From my America Out Loud Pulse podcast with Dr. Heidi Klessig –https://www.americaoutloud.com/ethical-considerations-in-organ-donation-with-heidi-klessig-md/
Organ donation is a wonderful gift to a fellow human. One organ donor of critical organs such as the heart, lungs, liver, and kidneys can save up to 8 lives. According to the Department of Health and Human Services (HHS) 105,820 Americans are awaiting organs and over 40,000 transplants were performed in 2021. But like so many things in today’s culture, the zeal to procure organs for transplant may have, as they say, gone too far.
Death is always an uncomfortable topic. And organ harvesting is even more so. I remember the first time I was delivering anesthesia for an organ harvest. I was thinking, if the patient is dead, why do they need me? Of course, the patient’s heart was beating and his kidneys were still functioning. I gave a good anesthetic, keeping all the vital signs stable with multiple drugs and every tool I had at my disposal. Then the surgeon looked up and instructed me to turn it all off. I could not walk away. I stayed until the patient’s heart stopped beating quite as while later.
So what death is for purposes of organ harvesting? In the United States, if a person is pronounced brain dead, they are legally dead. Death is defined in the United States by the Uniform Determination of Death Act (UDDA), proposed in 1981, as either (1) irreversible cessation of circulatory and pulmonary functions or (2) irreversible cessation of all functions of the entire brain, which means brain death. The need for human organs for transplants has spawned some eye-popping processes.
Currently, surgeons are experimenting with a Frankensteinian-sounding procedure whereby terminal patients are allowed to die, then their hearts are resuscitate while blood flow to the brain is clamped off. In January 2022, surgeons implanted a genetically modified pig heart into a human. The patient lived for 49 days. The surgeons got their transplants, but medical ethics may have died.
The American Medical Association’s Code of Medical Ethics addresses issues regarding organ transplantation, including xenotransplantation, that is, organs from a non-human. The first guideline states: “(1) . . . A prospective organ transplant offers no justification for a relaxation of the usual standard of medical care for the potential donor.”
Organ transplantation is a great medical breakthrough that saves and improves lives. As with any medical procedure, informed consent with a full discussion of all the available information and assurance that the highest ethical standards are essential. Unfortunately, sometimes the unattractive details of organ donation are glossed over. Today’s conversation will provide some food for thought.
