Pre-Mortem Organ Donation?

In response to an international shortage of kidney donors, in the latest issue of the American Journal of Bioethics, Paul E. Morrissey, of Brown University in Rhode Island, suggests removing both kidneys from brain trauma patients on life-support. Afterward the patient would simply be removed from life support and allowed to die, and two fresh viable kidneys are then available for rapid transfer to waiting recipients.

Morrissey's alibi is that "since life without your kidneys would be short - the argument could be made that the patient is so close to death anyway, you would not have to describe loss of kidneys as the cause of death - since the fundamental principle of transplant surgery is observed as, the Dead Donor Rule: that organ retrieval itself must not be the cause of death. Morrissey calls his new procedure proposal "pre-mortem donation."

Morrissey denies that the operation causes death because, "medically and legally the donor would be alive at the time of surgery (a zombie?) and would die, only secondary, to irreversible head injury at some interval after the surgical procedure. He feels this answers the ethical dilemma over organ donation via euthanasia or criminal execution.

Procuring both kidneys pre-mortem is the wedge for abandoning the Dead Donor rule.  That rule is "an ethical norm that has been formulated in at least two ways: 1) Organ donor must be dead before procurement of organs may begin: 2) Organ procurement itself must not cause the death of the donor. 

Morissey's Pre-mortem donation idea, is his suggested way to get around this Dead Donor rule.

Also, the President's Council on Bioethics says, that the legal definition of irreversible cessation of hearbeat and breathing used to justify Donation after Cardiac Death (DCD) and Non Heart Beating Donation (NHBD), has problems. 

Most of us have believed the term irreversible to refer to a stopped heart that cannot be re-started - when it actually means there is a deliberate decision NOT to try and restart the heart when it stops - and allow enough time to elapse to ensure the heart will not resume beating on its own. This has led to hearts being harvested from one baby - and re-started in another baby ... horror of horrors!  

So if your heart or the heart of a loved one stops, they may not attempt to re-start it in  your chest - but rather in another patient's chest.  (Don't sign the back of that driver's license.) 

Now, the suggestion is, to take both your kidneys, while you are on life-support and still alive. It doesn't matter that you won't live too much longer after the removal of these vital organs - the excuse is simply that you were alive when they removed them.  Ok, what is this line of reasoning called? 

Human beings have been reduced to utilitarian entities.  God forbid you or a loved one end up on a ventilator -  or have some other human limitations which label you as less than human in their eyes - because your organs will go on the auction block, and your relatives may want to sell them on Facebook.

I recall the first heart transplants in the early 1970's.  Before that, kidney transplants as well as less than vital organs, such as cornea transplants etc. seemed ok to me.  But the heart transplants?  That one seemed to stretch the limits of what science should do to prolong one persons' life, through the harvesting of an organ from another person.   

What is the real motive of science here?  This was the question I asked myself back then, as a young woman, who worked with a young man whose father had been one of the early recipients of a heart transplant. At the time,  it seemed macabre to me - and the rest of the people in our office. 

I recall my brother, who was a real grease-monkey, and loved tinkering with cars and engines in our yard. I specifically recall the day he transferred an entire engine block from one car to another - without the usual mechanical hoists used in regular garages, I might add.   Instead, he created his own make-shift hoist, via some heavy chains he threw over a heavy branch of our old oak tree in the front yard.  After much sweat, cussing and repeated attempts and failures, he was successful. 

But human beings are not cars! Our hearts are not engine blocks, to be hoisted from one vehicle chases to another.   Obviously, it was far easier for my brother to switch tires and other mechanical elements from one car to another, without too much trouble - and more importantly, without changing a major defining element of the car.  He ended up with the chases of a 1957 Chevy, but it had the engine of another make and model vehicle - which I don't recall today.

Death is an inevitability; science cannot change that reality.  Medicine should heal what they can - lessen the suffering of what they can't - but they cannot re-shuffle that deck.  And that's exactly what they're trying to do.

From the old Hyppocratic Oath: "I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being."