Is it cruel to question organ donation?

Steve Salerno wrote a piece for Playboy Magazine called, “The Heart Stopping Truth about Organ Donation”, in October 2002. No, I don’t read Playboy I’ve just read the article online.  I’m glad there was an article in Playboy, because wherever the TRUTH can be exposed about the lie of brain death being true death the better.

Mr. Salerno states that,  “According to the Centers for Disease Control, the mortality rate due to injury among men 18 to 35 years old is about twice that of the national average.” In other words, organ-procurement organizations (OPOs) are “waiting for you to do something stupid. In fact, they’re counting on it.”

The stats are on their side.

If you fall within that age range, you’re about four times more likely to meet a sudden end than your wife or girlfriend of an equivalent age is. Bottom line: If you’re the typical reader of Playboy magazine, you’re a prize candidate for organ donation. (Yes, glad Steve Salerno said it)

One popular belief peddled by the transplantation community is that brain death is as much a bedrock medical concept as conventional cardiac death. By those terms, a brain-dead patient is dead. Period.

In fact, brain death is an expedient “medical fiction,” to use Stuart Youngner’s phrase, invented to enable physicians to declare patients dead in a timely fashion and in a controlled environment.

“Anesthesiologist Philip Keep told the BBC that ‘nurses get really upset. You stick the knife in [into a patient whose organs are being removed], and the pulse and blood pressure shoot up.’ In an effort to squelch such disturbing manifestations, many British hospitals administer anesthesia prior to harvest. As Dr. Keep noted (without apparent irony), ‘If you don’t give anything at all, the patient will start moving and wriggling around and it’s impossible to do the operation.”

The Rules Have Been Written

The Dead Donor Rule

The Uniform Definition of Death Act

The Uniform Anatomical Gift Act

All of these laws are written to harvest your organs when you are pronounced brain dead. Though it’s not the kind of thing the medical establishment is eager to publicize, there has long been an arbitrariness to policies governing clinical determinations of death. “

Years ago one hospital, The Cleveland Clinic, wanted to implement a new standard that would declare a person dead with a five or seven-minute absence of a pulse,” says Carmen Marino, a former prosecutor for Ohio’s Cuyahoga County and one of a number of law-enforcement officials who have challenged the medical community’s willingness to alter current definitions of death.

“The organs that are most susceptible to blood deprivation after death are the heart and the liver. The liver transplant doctors said, “That’s too long. If we wait five or seven minutes, we’re not going to have a useful organ anymore. Let’s make it two minutes. And that was that.”

As a result, concludes Marino, “You go without a pulse for two minutes in some hospitals, you’re dead. They take your organs. In other places, at two minutes, they’re still trying to revive you.”

The reason for hushing up such facts is simple, says Stuart Youngner, director of the Center for Biomedical Ethics at Case Western Reserve University. “The OPOs are afraid that if we have these discussions publicly, it will slow down donations dramatically.”

Cynics look back on the Harvard milestone as a case in which a far-reaching medical judgment was made largely, if not purely, for non medical reasons.

Stuart Youngner is blunt: “The thrust of the Harvard decision was, ‘Let’s call them dead so we can’t be accused of killing them when we take their organs.”

Well regardless of Marino’s ability to stop the Cleveland temporarily eventually every hospital adopted a 2 minute rule, and now there are even shorter guidelines.

During transfer the patient is supported on a ventilator, the ventilator is turned off, the patients heart stops, death is pronounced, then the heart is  started again, then your organs are harvested.

The heart is the last to go and at that point you are dead like most people think of death.

The legitimacy of “brain death,” “cardiac death,” and even “circulatory death” – which can be declared only 75 seconds after circulatory arrest – as actual death has been an ongoing debate in public commentary on organ donation.

Many experts assert that doctors familiar with organ donation are aware that the terms, intended to delineate a threshold of probable death, is different from actual bodily death, rendering highly uncertain the moral status of organ donation.

Is it cruel to question organ donation?