ORGAN-DONATION AFTER VOLUNTARY DEATH
SYNOPSIS:
When we approach the end of our lives,
we might consider donating
our organs after we are finished with them.
Perhaps we registered
ourselves as organ-donors years before.
However, instead of waiting for natural death to take us,
we
might coordinate the time and place of our death
with
a new plan to donate our organs
immediately after death is
declared.
With careful planning (and the
cooperation of transplant centers),
we should be able to choose
the best time,
the best place, & the best methods of dying
so
that our re-usable organs can be harvested immediately after
death
and transplanted into waiting patients who will make better
use of them
than if our organs were merely buried or burned.
OUTLINE:
1. BELGIUM
IS A LEADER IN ORGAN-DONATION AFTER VOLUNTARY DEATH
2.
ORGAN-DONATION AFTER VOLUNTARY DEATH IN OTHER COUNTRIES
3.
CAREFUL PROCEDURES FOR ORGAN-DONATION AFTER VOLUNTARY DEATH
A. Has the Donor's Life Really Come to an End?
B. Which Methods of Managing Dying Would Be Best for Organ-Donation?
C. Might the Donor's Organs be Evaluated Before Death?
D. Which Transplant Center in America Will be the First
to Accept Organs Donated After
Voluntary Death?
4. ORGAN-DONATION AFTER MERCIFUL
DEATH
ORGAN
DONATION AFTER VOLUNTARY DEATH
by
James Leonard Park
1.
BELGIUM IS A LEADER
IN ORGAN-DONATION AFTER VOLUNTARY DEATH
Belgium has a presumed
consent law:
This means that all organs that might be useful to others
will
automatically
become available for
donation
unless the patient explicitly decides NOT to donate organs after death.
This law grew
out of the wide-spread willingness to donate.
Most people
philosophically favor giving their organs to others in need
once
they are dead and therefore no longer using their organs.
But,
historically speaking, very few people took the actual legal
steps
usually required to make their organs available after death.
So Belgian lawmakers filled this gap between plan
and action
with a law saying
that all organs will be presumed
to be available.
And
they wisely allowed some people to opt-out
of donation after death.
Only a few people do in fact register their preference NOT to
donate.
Also Belgium has a liberal
right-to-die law,
which allows patients to
choose the best time of death for
themselves.
They are not required to undergo endless
medical treatments before death.
When death seems inevitable, they can shorten the process of
dying
either by taking lethal drugs to cause death
or by
giving their doctors full permission
to bring their lives to a
peaceful and painless end.
And a few
Belgian patients who chose their own times of death
also
decided to donate their organs after their voluntary deaths.
This required some careful advance planning
to arrange their
deaths to take place within
hospitals
so
that their organs could be immediately harvested
to be
transplanted into patients in nearby operating rooms.
The doctors who help the patient to die
(usually by giving lethal
drugs known not to damage vital organs)
must
be completely separate and independent from
the medical team
that will harvest the viable organs after death
is declared:
One set of doctors takes care of the dying patient,
assuring him or her a completely painless and peaceful death.
After
the patient's death has been declared,
the transplant-team takes possession of the donor's body
(while
vital functions are maintained by the best medical means)
and
begins the process of transferring the re-usable organs
into
patients waiting in adjoining operating rooms.
In this early practice of organ-donation after voluntary death,
the
medical teams involved did not seem to be overly concerned
about
the exact timing of the declaration of death.
The whole process
was known to all medical persons involved:
The donor's life would
come to an end,
but some of the organs would be transplanted
immediately
into patients whose original organs were failing.
The dead-donor
rule says that only donors
already officially
declared to be dead would
have their organs harvested.
But sometimes the time of death for
the donor
was recorded as the time when the first vital organ was
removed.
A philosophically more correct timing would have
recorded the time
of death
for
the donor as the moment when permanent
unconsciousness
was
achieved by the drugs given in preparation for the operation
to
remove their organs for donation.
B.
Which Methods of Managing Dying
Would Be Best for Organ-Donation?
In states and countries that have right-to-die laws
permitting
physicians to help patients to manage dying,
the doctors have a
range of possible methods of achieving death.
And they will
select whatever combination of life-ending measures
seems most
appropriate for this donor,
depending, of course, on the medical
condition of the donor.
They might use some combination of drugs to bring
death
without
harming the organs intended for donation.
Where doctors are
explicitly authorized to prescribe gentle poison
there will be no
restrictions on the methods they use.
For
example, if they do not want to use any drugs
that might damage
the organs planned for transplant,
the terminal-care doctors
might decide upon some physical method
that will cut-off
the blood supply to the donor's brain
thus
causing obvious brain-death.
Blood-circulation to the rest of the
donor's body
could be maintained by the well-known methods
for
keeping the heart beating and the blood circulating.
Wherever such right-to-die laws are not yet in force,
doctors know
several good ways to manage dying.
Probably they will choose
special combinations of anesthetic drugs.
First they will put the
donor into a deep sleep
as
is needed for most surgical operations.
Then they will introduce
more drugs so that
they can say with absolute
certainty that
this donor's brain
will never
again have
another thought or feeling.
Then the
donor will be officially declared dead
using
the criterion of permanent unconsciousness.
This will be
especially authorized by this patient beforehand.
The dying
patient and/or his or her proxies
will authorize in writing their
agreement to have this donor declared dead
when permanent
coma is
achieved by recognized medical means.
Only
after the donor has been officially
declared dead
and after that
death has been duly recorded in writing
will the remains be
handed over to the transplant-team.
And no doctor who was part of
the terminal-care team
will be a part of the team of doctors
who
will harvest and transplant the usable organs.
These two teams
must be completely separate.
C. Might the Donor's Organs
be Evaluated Before Death?
Because this will be a death planned well in advance,
rather than
a sudden accidental death
(which is the source of most donated
organs),
the dying patient who wishes to donate his or her organs
after death
will agree to all useful medical investigations
to
determine the viability of any organs that might be donated.
Moreover, likely recipients of the organs can
also be identified.
Good matches of blood
and tissue types can be achieved
so that the donated organs will
have better chances of living
than when hurried preparations are
required by unexpected donor-deaths.
All
such medical preparations for donation after voluntary death
will
make the whole process more real for everyone who knows about it.
The family of the donor will begin adjusting to their loss,
knowing that some organs will find new life in other persons.
As the process continues to move ahead
smoothly,
recipients can be medically prepared
to receive
their new organs in nearby operating suites.
D.
Which Transplant Center in American Will be the First
to Accept Organs Donated After
Voluntary Death?
The articles and news reports of organ-donation in Belgium
mention
no problems encountered in getting cooperation from doctors.
So,
perhaps it was a simple process of getting official approval
from
whatever committees oversee organ-transplantation.
The obvious
safeguards are mentioned:
(1) The dying patient must fulfill the safeguards for life-ending
decisions.
For example, has the
dying patient given full, informed consent for death?
(2) The
decision
for death must
be separate from the decision
for donation.
These
two teams of doctors must be completely separate and independent
to
avoid even the appearance
of conflict of interest.
Doctors participating in the life-ending decisions of the dying
patient
must not be the same doctors who are trying to save other
patients
by
transplanting donated organs.
New policies
at transplant centers might first emerge as exceptions
to
previous policies and procedures.
If the transplant center has
automatically rejected organs from 'suicides',
perhaps a
carefully planned death in the same hospital
would never be
called a 'suicide'.
This death-before-donation will be carefully
planned
so that none of the worries related to people who
committed suicide
would apply to this particular voluntary death.
Transplant centers should maintain a
positive public image.
They do not want adverse
publicity arising from a questionable death.
So, when considering making exceptions to the general rule
about
not accepting organs from people who committed suicide,
they
might accept a donation from a former staff member,
who has now reached the end of his or her life.
"Retired Transplant Surgeon Donates His Own Organs"
would
be a wonderful headline.
Because most of the people involved with
his death
would be other doctors who knew him for years,
there
would be no doubts about the wisdom
of the life-ending decisions
the retired doctor is making.
Those who support the dying doctor
would be fully informed about his reasons for choosing death.
And they would agree with their dying former colleague
(given
all of the medical facts and professional opinions)
that death
at this time is
better than death
at some later time.
Likewise, because they know first-hand the
benefits of organ-donation,
they fully approve the additional
decision to donate organs
after the retired transplant surgeon
has come to the end of his life.
Are the other
transplant surgeons organ donors themselves?
And
this first case of organ-donation coupled with life-ending decisions
might inspire them to make similar plans for their own
deaths:
They agree to forgo the last month of futile medical care
if they know that their organs will have a better chance
of
coming back to life in the bodies of other patients
giving
the new owners many more years of meaningful life.
If the surgeon's donation is the first
such case in that transplant center,
the positive publicity will
inspire others to become organ-donors,
even if they would not
consider ending their lives in the same way.
The example set by this very-careful first donation
could allow
that transplant center to establish good policies
to allow other
such donations after voluntary death.
4.
ORGAN-DONATION AFTER MERCIFUL DEATH
Once organ-donation after voluntary death has been accepted,
then
the obvious next question concerns possible donation
from
patients who have already passed the point
of making their own
end-of-life decisions.
The largest group of such potential
'donors' would be
patients with Alzheimer's disease or other
forms of dementia
or patients with non-functioning brains.
If the patient can no longer cooperate with any plans for
death,
then it could not be called a "voluntary
death".
The decision-making authority has passed to the
proxies,
who were probably carefully chosen by the patient
before the
patient's mental capacities disappeared.
And when proxies must make all remaining end-of-life decisions,
and
if they conclude that a chosen
death now
is
better than a random
death later,
their life-ending decisions might be called choosing a "merciful
death".
Patients who come to
the end of their lives because of mental decline
or because of any
neurological or brain-disease
would make ideal candidates for
organ-donation.
Even tho their meaningful lives are over
because
of whatever has happened to their minds or brains,
the
best of their other organs might be still working well.
If and when this happens at the end of my
life,
I want my
proxies to choose a merciful death for me
and then to donate my
usable organs so that others might live.
Others can make similar
plans for their organs:
Once meaningful life has become
impossible,
let my proxies choose a merciful death for me
followed
by the donation of whatever organs
might have continued life in
the bodies of other persons.
My plan is more explicitly stated
here:
If
I Get Alzheimer's, Donate My Organs.
Of course, even more elaborate safeguards must be applied
when the
patient can no longer make such life-ending decisions
or
plans for recycling organs after death.
Here is a detailed account
of how several possible safeguards
might be applied to life-ending
decisions
for patients beyond deciding for themselves:
Life-Ending
Decisions for Alzheimer's
Patients.
The other questions concerning organ-donation after voluntary
death
also apply to
situations where proxies
make the life-ending
decisions:
B. the best methods of bringing this life to an
end;
C. evaluating the best organs beforehand for
transplant;
D. finding a transplant center open to
donation after merciful death.
As medical
science makes transplantation more workable
and as ethics accept
organs donated following freely-chosen deaths,
more patients in
need of new organs will have their lives extended.
AUTHOR:
James Leonard Park is an independent philosopher
with deep interest in
many end-of-life issues.
He
does intend to donate his own body to medical science
including
possibly organ-donation
when
meaningful life is no longer possible for him.
If he is still
able to decide, he will choose voluntary death for himself.
If his
capacities to make such decisions disappear,
his
proxies are authorized to donate his organs
after his merciful
death has been achieved.
Much more
will be discovered about James Park
on his personal websitethe
last link below.
Created
December 3-4, 2014; Revised 12-17-2014; 12-21-2014;
1-20-2015;
3-7-2015; 3-14-2015; 10-16-2015;
1-19-2016; 3-15-2016; 8-9-2017; 10-16-2018;
As
noted in the last section of this essay,
organ-donation should be
available for patients
who have already lost their capacity to
make end-of-life decisions:
If
I Get Alzheimer's, Donate My Organs
These
two on-line essays about organ donation
have been gathered with
several others to create
Medical
Ethics at the End of Life
background
articles:
"Should
We Allow Organ Donation Euthanasia?
Alternatives
for Maximizing the Number and Quality
of
Organs for Transplant"
Bioethics
Vol. 26, Issue 1, pages 32-48, January 2012.
http://www.onlinelibrary.wiley.com/doi/10.1111/j.1467-8519.2010.01811.x/full
"Organ Procurement After Euthanasia: Belgian Experience"
www.coma.ulg.ac.be/papers/death/organ_euthanasia09.pdf
"Safeguards
for Life-Ending Decisions Used in Belgium"
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/SG-BELG.html
If
we worry that someone might be put to death
for
the purpose of harvesting his or her organs,
here
is a chapter listing 22 safeguards to prevent such abuses:
"Protecting
Patients from Being Put to Death without
Authorization"
Go to
the beginning of this website
James
Leonard ParkFree
Library