Is The Donor Really Dead Or Just Dead Enough

This week on the cover of Canada's National Post came a long overdue discussion on whether the organ donor is alive or dead. Organ donation has been debated since 1981, when the definition of death was changed to the notion of "brain death". Actually, the Universal Definition of Death Act (UDDA) had to be passed by every state in the US. This Act defined "brain death" as a definition of death used only for organ donation.

On Wednesday, in Canada, a group of doctors have called on the medical community to stop harvesting organs from patients whose hearts have stopped beating. The physicians say that many doctors are misleading families to believe that the patient died, when in fact, the patient is still alive.

Eight pediatric intensive care specialists, writing in Pediatric Critical Care Medicine, said, "A long standing tenet of ethical organ donation is, that the nonliving donor must be irreversibly dead at the time of donation." The authors explain that organs were originally taken from cadaveric donors, who died in the conventional way, irreversibly losing all electrical and mechanical activity from the heart (circulation), and all brain function, despite medical efforts to save them.

However, this method of organ procurement created a problem for organ transplantation. If the patient died in the conventional way, then at the time of irreversibility, so did most of the organs.

Enter 1991 and the Pittsburgh Protocol, which was developed to allow doctors to harvest the organs of adults, after the person's heart had stopped for a certain period of time. This protocol involves removing the patient from life support for 30 to 60 minutes in the operating room. If the patient's heart continues to beat after that period of time, they are returned to the ICU. But, if the heart stops for a prescribed period (around 2 minutes, ranging from 75 seconds to 10 minutes depending on the jurisdiction), the organs are harvested. The authors continue, "No efforts are made to access the patient's brain function at the time of organ removal. The claim is that circulation has irreversibly stopped after 2 mins. of observation."

The authors allude to the point that it's possible that a doctors desire to prolong lives through organ transplants, can "foster physician and institutional bias" for the cardiac death criteria.

Knowing these facts, it may be wise to investigate before you sign the back of your driver's license; which in Illinois makes you a first person donor, and no other consent is needed.