Dying to Donate?The Transplant-Medicine Community Should Reassure the Public Original Article
As I travel the country speaking about the many ongoing controversies in bioethics, I am occasionally approached by grieving people who believe that a catastrophically injured relative who had been declared “brain dead” did not die from injuries but was actually killed during organ procurement. I always assure these emotionally devastated folks that as far as I have been able to determine, vital-organ procurement in the United States is only performed on people who have truly died—either after suffering “brain death,” meaning their whole brain and each constituent part have ceased completely to function as a brain, or after being taken off life support and experiencing irreversible cardio/pulmonary failure.
But now a very disturbing event has occurred in western Colorado: It may be the first identifiable case of death by organ procurement in the United States. On September 26, William Thaddeus Rardin, age 31, shot himself in the head in a suicide attempt. He was rushed to Montrose Memorial Hospital, where he was declared brain dead. Determining this requires specific medical tests. But according to the Denver Post report, no testing was done at Montrose.
Rardin was then air lifted to St. Mary’s Hospital in Grand Junction, where surgeons removed his heart, liver, pancreas, and two kidneys for transplantation. A St. Mary’s spokesperson insists that appropriate neurological testing confirmed the diagnosis of brain death before the organs were procured.
But Mark Young, the Montrose County coroner, didn’t see it that way. In consultation with the local district attorney, he determined that the two hospitals did not follow proper procedures in determining that Rardin was really dead. He therefore declared the cause of Rardin’s death to be homicide. Indeed, Young told the Rocky Mountain News, “The cause of death was removal of the internal organs by an organ-recovery team.”
It is important to note also that Young, who is not a doctor, believes the hospitals acted in good faith and didn’t intentionally kill for organs. He also found that Rardin would have died within a few days from the gunshot wounds had his organs not been procured. However, this determination is irrelevant since vital organs are only supposed to be removed from the certifiably dead.)
In discussing this disturbing episode, we must be very careful. Rardin’s death could be easily sensationalized and lead to an unwarranted loss of public confidence in organ-transplant medicine. Moreover, the issue of brain death remains highly controversial, despite every state permitting organ procurement from patients who have been declared dead by “neurological criteria.” And while a (relative) few physicians and bioethics observers—primarily well-intentioned skeptics within the pro-life community, along with the internationally respected pediatric neurologist Dr. Alan Shewmon—believe that the entire concept of brain death is fallacious, the vast majority of neurologists and transplant medical professionals accept that to be brain dead is indeed to be dead.
But that assumes proper diagnosis. As the Rardin case has exposed, standards for determining brain death differ widely across the country and even from hospital to hospital within the same state. This is unacceptable, and leads to the worry that sometimes corners may be cut. Thus if confidence is to be maintained in the organ-procurement system, we need to establish a binding, uniform national standard of testing for determining death by neurological criteria. Moreover, these criteria should be so thorough and clearly established that they are beyond reasonable reproach. Most importantly, these uniform standards must reiterate the irrevocable requirement that vital, non-paired whole organ donors be really and truly dead before their body parts are procured.
This last point should go without saying. Unfortunately, it cannot. Because of the ongoing organ shortage, some at the highest levels of bioethics and organ-transplant medicine have for the last several years agitated for a more liberal organ-procuring license. These proposals generally come in two forms: either that death should be redefined to include a diagnosis of permanent unconsciousness or that the “dead donor rule” itself should be rescinded to permit living patients to be harvested even though doing so would directly cause their deaths.
Thus several doctors, writing for an international forum on transplant ethics argued in the November 1, 1997, edition of the British medical journal The Lancet that the legal definition of death should be expanded “to include comprehensive irreversible loss of higher brain function” so that “it would be possible to take the life of a patient (or more accurately stop the heart since the patient would be defined as ‘dead’) by ‘lethal’ injection” and then procure organs upon receiving proper consent. Consider this: Under such a regimen, Terri Schiavo would be eligible to be killed for her organs on the pretense that she has already died. And consent could be given by the odious Michael Schiavo.
Two Harvard doctors advocated an even more radical approach in the September 2003 Critical Care Medicine. Drs. Robert D. Troug and Walter M. Robinson proposed that “individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be allowed to donate their organs, without first being declared dead.” Were such criteria to be adopted, the apparent homicide of William Thaddeus Rardin would be transformed from an alarming, unintended, and potentially criminal anomaly into a standard operating procedure in transplant hospitals across the country.
Organ-procurement professionals worry that the publicity surrounding Rardin’s death will “affect future donations.” Well, they should. But whatever went wrong in this case—assuming anything did—is correctable by the transplant community redoubling its efforts to assure that no corners are cut when diagnosing brain death and establishing sufficient standards of universal and reliable testing that must be performed in every such case.
The real danger to public confidence, not to mention the morality and ethics of medicine, lies in the growing advocacy to permit devastated and dying patients to be killed for their organs. Such a radical policy shift would not only shatter the public’s willingness to sign organ-donation cards, but worse, it would turn would-be organ sources into commodities, reducing them from the status of fully human persons to mere harvestable natural resources. The Rardin case offers the transplant-medicine community an important opportunity to assure the public that killing for organs will never be permitted.
Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture. His next book will be Consumer’s Guide to a Brave New World.