Some Patients’ Organs Harvested Before Death, Analysts Caution

Published July 1, 2008

Will your organs be “harvested” before their time? Perhaps!

Given recent reports and the incentives involved, it’s likely some doctors are indeed taking persons’ organs from their bodies before death. The goal of saving lives (in this case, by transplanting organs) is praiseworthy; but the means to this end involve potentially tragic dilemmas.

Speeding Up Death Declaration

Because solid internal organs (such as the kidneys, liver, and heart) deteriorate rapidly after death, transplant doctors want to have an expeditious diagnosis of death so they can remove the organs for transplanting.

In most cases, doctors make a diagnosis of brain death before organs are taken. The diagnosis of “brain death” was created to allow expeditious organ harvesting.

Brain death is defined as “irreversible coma with absent brainstem reflexes (such as reactions of the pupils to light).” The word ‘irreversible’ implies doctors can predict the future of a patient in coma. In reality, medical science hasn’t reached this degree of perfection.

‘Brain Death’ Uncertain

In newspapers, medical books, and journals, we’ve read about many patients who seemed to be in a permanent coma but who woke up days, months, or even years after doctors incorrectly made the diagnosis of irreversible coma.

Likewise, “absent brainstem reflexes” simply means the brainstem isn’t working properly and generating electrical impulses. Damage to the cells (for example, from lack of oxygen or nutrients) can make them temporarily too weak to generate nerve impulses or EEG signals. With reversal of the damage, the brain cells often heal and resume normal function.

Other diagnostic factors such as “low body temperature (hypothermia), sedative or paralytic medicines, or the presence of severe metabolic disorders … might confuse the diagnosis of brain death,” wrote doctors Steven Laureys and Joseph J. Fins in an editorial in the January issue of the medical journal Neurology.

Hospital Practices Vary

Individual doctors weight these factors differently in making a brain death diagnosis, and hospitals all do diagnostic tests somewhat differently.

“There are substantial differences in practice that may have consequences for the determination of death and initiation of transplant procedures,” conclude Dr. David M. Greer of Massachusetts General Hospital in Boston and colleagues in their article in the same issue of Neurology, titled “Major differences exist in brain death guidelines among the leading neurological hospitals in the United States.”

Similarly, “Hospitals vary widely in determining brain death” headlined a January 25 Reuters article. Dr. James L. Berna from Dartmouth Medical School in Hanover, New Hampshire described a “disturbing pattern of non-uniformity.”

No Universal Guidelines

Does this mean an organ harvest could be premature? Some neurologists certainly think so.

Neurologist Lawrence Huntoon, M.D., Ph.D., editor-in-chief of the Journal of American Physicians and Surgeons, wrote in the January 7, 2008 issue of that publication, “Top hospitals typically disregard brain-death guidelines.” He continued “… the survey indicates a high likelihood that some patients are being ‘harvested’ in some hospitals before they are dead! In hospitals with aggressive transplant programs (hospitals make a huge amount of money on transplant cases), making sure a patient is dead before going to the ‘harvesting suite’ may be viewed as a minor technicality.”

Many transplants–such as blood transfusions, bone marrow transplants, adult stem cell treatments, skin grafts, and living kidney transplants–don’t require the death of the donor; these successful medical innovations are not at issue here.

Given the lack of universal guidelines and consequent variety of hospital policies, it’s important for individuals to clearly express their preferences regarding these care decisions. To make sure your personal wishes are honored, you can establish an Advance Health Care Directive (AHCD) and a living will in addition to a Last Will and Testament.

It’s also a very good idea to designate an agent for health care, to make decisions on your behalf when you’re unconscious or otherwise unable to do so yourself.

No human organs–particularly yours–should be harvested before their time.

Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute. Michael Arnold Glueck, M.D., is a visiting fellow in economics and citizenship of the Washington International Trade Council. They may be contacted at [email protected].