Ethics of receiving donated vital organs

Anyone done research on the ethics of receiving donated vital organs? I’m not talking about the first kidney but the second kidney; heart; liver; etc. – specifically to what extent “harvesting” the organ before the donor’s actual death may be common, central to organ donation, etc.

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I’ve done a fair bit of research on it. I’m not comfortable with the ethics of it, but there are not very many who seem to share my opinion.

It all comes down to a few things:

  1. whether “brain death” is really the moral equivalent of some other definition of death—generally cardiac death
  2. if brain death is real, whether we can (always) accurately “diagnose” it
  3. if we can (always) accurately diagnose it, whether we always do accurately diagnose it

Regarding #1, we are talking about permanent loss of all brain function, including the brain stem, such that there is nothing whatsoever happening in the body as a result of the brain, including breathing and heartbeat, and that this condition is known to be permanent. A ventilator is what keeps the lungs and heart going, and oxygen going to the whole body. Death actually is remarkably hard to define. People without a heartbeat are not necessarily dead… yet. However, I’m not entirely comfortable with brain death as a definition. A body with circulating, oxygenated blood seems… alive to me.

But assuming you’re fine with that, then regarding #2, we have examples of failures to accurately diagnose. We’re not talking about a severely brain-damaged person, supposedly in a permanent coma, waking up. That happens, too, but those people haven’t been diagnosed as dead. We’re talking about people who have been diagnosed as dead, selected for organ donation, and woken up before their organs were harvested. Clearly this is rare, but knowing that it has happened ought to make everybody ask the questions how? and why? Is it because our diagnosis procedures do not always yield accurate answers? If so, the whole concept of these organ transplants needs to be rejected, as the ends (saved lives and improved standard of living for some who receive transplants) do not justify the means (occasional murder).

My personal opinion is that the complexity of this diagnosis means it will inevitably sometimes be wrong. Keeping a person’s organs from being damaged requires a few things that are contradictory to finding out with certainty that they are brain dead. First, they need to keep the body temperature low, but you’re not dead until you’re warm and dead. Second, they need to verify whether there is any impetus to breath without the ventilator, but turning off the ventilator will lead to a lack of oxygen, damaging the organs. Third, they need to make the diagnosis quickly, as the body will often start failing regardless of the ventilator, but trauma takes time for the body to recover from, which is the point of the ventilator in the first place.

Even if you trust the diagnosis protocol, you still have to account for the people who were wrongly diagnosed. It’s one thing for the occasional mistake from a sleep-deprived doctor to lead to a patient needlessly dying. These things happen. The more concerning question is whether there are undue pressures inherent in the system that will tend toward improperly diagnosing somebody as dead. Though efforts have been made to prevent this, such as not allowing the team trying to save a person to be involved in the transplant process, the reality is that there are vast pressures to diagnose as dead, simply because there are other people that are on waiting lists until somebody is diagnosed as dead. Note what the mother in this video was told:

Five kids needed organs that matched him, and it was unfair to keep bringing him back, because it was just damaging his organs even more.

There are also other reasons why I suspect the diagnoses could possibly be skewed. Transplant surgeons are the super stars at hospitals and everybody knows they need to keep them happy. Or the fact that it’s sad to treat a person whose “standard of living” will likely be much lower even if he survives.

But as I said to a brother facing this question, if I was told an organ was available for my son, I’m not sure I’d decline it.