Ethical Dimensions of Organ Donation After Death

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Table of Contents

Introduction
Case Study
History of Organ Transplant
Are Patients of Cardiac Death Dead?
Withdrawal of Life Support
Recovery of Organs from Nearly Dead Patients
Conclusion
References

Introduction

Everyone understands what “brain dead” means: an individual for whom the brain no longer works. “Braindead” is a commonly used term, and in many diverse situations, it is not surprising that people believe that a person who is brain dead is not technically or unconscious patient is mentally dead. Such misunderstandings and ambiguities help to explain why there is still much debate about the connection between death determination and organ donation (Moschella, 2018). There is reason to doubt the rationality and logic of the current definitions of dying and relevant topics, like the “Dead Donor Rule” (DDR), which is at the heart of the prevailing organ procurement policy (White, 2019). The debate over these issues is becoming heated enough that health professionals should comprehend the foundation of the debate and how it may affect their practices. Turning into an organ giver after death is not just a significant choice but a significant choice for existence; it is beneficial for medical research and is a noble deed.

Case Study

The Aden Hailu case helps in understanding organ donation after death situation. The American Academy of Neurology (AAN) brain death guidelines were recently called into question in the 2015 Supreme Court of Nevada, particularly in the Aden Hailu case, who experienced intraoperative anoxic serious injuries (den Hartogh, 2019). She was declared brain dead after losing brainstem reflexes and demonstrating no impulsive respiration on an apnea test. Her father sought a restraining order to prevent the hospital from ceasing organ support. The district judge denied the request, ruling that Hailu fulfilled the AAN regulations for brain death and was legally dead.

The case was brought to the Nevada Supreme Court, which asserted that the health center had incorrectly determined Hailu to be brain dead. The matter was appealed to the Nevada Supreme Court, which ruled that the hospital had incorrectly determined Hailu to be brain dead. The Nevada statutory provisions overruled the lower court’s ruling, holding that the AAN regulations failed to adequately assess all operations of the entire brain, such as the brain stem. Moreover, it was doubted if the AAN regulations were considered approved medical guidelines by the medical world (den Hartogh, 2019). The main issue regarding brain death is whether such a victim should be considered a viable donor for transplant organs.

While death by neurocognitive standards has been a legal concept of dying in all fifty states since USDA’s implementation, the validity of brain death identification has been called into question since its inception. Particularly in light of popular media accounts of brain-dead patients regaining consciousness. In the recent decade, case reports have been defined of patients who were declared brain dead but later discovered to have some form of cognitive performance of unknown origin. A careful examination of these case reports uncovers incomplete and inconsistent records of the confirmatory studies conducted (den Hartogh, 2019). Because of the uncertainty surrounding the careful implementation of AAN brain death guidelines, retrospective assessment of these cases is impossible.

History of Organ Transplant

Organ transplant is a practice that did not start in the 21^st century and is a matter that has been happening. The era of medical organ transplant began in 1954 when Joseph Murray implanted a kidney from one twin into another (den Hartogh, 2019). Heart and liver transplantation, which require organs that can only be obtained from the dead, became a reality in 1963 through the achievements of Thomas Starzl and in 1967 by Christiaan Barnard (den Hartogh, 2019). Before the introduction of cyclosporine in 1980, survival rates following heart and liver transplantation remained low. In combination with other, less effective immunosuppressive drugs, this drug significantly increased survival rates, resulting in the rapid quick development of the organ transplantation field. This, in turn, increased demand for organs, particularly from deceased individuals, creating a paradox that there are willing dead owners and living bodies.

Death has consistently been recognized in the pre-resuscitation period as a unitary situation of loss of unexpected respiratory and circulatory functions preceded by loss of the overall central nervous system mechanism. With no chance of resuscitation, brain function inevitably ceased, which was inherently integrated into the cardiovascular criterion for death (Moschella, 2018). The brain, heart, and lungs are the three essential organs through which death approaches. The remaining two are quickly arrested if one of the three ceases to function.

As a result, failure of any of the three components of the chain is potentially lethal. Similarly, the presence of bloodstream and respiration indicated that tragedy had not occurred. Cardiopulmonary resuscitation and cardiopulmonary techniques provided exceptions to pathophysiological-based healthcare definitions of death while misunderstanding intuitively oriented legal definitions by providing contradictions (Kentish-Barnes et al., 2019). With the accessibility to mechanical ventilation and synthetic cardiac pacing, respiratory and cardiac functions could be maintained either spontaneously or artificially, even in severe neurologic injury. Den Hartogh (2019) characterized a group of patients in 1959 who were mechanically ventilated but had no brain stem reflexes, apnea without a support structure, and a flat electroencephalogram. The nascent profession of organ transplantation focused intense attention on these patients, questioning whether they should be considered heart-beating cadavers.

Are Patients of Cardiac Death Dead?

Organ deficiency is today the biggest problem facing transplantation treatments. According to Moschella (2018), the scarcity of organs for transplantation has worsened over the last 15 years; there has been a lot more emphasis on donation upon cardiac death. Patients with severe brain injuries who are not comatose may still be donors if the patient or the victim’s family decides to withdraw life support via an advance directive. Following that decision, consent for organ transplantation is obtained (Kentish-Barnes et al., 2019). The patient is taken to the operating room, life support is removed, and when the heart stops beating after several minutes to an hour without ventilation or other assistance. The doctor then observes the patient for a few minutes to ensure that the heart does not keep beating spontaneously.

The Uniform Determination of Death Act (UDDA) requires irreversible cessation of respiratory and circulatory functions. However, in the case of Developmental coordination disorder (DCD), the heart has not been irreparably arrested since cardiopulmonary resuscitation can typically reinstate cardiac function after a 10-15 minute or more extended arrest (White, 2019). To avoid violating the DDR, the argument has been made that the phrase “irreversible” should be replaced with “permanent.” In cases with no particular goal of reviving the heart, the lack of a mechanism is permanent, and the patient can be considered dead. This rhetorical question is only required to satisfy the DDR; in the absence of DDR, semantic intervention would not be required.

Withdrawal of Life Support

Ever since the New Jersey Supreme Court’s ruling in the Karen Ann Quinlan particular instance in 1976, it has been widely accepted that withdrawing life support does not entirely cause the patient’s death. The decision to withdraw life support enables the patient to die (Biel & Durant, 2020). This means that the disease, not the physician, causes the patient’s death. This viewpoint, however, cannot be correct because the physician is the principal cause of the person’s death. Although removing life support causes death, not the patient’s disease, it is not an entirely legal or morally culpable act. The claim that withdrawing life support is unethical if it results in death is a red herring argument. The critical concern is not a causal link but the overarching principle of regard for the patient’s wishes. The basic concept of self-determination concerning one’s body has long been accepted in American law. The right to autonomy can be exercised explicitly or via an advance directive by a competent person, a proxy assigned by the person, or a legally permitted surrogate agent.

Recovery of Organs from Nearly Dead Patients

Even if brain-dead clients are near death but not truly dead, retrieving vital organs is ethically sound. Since 1968, the assessment of brain death has been comprehended to validate the removal of life support and the recovery of major organs. This does not alter when brain-dead humans are acknowledged to be in an irreversible coma while still alive — they still fulfill the UDDA conditions (Biel & Durant, 2020). If it is fair to cause the death of a brain-dead patient by withdrawing life support, it must logically be okay to induce the patient’s death by recovering crucial organs before withdrawing life support.

In the scenario of DCD, the same logic applies if the person is near death and being supported by ventilation. If a person uses her right to autonomy by first consenting to the removal of life-sustaining care and then agreeing to recover significant organs, a chain of events unfolds that leads to the patient’s death. Because this sequence of events does not cause injury or wrong to the client or others, it should not be considered a criminal act.

Conclusion

Beyond the bioethics of detecting brain death in organ donors and transplants, the health professional faces the morality of custodianship in the context of limited medical resources and their responsible application. While being mindful and considerate of different religious and cultural beliefs, it is not an ethical responsibility to continue cardiopulmonary assistance for a deceased patient. Moreover, applications for undefined continuous support should be matched against the ambiguity of the health professionals in providing futile care and potential damage to other patients. Therefore, the lower court ruled the case of Aden Hailu correctly. The Supreme Court seems to have failed to acknowledge the AAN guidelines regarding brain death. When a patient becomes brain-dead, it is safe to perform an organ transplant. However, this is only possible if the patient, or their immediate family, consents to organ donation. The professional healthcare provider is responsible for ceasing life support when resources are deemed scarce, or there is harm to other patients. This paper has proved that organ donation after death is only possible when individual patients or affiliated family members agree to cease supporting life treatment to donate vital organs—this helps save other patients’ lives in need of organ transplants.

References

Biel, S., & Durrant, J. (2020). Controversies in brain death declaration: Legal and ethical implications in the ICU. Current Treatment Options in Neurology, 22(4), 12. Web.

den Hartogh, G. (2019). When are you dead enough to be a donor? Can any feasible protocol for determining death on circulatory criteria respect the dead donor rule?Theoretical Medicine and Bioethics, 40(4), 299–319. Web.

Kentish-Barnes, N., Siminoff, L. A., Walker, W., Urbanski, M., Charpentier, J., Thuong, M., Sarti, A., Shemie, S. D., & Azoulay, E. (2019). A narrative review of family members’ experience of organ donation request after brain death in the acute care setting. Intensive Care Medicine, 45(3), 331–342. Web.

Moschella, M. (2018). Brain death and organ donation: A crisis of public trust. Christian bioethics: Non-Ecumenical Studies in Medical Morality, 24(2), 133–150. Web.

White F. J., 3rd (2019). Controversy in the determination of death: The definition and moment of death. The Linacre Quarterly, 86(4), 366–380. Web.

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