Can the Brain-Dead Be Harmed or Wronged?: On the Moral Status of Brain Death and its Implications for Organ Transplantation

Abstract

The majority of transplantable human organs are retrieved from patients declared dead by neurological criteria, or "brain-dead." Since brain death is considered to be sufficient for death, the procurement of vital organs is not considered to harm or wrong such patients. In this essay I argue that this is not the case. After distinguishing welfare, experiential, and investment interests, and defining precedent autonomy and surviving interests, I argue that brain-dead patients can be, and many are, harmed and wronged by organ procurement as currently practiced. Indeed, with respect to precedent autonomy and surviving investment interests, the brain-dead are morally equivalent to patients with severe dementia, and thus can be harmed and wronged if and only if, and to the extent that, patients with severe dementia can. The "bright line" that separates brain death from all other conditions for clinical and legal purposes is not justified by any morally relevant distinctions.

RETRACTED: Routine parental request of organ donation in end-of-life care of children in the United Kingdom: Unresolved medical, legal, cultural and religious challenges

“…functions such as conscious awareness and nociception may have not ceased irreversibly. 18,25 The surgical procurement of transplantable organs without general anaesthesia would likely be associated with additional child distress if the clinical diagnosis of brain(stem) death is faulty. To sum up, the UK legal standard of the best interests could well prohibit non-palliative medical interventions for the retrieval of donor organs in the end-of-life care of children, irrespective of parental consent.…”

“…5,18,26,27 Failing to respect and accommodate these diverse values and beliefs can have a profound negative impact on surviving parents and family members. 6,18,25,27 Although routine integration of organ donation can conflict with religious beliefs, some commentators believe that religious beliefs should not ''be allowed to stonewall a secular approach'' to the end-of-life care of children in a multicultural society. 28 Other commentators have downplayed the conflict with religious beliefs by claiming that donating a child's organs can lessen parental bereavement symptoms.…”

La confiscación de órganos a la luz del derecho constitucional a la protección de la salud

“…En primer lugar, porque los criterios de determinación de la muerte bajo los cuales la extracción de órganos es viable podrían incrementar el número de falsos positivos. En efecto, las dudas que persisten acerca de la validez de los criterios legales actualmente empleados para determinar la muerte, las referidas tanto al criterio neurológico como al criterio cardiorrespiratorio, conducen a algunos autores a la conclusión de que ciertos donantes de órganos podrían estar siendo prematuramente considerados como legalmente muertos (Naïr-Collins, 2015). En segundo lugar, porque los pacientes que son simultáneamente considerados como donantes potenciales pueden ser sometidos a intervenciones fútiles que aceleran o propician su muerte con el único propósito de maximizar la utilidad de un futuro trasplante.…”

“…En tercer lugar, no todos los donantes llamados cadavéricos presentan en el momento de la extracción una pérdida total e irreversible de las funciones de su cerebro (tales circunstancias no son exigidas en la donación en asistolia), lo que podría implicar, según algunos autores, que esos donantes conserven o puedan recuperar, a resultas de las medidas de preservación, cierta funcionalidad neurológica compatible con la conciencia (Dalle y Bernat, 2018). En estos casos, además de que se les pudiera estar considerando erróneamente como muertos, los pacientes no reciben medidas sedativas en el momento de la extracción de órganos, toda vez que se asume que los cadáveres no pueden sentir (Naïr-Collins, 2017).…”

Rethinking Brain Death as a Legal Fiction: Is the Terminology the Problem?

“…Although current approaches to obtaining informed consent for organ donation have been criticized as deceptive and should be reformed to describe what is known about brain death more accurately, the system of organ procurement could be ethically justified if valid consent was obtained. Yet legal disputes between families and hospitals, which seem to be becoming more common, have the potential to upend our system of determining death by neurological criteria and the practice of organ transplantation from brain‐dead donors …”