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Why the thought of organ donation makes me nervous

There is much about brain function that is not yet understood and it appears that the medical definition of ‘brain death’ is not infallible

By on Tuesday, 12 August 2014

'The more divided the medical establishment seems to be on "brain death",  the more I hesitate to sign an organ donation card' (PA)

'The more divided the medical establishment seems to be on "brain death", the more I hesitate to sign an organ donation card' (PA)

My blog for July 25 discussed the case of a baby born with anencephaly, a terminal condition, whose parents, devout Christians, had made the decision to donate his organs to help other sick babies. As it turned out, he was born prematurely and his organs were too immature for the purpose of donation, so after a brief period on a respirator, he was allowed to die naturally when his heart stopped beating. During the radio debate on the case I learnt that the criteria for what is called “brain death” is not used on babies as they are simply too tiny for it to be feasible. But it is used routinely in the case of adults whose organs are to be donated.

It brought me back to the whole question of organ donation after death – which is approved by the Church: note 2301 in the Catechism of the Catholic Church states that “the free gift of organs after death is legitimate and can be meritorious.” I agree with this in theory – but in practice I have never signed one of those cards that you are meant to carry around with you, giving permission for your organs to be harvested when you die. I feel too nervous about the whole subject – probably quite irrationally – having read of those rare yet widely publicised cases of people being thought to be dead by doctors, but who then make a seemingly miraculous recovery. All this (plus a dose of “premature burial” stories in Edgar Allan Poe, which I read in my youth) is enough to make me cravenly hesitate.

A recent article from the Life Issues Institute has resurrected my own fears. It discusses the case of a 21-year-old, Sam Schmid, who was severely injured in a car crash in Arizona. “Thought to be brain dead, hospital personnel began palliative care and discussed organ donation with his parents. They contemplated taking Sam off life support. But much to the surprise of everyone, he began to respond. In an act that defied explanation, Sam held up two fingers. That simple action quite possible saved his life…”

The article points out that the traditional definition of death occurred when you stopped breathing. In 1968 a paper was published in the Journal of the American Medical Association that first introduced the notion of “brain death” as a determination of death. This coincided with new technology making the transplant of vital organs feasible for the first time. In 1981 in America, “brain death” was defined as the “irreversible cessation of circulatory and respiratory functions, or the irreversible cessation of all functions of the entire brain, including the brain stem.”

The article argues that the current criteria for brain death are not “infallible”, begging the question: is “brain death” truly death – especially when the functions of breathing and circulation have to be maintained to prevent vital organs from deteriorating? There is much about brain function that is not yet understood – as those medically inexplicable cases of patient recovery make clear. And at the same time the demand for viable organs also means that there is, as the article points out, a “vested interest” in a “brain dead” diagnosis. A longer article in Catholic World Report for April 27 2011, by JJ Ziegler, entitled “The principle of caution must remain”, raises all these same issues in greater depth. The more I read, the more divided the medical establishment seems to be on this subject – and the more I hesitate to sign an organ donation card.

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  • Guest

    I would urge everyone to watch this video – Chilling!!!!
    – Killing for organs – Are we alive or dead?

    http://www.youtube.com/watch?v=vrr4vjOBqfs

  • James M

    “There is much about brain function that is not yet understood and it appears that the medical definition of ‘brain death’ is not infallible”

    ## The same could be said of epilepsy. That range of conditions is far better understood than it was even 80 years ago, but much is still unknown. Is there any condition, involving the brain, of which that is not true ? If infallibility on the part of the medical profession had been required in the past, before Catholics could make decisions of this kind, Catholics would still be using leeches and trepanning skulls. Why require infallibility for this issue – but not for research into (say) anti-epileptic drugs ? Are we to believe that only beginning-of-life & end-of-life medicine matters – and that, by inference, no other kind does ? If that is not meant – and how can it be ? – care is not being taken to exclude that inference; but it needs to be.

    From the moral theology I’ve read – that of the 1920s – people are morally obliged to have a high degree of moral certainty that their actions – including their medical decisions and techniques – are morally good and in accord with right reason, since to do otherwise would be a sin of imprudence; they are not obliged to have infallible certainty. Which in the nature of the case, is impossible, since infallible certainty is a species of certainty peculiar to the theological virtues. But medical science, even when the motives of a given practitioner of it are supernatural, relies upon the cardinal virtues for its exercise.
    Insight into how to dispense medications properly requires, not the exercise of the theological virtues of faith, hope and charity, but the exercise of the cardinal virtues, such as prudence and wisdom. If medical work & decisions needed the theological virtues, only Christians in a state of grace would be eligible for such work. Which is absurd.

    There is no need whatever for the rigorism and the requirement for absolute certainty that seems to have crept into the consideration of issues that, of their nature, cannot avoid a degree of imprecision – the course that may, conceivably, be the one allows for the least margin of error or none, need not be the only morally good course. There is such a thing as the best’s being the enemy of the good.

    I think those whom the law allows to donate their organs are very privileged to be able to do so. STM an act of very great generosity. John 15.13 & other such passages seem very relevant.

  • bluesuede

    You won’t find many donors among doctors. Hmmmm.

  • SimonS

    What an absurd statement. Of the doctors I have as friends, all of them (that I have asked) are registered as donors.

  • SimonS

    I hope it is uncontroversial that the medical profession needs to have a working definition of death.

    If you wish to dispute the viability of brain death as a criterion, please suggest something that is better.

    All other vital signs that could be used have genuine (and not exactly rare) cases of people recovering. The traditional definition of death referenced in the article (pulmonary failure) has so many cases of recovery that it is useless – indeed mouth-to-mouth ventilation is taught as part of basic first aid. To make it worse, these vital signs can be sustained almost indefinitely artificially.

    In contrast, I have yet to come across a case where a brain dead patient has recovered (as opposed to where a doctor has mistakenly labelled a patient as brain dead).

    Doctors need a way to label people as dead. If you (or anyone) can suggest a less error-prone, and more final means to determine that someone has died I can see no reason that the medical profession (and researchers) would not switch to using it.

    Until then, it seems reasonable to use the best test we have.

  • bluesuede

    Maybe in your country.

  • SimonS

    I have no idea where you live, so can make no comment. I live in the UK (alternately in Cambridge and London).

    Whilst I hope that nothing happens to cut my life artificially short, it is a privilege to be able to offer myself as means to help someone else live if I am not able to. (As an aside, if it came to it I would be happy to accept a donated organ if I needed it, and I sortof feel that willingness to be a donor follows fairly naturally).

  • bluesuede

    I’m sure your intentions are the best SimonS.