Should organs from patients in permanent vegetative state be used for transplantation?

Hoffenberg, R.; Lock, Max; Tilney, Nicholas L.; Casabona, Carlos María Romeo; As, Daar; Rd, Guttmann; Kennedy, Ian; Nundy, Samiran; Radcliffe-Richards, J; Sells, R A

doi:10.1016/s0140-6736(97)02306-4

Cited by 31 publications

(16 citation statements)

References 4 publications

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“…25 A pesar de las reiteradas propuestas que ha habido para integrar tanto a pacientes en estado vegetativo como a bebés anencefálicos en la categoría de donantes potenciales (Hoffenberg et al, 1997;Truog and Fletcher, 1990), siguen persistiendo dudas al respecto, motivadas en gran medida por la sospecha de que el aumento de órganos disponibles gracias a esos pacientes no sería lo suficientemente importante como para justificar el posible riesgo que un necesario cambio en la definición y los criterios para determinar la muerte podría acarrear para la sociedad (Shewmon, Capron, Peacock and Schulman, 1989). Verheijde y otros se refieren a diferentes estudios que sugieren la ausencia de certeza sobre la supuesta pérdida total y definitiva de conciencia en los individuos en muerte encefálica, lo que implicaría que incluso esos individuos podrían requerir anestesia en el momento de la extracción (Verheijde and Rady, 2011).…”

Section: Notasunclassified

Ni vivo ni muerto, sino todo lo contrario. Reflexiones sobre la muerte cerebral

Rodríguez‐Arias¹

2013

Arbor

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RESUMEN:Determinar el momento exacto en que tiene lugar la muerte siempre ha sido un problema de difícil resolución. Las propuestas tradicionales y contemporáneas para justificar los criterios legales de determinación de la muerte se han visto condicionadas por intereses sociales -en particular, recientemente, relativos a los trasplantes de órganos-. Los criterios legalmente aceptados para declarar la muerte siguen careciendo de soporte conceptual o científico. En este contexto de ausencia de consenso sobre la demarcación exacta de la frontera entre la vida y la muerte, estas son algunas de las preguntas que abordo en este artículo: ¿Cómo podemos definir la muerte? ¿Es la determinación de la muerte una tarea basada únicamente en hechos, o también en juicios de valor? ¿Equivale la muerte cerebral a la muerte humana? ¿Qué papel le corresponde a la bioética en los debates relativos a la determinación de la muerte y la obtención de órganos? PALABRAS CLAVE: Determinación de la muerte; Trasplantes de órganos; Gradualismo; Pluralismo; Definición de la muerte; Muerte cerebral; Bioética. ABSTRACT:Determining the precise moment of death has always been a difficult problem. Traditional and contemporary attempts to justify legally accepted standards for death determination have been based on social interests -particularly related, more recently, to organ transplantation policies. Legally accepted criteria for declaring death still lack both conceptual and scientific support. In this context of absence of consensus about the exact location of the boundary between life and death, this article aims to address the following issues: How can we define death? Is the task of determining death strictly based on facts, or do values also play a role? Should brain death be equated to death? What role should bioethics play in the debates related to death determination and organ procurement?

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Section: Notasunclassified

Ni vivo ni muerto, sino todo lo contrario. Reflexiones sobre la muerte cerebral

Rodríguez‐Arias¹

2013

Arbor

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“…Since 1997, pressure has been growing to expand the recovery of transplantable organs from patients with other states of impaired consciousness, such as those in a vegetative state (Hoffenberg et al 1997). In September 2007, The President's Council on Bioethics discussed the Draft White Paper on neurological determination of death and renewed the interest in organ procurement from vegetative state to meet an increasing demand for transplantable organs (The President's Council on Bioethics 2007a).…”

Section: Accuracy Of Determining Other States Of Impaired Consciousnessmentioning

confidence: 99%

“…Because these patients may be allowed to die, they may be considered for organ donation; however, unless physician-assisted death is legalized, patients in PVS are ineligible to become organ donors (Detry et al 2008). Although some have advocated the acceptance of the concept of higher brain death so that organs from patients in permanent vegetative state can be used for transplantation (Hoffenberg et al 1997), this concept of death has not been endorsed, accepted, or legalized in the United States.…”

Section: Accuracy Of Determining Other States Of Impaired Consciousnessmentioning

confidence: 99%

“…The Pittsburgh protocol, established in 1993, lays the groundwork for the justification and legalization of recovery of transplantable organs from patients with other neurological states of impaired consciousness (Fig. 1) who cannot be declared brain-dead (Hoffenberg et al 1997). The Pittsburgh protocol defines the loss of arterial pulse with circulatory arrest for 2 min as the circulatory criterion for determining death in NHBOD.…”

Section: Introductionmentioning

confidence: 99%

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Brain death, states of impaired consciousness, and physician-assisted death for end-of-life organ donation and transplantation

Verheijde

Rady

McGregor

2009

Med Health Care and Philos

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In 1968, the Harvard criteria equated irreversible coma and apnea (i.e., brain death) with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism (locked-in syndrome), minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. (1) Brain death does not disrupt somatic integrative unity and coordinated biological functioning of a living organism. (2) Neurological criteria of human death fail to determine the precise moment of an organism's death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. (3) Brain-based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. (4) Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. (5) The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heartbeating organ procurement from patients with impaired consciousness is de facto a concealed practice of physicianassisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs.

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“…It is very difficult for everybody to see such a pregnant braindead woman as a 'non-person' or just an impersonal 'organism' with a developing child inside her womb. Furthermore, a patient in a persistent vegetative state is also not regarded as a 'rational agent' anymore, but is not categorically treated as an 'organism' or a 'non-person', not deserving our respect, although some think that they are even 'more dead than dead' [3] and others think they should be used as organs donors [4].…”

mentioning

confidence: 99%