Truthfulness in transplantation: non-heart-beating organ donation

Abstract

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit.Verheijde, Rady, and McGregor attack the deception involved in NHBD, arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent. Such honesty about NHBD should be welcomed.However, NHBD violates a fundamental end of medicine, nonmaleficience, "do no harm." Physicians should not be harming or killing patients, even if it is for the benefit of others. Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: The role of legislation in reinforcing ideology in pluralistic societies

“…The lack of transparency about end-of-life practices in organ donation for transplantation can create distrust in the medical profession [14]. There is also growing scientific and medical evidence indicating that donors may not be truly dead when organs are removed at the end of life [8,[14][15][16]. In acknowledgment of this evidence, transplant advocates have defended the medical practice of removing organs based on ambiguous and controversial criteria to define death in donors [17][18][19][20].…”

“…The lack of transparency about end-of-life practices in organ donation for transplantation can create distrust in the medical profession [14]. There is also growing scientific and medical evidence indicating that donors may not be truly dead when organs are removed at the end of life [8,[14][15][16].…”

Organ donation in France: legislation, epidemiology and ethical comments

“…Are the criteria adopted sufficiently robust? What is the position regarding non heart beating donor transplantation with new technical resuscitation providing extracorporeal life support for prolonged cardiac arrest (Potts, 2007;Bernat, 2008)? There is certainly a need for better scientific validation of the timing of organ procurement to ensure that organ recovery is not an irreversible event defining death in non heart beating organ donation.…”

Premortem interventions in dying children to optimise organ donation: an ethical analysis

“…Concerns about compromise to the care of dying patients care and the validity of the consent for such practice were being raised,4 when the Department of Health (DH) produced a document ‘Legal issues relevant to non-heart beating organ donation 2009’ to help clarify matters 5. This document expressed the UK government's view of the law regarding actions taken prior to death to support successful DCDD.…”