organ donation | Carrie's Take

BROOMALL, Pa., July 21, 2023—The National Catholic Bioethics Center (NCBC) and the National Catholic Partnership on Disability urge the Uniform Law Commission not to change its recommendation for the definition of brain death from the irreversible cessation of brain function to the permanent cessation of most brain activity. Such a change in policy would allow living patients with severe brain damage to be declared legally dead.

Under the proposed changes to the Uniform Determination of Death Act, whole brain death would be replaced with partial brain death. Consequently, nonresponsive patients with severe neurological injury could be declared brain dead even if they still exhibit some integrated brain function. Rather than improve the accuracy of clinical protocols, this change would bring them in line with current practices, which have been criticized for their lack of rigor and potential for abuse. Moreover, although motivated by a noble desire to save lives through organ donation, relaxing the existing standard of whole brain death involves an implicit judgment that doctors can violate the physical integrity of these vulnerable patients to benefit other patients whose lives are considered more worth saving.

Patients with severe neurological injury cannot speak for themselves, and given the complexity of their conditions, it can be very difficult for their family and friends to effectively advocate on their behalf if they do not have medical expertise. Consequently, the medical and legal communities have a special duty to protect these patients by establishing adequate safeguards so that vital organs may not be procured prior to death or be the cause of the donor’s death. In this context, relaxing the criteria for declaring a person brain dead not only could dissuade people from becoming donors but also could have a disastrous effect on trust in the physician-patient relationship.

To ensure that organ donation remains a selfless gift motivated by genuine love of neighbor, and to support a strong relationship of trust between patients and physicians, the standard for determining brain death must include the complete and irreversible cessation of integrated function in the whole brain. Commenting on the review process, NCBC Staff Ethicist Edward Furton said, “The Uniform Law Commission is about to affirm that current neurological criteria for determining death are too rigorous and need to be relaxed. Instead of calling for their more careful application, the lax standards are to be incorporated into the rule. This will result in the withdrawal of support from those who demand complete confidence that the patient has died before organs are donated.”

The National Catholic Bioethics Center provides education, guidance, and resources to the Church and society to uphold the dignity of the human person in health care and biomedical research, thereby sharing in the ministry of Jesus Christ and his Church. The NCBC envisions a world in which the integral understanding of the human person underlying Catholic teaching on respect for human life and dignity is better understood and more widely embraced in America and worldwide. More information can be found at ncbcenter.org.

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Source:
Proposed Changes to Definition of Death Threaten Brain-Damaged Patients

Part One

By Nancy Valko, RN, ALNC

Most people who sign organ donor cards assume that they will be carefully diagnosed as “brain dead” before their organs are donated. That was generally true years ago, but a new non-brain death organ donation procedure was developed in the 1990s even though the language on organ donor cards did not change.

The current non-brain death organ donation policy started with ethics journal articles in the 1990s. At that time, it was called “non-heart beating donation” and promoted as a way to increase the supply of organs for transplant beyond the usual “brain death” organ donations. This was made possible by linking organ donation to withdrawal of treatment decisions from people considered hopelessly ill or dying but who did not meet the criteria for “brain death.”

This change in policy came in the wake of court decisions upholding the right to refuse treatment for incapacitated patients like Nancy Cruzan, a brain-injured woman said to be in a so-called “vegetative state.”

Since Dr. George Isajiw and I presented the following paper (“Non-heart beating organ donation” and the “vegetative state”) in 2004, the term “non-heart beating organ donation” has been changed to “donation after cardiac death” (DCD) and now around 5% of organ donations are from nonbrain death organ donors.[i] The numbers are expected to increase with organ donation policies such as the following: In June 1996, the American Medical Association issued its opinion that non-brain death organ donation was ethical.[ii] Eventually, the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) required all hospitals to develop policies for DCD, effective January 2007, while the United Network for Organ Sharing (UNOS) proposed new bylaw amendments requiring all transplant centers and Organ Procurement Organizations (OPOs) to develop DCD policies by January 1, 2007.[iii]

Moreover, hospitals currently are being asked to report all deaths, imminent deaths and potential organ donor situations to the local organ procurement organization. Years ago, when only brain death criteria could be used, doctors themselves talked to families about organ donation. Now, many hospitals have policies that only trained organ donation representatives talk to families about donation. Such policies are said to increase the number of families consenting to organ donation.

In Part Two, I will discuss other strategies to increase the number of organ donations.

[i] “The Challenge of Organ Donation After Cardiac Death,” Matt Wood, Science Life, 02/20/2014; http://sciencelife.uchospitals.edu/2014/02/20/the-challenge-of-organ-donation-after-cardiac-death

[ii] “Opinion 2.157 – Organ Donation After Cardiac Death,” AMA Code of Medical Ethics, issued 06/1996 and updated 06/2005; http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2157.page

[iii] “Donation After Cardiac Death: Analysis and Recommendations from the New York State Task Force on Life &the Law,03/17/2007;http://www.health.ny.gov/regulations/task_force/donation_after_cardiac_death/docs/donation_after_cardiac_death.pdf

Nancy Valko, RN, ALNC, has been a registered nurse for 45 years and is a spokesperson for the National Association of Prolife Nurses (www.nursesforlife.org). A long-time speaker and writer on medical ethics and other health issues, she has a website at: http://www.wf-f.org/bd-nvalko.html.She is also now a legal nurse consultant (www.valkogroupalnc.com ).