Les Sillars - Ditching the dead donor rule

MARY REICHARD, HOST: Today is Tuesday, February 4th. Good morning! This is The World and Everything in It from listener-supported WORLD Radio. I’m Mary Reichard.

NICK EICHER, HOST: And I’m Nick Eicher. Recently, we ran a report on problems with organizations that procure organs from people who have died. These are known as OPOs, organ procurement organizations. Clearly, OPOs do much good and organ transplant saves lives. 

And yet there’s another side to this issue. WORLD reported on a Canadian OPO that targets patients who die by physician-assisted suicide or euthanasia.

WORLD Radio’s Les Sillars says this is what you get when the demand for organs gets ahead of ethics.

LES SILLARS, COMMENTATOR: Canada legalized assisted suicide in 2016. Now less than four years later, the Ontario government has hired Trillium Gift of Life Network to approach patients approved for assisted suicide. The idea is to pitch them on donating their organs. 

The Ottawa Citizen newspaper described how in the last two years the number of organ donations from people whose death doctors—quote-unquote—“aided” has doubled to 113.

This development is troubling but predictable. Disabled, elderly, and vulnerable Canadians might wonder how committed their doctors are to keeping them alive. 

Here’s the history:

The first successful transplant from a dead donor was in 1962. It was a kidney. The big question was whether the recipient’s body would accept or reject the organ. 

New drugs and techniques gradually improved success rates, but there was another problem. Most organs deteriorate soon after the supply of blood and oxygen stops. And transplant teams were rarely on hand the moment someone died. 

But the life support machines arrived in the 1970s. They kept the hearts and lungs of patients with severe brain damage pumping until the organs could be extracted.

So the question became: How do you determine when a person on life support is truly dead? That used to be straightforward. “Cardiac death” is when the heart stops. Patients turn cold and stiff. But people on ventilators can stay warm and breathing for months, even years.

So in 1968 an ad hoc committee at Harvard Medical School offered a “brain death” definition: the irreversible loss of brain function. It allows doctors to end life support and remove vital organs without violating the self-explanatory “dead donor rule.” The legal and medical communities gradually accepted brain death over the next few decades.

But usable organs were still in short supply in the 1990s, so doctors embraced “donation after cardiac death.” When the prognosis is poor enough, the patient’s family and doctors agree to shut off life support. Even if the patient is not brain dead. Doctors wait a bit for the heart to stop beating. Then they take the organs.

In the mid-2000s, some in the medical community objected. Clearly, they said, doctors were just gerrymandering the definition of death to convince the public that they didn’t kill people for their organs.

But critics weren’t saying that because human life is sacred and the nature of “brain death” is unclear doctors should be more cautious. No, that would reduce the number of available organs. Those critics thought that doctors should just ditch the dead donor rule in favor of consent, from either the patient or the family. Mostly dead, plus consent. That should be enough.

We’re almost there. The dead donor rule still applies in theory, but doctors skate right up to the line. Now some states and countries have added doctor-assisted suicide. Throw in the fact that procurement companies rake in billions a year, and what could go wrong?

A Trillium spokesman said there’ll be no pressure on vulnerable people. Of course not. No one will mention “death with dignity” or “leaving a legacy,” or the lives that could be saved. All that will be understood.

In the U.S., according to one physician in a USA Today column, doctors have already begun discussing taking organs from live patients. If that happens, the dead donor rule will not just be irrelevant. It’ll be reversed.

I don’t question the value of organ donation. I’m a donor. But there has got to be a limit. Left to itself, the medical community will just keep on making “progress.”

For WORLD Radio, I’m Les Sillars.

(Photo/Shutterstock, Wutzkohphoto)

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