A line of trust

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NICK EICHER, HOST:Coming up next on The World and Everything in It: what if the person whose life saved yours wasn’t actually gone?

Doctors, lawmakers, and ethicists are asking hard questions about how, and when, we decide to pronounce someone dead.

WORLD’s Lauren Canterberry reports.

THOMAS CAINES: My 20th birthday present was my new heart.

LAUREN CANTERBERRY: Thomas Caines was a freshman at Covenant College in Tennessee when he returned home in January 2022. His mother, Sarah says he had been battling chronic fatigue, cold-like symptoms, and a persistent cough for weeks.

SARAH CAINES: That cough just kept progressing and we kept going back to the doctor.

Weeks later, an echocardiogram showed his heart was failing. Thomas was just 19 years old.

Doctors placed Caines on the transplant waiting list.

SARAH: For us, it was kind of a fast and uncertain process. There wasn’t a lot of waiting time, there wasn’t a lot of time to ask questions.

A new heart became available about three weeks later.

SARAH: There is a bit of a guilt feeling that for my son to live, someone else’s son will have to die.

Four days after he turned 20, Caines received his new heart. Months later, as Caines was beginning the recovery process, the donor’s mother wrote them a letter about her son.

THOMAS: He was 37, he had a kid, he was a construction worker, I remember that.

More than 100,000 people in the United States are on the national transplant waiting list. While living donors can donate some organs, like a kidney, most come from someone who has recently died. 90% of U.S. adults support organ donation, yet only about 60% are registered organ donors.

The Department of Health and Human Services released a report last month that showed some hospitals began the organ harvesting process even though patients still showed signs of life.

Days later, the House Committee on Energy and Commerce held a hearing about alleged safety lapses in organ donation.

Here’s Chairman John Joyce—a Republican from Pennsylvania.

JOYCE: For every doctor, one of the most important tenets in the patient-physician relationship is above all, do no harm, but what happened in these cases fractured the doctor-patient relationship and saw patients subjected to pain and suffering that never should have occurred.

The report included the case of a 36-year-old Kentucky man who in 2021 was declared dead. But as doctors were preparing his body to remove his organs, he woke up on the operating table. He went on to make a full recovery.

The HHS report did not include any documented cases of inappropriate organ removal, though it suggested it has likely happened.

Doctors use two primary criteria for determining when a patient has died. The most common method is circulatory death—when the heart stops beating.

In 1968 a Harvard Medical School committee published a report outlining a new way to determine death—brain death.

According to the study, doctors could declare a patient brain-dead if the patient did not respond to external stimuli, did not display spontaneous muscle movement, had no reflexes, and had a flat reading on a brain scan.

Dr. Heidi Klessig is a retired anesthesiologist who now advocates for organ donors’ rights.

KLESSIG: They thought they could redefine them as being dead on utilitarian grounds. They said that it would help free up ICU beds and it would remove the controversy in using them as organ donors.

After a patient is declared brain-dead, they are often supported on a ventilator and their heart is still beating when organ procurement begins. The sooner organs are harvested after death, the more likely they are to be transferred successfully.

In 1980, a commission created the Uniform Determination of Death Act to standardize legal definitions. More than two-thirds of all states have adopted the model law, which recognizes either circulatory or brain death as criteria.

Scott Henderson is an associate professor of philosophy at Luther Rice College and Seminary.

HENDERSON: We are not just our brains. There is no theory of consciousness out there today that is acceptable by people who study it.

Henderson is concerned that some patients who are declared brain dead may be alive but unable to communicate. He points to cases where a patient was declared brain dead but lived for years after the diagnosis.

Other doctors believe brain death is an accurate determination of death. Dr. Gary Ott is a heart surgeon in Oregon and has performed heart transplants for decades.

OTT: To me, as someone who believes we are created in the image of God and a precious gift of life, that spirit has fled.

While Ott does not have issues with using circulatory or brain death criteria for organ donation, he expressed concerns about a relatively new practice called normothermic regional perfusion. That’s when doctors temporarily restore blood flow to organs after circulatory death while they are still inside the donor’s body in an attempt to increase the chances of a successful transplant. But doctors block the blood vessels that go to the brain. Ott says that if someone's heart is restarted and their brain begins functioning, they were never dead.

OTT: I would rather not take a few more donors than cross the line over who’s a person and who’s not. I think that those of us who have that line are a minority.

As a doctor, Ott wants all of his patients to trust that he will do his best to save their lives instead of pushing for organ donation. But he also believes organ donation is a picture of Christ’s sacrifice of His own life so we can live.

OTT: Out of this tragedy, God can bring good and change your life. That’s a powerful message, and we get to participate in that.

Reporting for WORLD, I’m Lauren Canterberry.

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