In my last commentary, I discussed “brain death,” and whether a patient is “mostly dead”—like Westley, the character from The Princess Bride—or truly dead. WE don't want to call someone dead who is not. Prior to the development of the “brain death” standard, a person was declared dead when their heart stopped pumping blood and they quit breathing.
There is a renewed interest in declaring someone dead whose heart has stopped beating, because of the potential for harvesting their organs. Often, by the time a person is declared to be brain dead, their organs have deteriorated too much to be transplanted. To be blunt, the longer it takes to declare death, the less useful many of the organs are likely to be to potential recipients.
But, a patient who is supported by a ventilator could become a donor after cardiac death. This presumes the patient has a valid “do not resuscitate” order (DNR). After the ventilator is turned, they could be declared dead, and their organs removed within minutes after they stop breathing. It is the possibility of organ donation that can drive the decision about when to turn off the ventilator.
Just as with my previous discussion of “brain death,” Christian ethicists and physicians have not reached consensus about the criteria for donation after cardiac death. There is a tension between wanting to be sure a person is dead before removing their organs, and the need to harvest vital organs as quickly as possible after death.
Some ethicists--not the Christians I'm referring to--suggest that we already do remove organs from people who are not dead; we just don’t call it that. Others argue it is ethical to take organs from people in a coma or persistent vegetative state, regardless of cardiac death.
The central ethical challenge, in the words of Dr. Edmund Pellegrino, is how to “give the gift of life to one human being without taking life away from another.”[1] Our safeguard is the ethical fidelity of the potential donor’s physician, who places the good of the dying donor over the good of the dying potential recipient. But this can place the good of the individual in tension with the social good of organ donation. That’s one of the reasons these decisions are so difficult.
Another reason is the important philosophical question about when death occurs. Plato described death as the separation of the soul from the body. How do we measure that? Again quoting Dr. Pellegrino, we need better physiological criteria to close “the gap between philosophical concepts and clinical reality.”[2]
In the meantime, The Center for Bioethics & Human Dignity is continuing charitable dialogue about the ethical determination of cardiac death. It’s vitally important that we get this one “right.”
[1] Personal Statement of Edmund D. Pellegrino, Chairman. The President’s Council on Bioethics. Controversies in the Determination of Death, 2008. (Washington, DC: GPO, 2008), 119.
[2] Ibid., 111.