As supply and demand for various products fluctuate, the requirement for organs remains high (Sade, 2014, para. 16; Ghahramani, 2010, para. 3; Lentine, 2012, para. 2). Live organ donation can be done while preserving the life of the organ donor and is considered ethical because the potential benefits outweigh the risk of harming the donor (Lentine, 2012, Ghahramani, 2010, para. 10). Donation after death presents more ethical dilemmas. Despite the complexity, individuals retain the right to legally donate their organs after a brain or cardiac death with explicit consent. However, public sources fail to fully explain the process and consequences of organ donation after death (Potts, 2005, pg. 408)
Organ donations after death follow the Dead Donor Rule (DDR), which was established in 1968 by a Harvard Medical School Ad Hoc Committee. The DDR later resulted in the Uniform Determination of Death Act (UDDA) of 1981 (Sade, 2011, para. 9). Both DDR and UDDA include the irreversible cessation of respiratory and circulatory functions (cardiac death) and the permanent cessation of all brain functions (brain death) as legal death (Sade, 2011, para. 7, 9; Schweikart, 2020, pg. 1020). Organs are most viable in the case of brain death or shortly after cardiac death (Sade, 2011, para. 9; Schweikart, 2020, pg. 1021).
The DDR and UDDA protect physicians from legally committing homicide by requiring a declaration of death prior to retrieving organs (Potts, 2005, pg. 406). After all, you cannot kill that which is already dead. In practice, the stipulations allow for a biologically living person (having a beating heart) with no brain activity to be classified legally as dead (Schweikart, 2020, pg. 1019). Most people think more of cardiac death because it coincides with biology, so taking someone’s vital organs when they are technically still alive and giving them to another person appears unethical (Sade, 2011, para. 7; Schweikart, 2020, pg. 1021).
Furthermore, both forms of post-mortem donation cannot technically follow the permanent aspects of the DDR and UDDA because the complete loss of brain functions would imply that the heart and physiological processes have also ceased. For donation after cardiac death (DCD), cardiopulmonary resuscitation (CPR) could stabilize the heart up to 15 minutes after it stopped beating (Sade, 2011, para. 7).
“Not all the functions of the brain need to be lost for a patient to be dead, only those that are critical to maintaining integration of the body functions; loss of these critical functions will inevitably lead over hours or days to cardiac arrest, even with continuing intensive life-support.” (Sade, 2011, para. 7)
Braindead individuals can live years unconsciously for years with only bodily processes (Sade, 2011, para. 7). So, taking their organs would biologically kill them if it were not for the fact that the inevitable loss of brain function would lead to a heart attack (Sade, 2011, para. 7, 9). In these cases, the physician must determine what the patient’s quality of life is in the most objective manner possible before taking the next steps.
The context of the situation within the process of DCD contains both legal and ethical problems as well. DCD involves a physician withdrawing life support and waiting for cardiac death before retrieving organs (Sade, 2011, para. 8). In a different context, such as a person with evil intention unplugging the ventilator, the patient's death appears as murder.
“The conventional view is that withdrawing mechanical ventilation, or other means of life support, merely allows the patient to die, but does not cause the patient's death. Rather, the patient's underlying medical condition causes death. This view, however, is not credible and fails to withstand critical scrutiny.” (Sade, 2014, para. 8)
This issue calls for a revision of the DDR (Schweikart, 2020, pg. 1021; Sade, 2011, para. 21). Defining the cause of death using this measure means that withdrawing life support would only result in a person’s natural death (Sade, 2014, para. 8). Disregarding the cause of death, killing the patient for the good of others is unjustifiable and appears to directly violate the “do no harm” clause in the Hippocratic Oath (Potts, 2005, pg. 408; Dalal, 2015, pg. 45). In the end, self-determination and informed consent invalidate the cause of death associated with organ donation (Sade, 2011, para. 9, 12-14).
Organ donation practice is complex and has questionable ethics, which should face periodic revision. While people have the choice of becoming an organ donor after death, it is important to know the legal definition of death which is not thoroughly explained by public sources. Advanced directives are a great way to clearly state your will; it is wise to determine the fate of your organs before someone else does.
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Ghahramani, N. “Living Organ Donation: An Ethical Evolution or Evolution of Ethics?.” International journal of organ transplantation medicine vol. 1, no. 2, May 2010, pp. 57-62.
Lentine, Krista L., and Anita Patel. “Risks and Outcomes of Living Donation.” Advances in Chronic Kidney Disease, vol. 19, no. 4, July 2012, pp. 220–228., https://doi.org/10.1053/j.ackd.2011.09.005.
Potts, M. “Does It Matter That Organ Donors Are Not Dead? Ethical and Policy Implications.” Journal of Medical Ethics, vol. 31, no. 7, 30 June 2005, pp. 406–409., https://doi.org/10.1136/jme.2004.010298.
Sade, Robert M. “Brain death, cardiac death, and the dead donor rule.” Journal of the South Carolina Medical Association (1975), vol. 107, no. 4, Aug. 2011, pp. 146-149.
Sade, Robert M. “Consequences of the Dead Donor Rule.” The Annals of Thoracic Surgery, vol. 97, no. 4, Apr. 2014, pp. 1131–1132., https://doi.org/10.1016/j.athoracsur.2014.01.003.
Schweikart, Scott J. “Reexamining the Flawed Legal Basis of the ‘Dead Donor Rule’ as a Foundation for Organ Donation Policy.” AMA Journal of Ethics, vol. 22, no. 12, Dec. 2020, pp. 1019–1024., https://doi.org/10.1001/amajethics.2020.1019.