the transplant center.

    For example, if the transplant-team knows in advance
that the donor's heart is weak or has some artificial parts
(and will therefore not be used for transplant),
they will make all necessary preparations to keep other organs working
while the body is moved to the transplant center.
If they know that some organs will not be usable,
the organ-procurement team can do their best to protect the better organs,
perhaps by sacrificing the organs they were not planning to transplant.




6.  NEWS MEDIA WILL WANT TO KNOW WHO GOT THE ORGANS.


    In the first cases of voluntary execution followed by organ donation,
the mass media will be intensely interested
in what lives were saved by the donated organs.
And this can become the most positive part of the whole story.
Because of the careful advance planning possible
with voluntary execution followed by organ donation,
more organs than usual will probably be transplanted.
None of the organs will be damaged by the cause of death
which is usually the case with accident-victims.

    Also, the initial horror stimulated by some media coverage
will be overcome by the living testimony of some organ-recipients,
who are very grateful for this gift of life,
no matter where their new organs came from.
If they had not received these specific organs,
they would probably be dead now.
And if they had received organs from entirely other donors,
someone else who was waiting for organs would now be dead
because of the lack of transplantable organs.

    If the various news media handle this story well,
more people will be encouraged to sign up as organ-donors.
If a prisoner can donate organs to save lives, then why can't I?
Ordinary organ-donors do not usually know their dates of death,
but they can still specify in advance
their wish to donate their organs after their deaths.

    And the media might focus on other dimensions of organ-donation.
The more positive stories we read or view in any media,
the more likely we will cooperate in donating our own organs
and the organs of other family members.
When lives can be saved by organs
that would otherwise be buried or burned,
why not transplant them into the bodies of the living?

    Donated organs can ensure many more years of meaningful living
for the people who receive such gifts of life.



Created April 22, 2010; Revised 4-28-2010; 8-27-2010; 10-25-2010;
2-5-2011; 4-14-2011; 7-8-2011; 12-11-2011; 4-20-2012; 10-12-2012;
6-29-2013; 9-7-2013; 10-4-2013; 10-5-2013; 10-30-2013;
4-23-2014; 2-1-2015; 10-27-2015; 9-8-2016; 1-30-2018;



AUTHOR:

    James Leonard Park is an independent philosopher and medical ethicist.
He has written a few other essays on closely related themes,
which are linked below.
Much more about him is available on his website, linked at bottom.
See especially the section devoted to medical ethics.



See some related on-line essays:


Brain-Death as a Method of Voluntary Execution

Voluntary Execution:
Better than Capital Punishment?


Voluntary Execution Followed by Organ Donation

Organ Donation After Voluntary Death

Can Prisoners Ever Make a Free Choice?

Do Organ Carry Personal Character?

The Dead-Donor Rule:
How Dead Do You Have to Be?


Choosing Your Date of Death:
How to Achieve a Timely Death
Not too Soon, Not too Late

Choosing Your Own Pathway towards Death 

Organ Donation After Voluntary Death




A Facebook Page has been created:
Prisoner Organ Donation.
This group welcomes participation by anyone
interested in organ donation from prisoners:

prisoners who have Internet access, family members, friends,
lawyers, prison authorities, transplant surgeons, medical ethicists, journalists, & students.

The above suggested protocol for voluntary execution followed by organ donation
has become Chapter 5 of Organ Donation After Execution.
This Internet Book was discussed chapter-by-chapter
on this Facebook PagePrisoner Organ Donationin 2014.



Go to the beginning of this website
James Leonard Park—Free Library