Written by Heidi Klessig MD and originally published on LifeSite News on November 15, 2024. Read the original article here.
Sociologist Renee C. Fox sharply criticized the DCD protocol, calling it, “an ignoble form of medically rationalized cannibalism” that “borders on ghoulishness.”
A friend of mine was recently counselling a heart-sick family at the bedside of their dying child. The family had already refused to make her a “brain dead” organ donor since they understood that brain death is not death, but rather a social construct designed to allow organ harvesting from vulnerable, brain-injured people. Undeterred, the organ procurement team asked whether they would consider making their daughter an organ donor after “circulatory death.” While this might sound like an ethical option, the devil is in the details.
In 1993, the University of Pittsburgh Medical Center introduced a new protocol for harvesting organs from people who had consented to be given a “Do Not Resuscitate” (DNR) status called donation after circulatory death, or DCD. DCD is a death that is planned to occur at a specific time and place. These people are not brain dead, but are either not expected to survive or have decided that their quality of life is unacceptable and have requested that life support be withdrawn in a way that allows for organ harvesting. DCD donors are taken to the operating room (or a suite nearby) and are removed from all life-sustaining care, including their ventilator. Once they become pulseless, doctors observe a two to five minute “no touch” period to be sure that their heartbeat does not spontaneously resume. Organ harvesting begins as quickly as possible thereafter, since warm organs very quickly become unsuitable for transplantation in the absence of circulation.
But are these people dead after just two to five minutes of pulselessness? Many medical professionals are uncomfortable with DCD because we know that people are routinely resuscitated within this timeframe. Because DCD donors could still possibly be resuscitated, they are not yet dead. The only reason they are not being resuscitated is that the patient or their family has decided to forego resuscitation (even though it might have been successful) and become an organ donor. Sociologist Renee C. Fox sharply criticized the DCD protocol, calling it, “an ignoble form of medically rationalized cannibalism” that “borders on ghoulishness.” She deplored dying a death away from family in an operating room, a “desolate, profanely ‘high tech’ death that the patient dies, beneath operating room lights, amid masked, gowned, and gloved strangers.” And Dr. Ari Joffe, a clinical professor of pediatrics and critical care at the University of Alberta, in reviewing the medical literature found a dozen patients whose hearts restarted without any medical intervention at all after as much as 10 minutes of cardiac arrest, with some of these patients making a complete recovery. Worldwide, many countries have decided that DCD is unethical: the practice is banned in Finland, Germany, Bosnia-Herzegovina, Hungary, Lithuania, and Turkey.
In 2021, a case report appeared of a DCD organ donor who self-resuscitated on the operating room table during the removal of her kidneys. This unfortunate 39-year-old woman with Down Syndrome had suffered a ruptured aneurysm in her brain. She was not brain dead but was not expected to survive. Her family consented to donation after circulatory death. So, instead of being held in her mother’s arms and entering eternity knowing she was loved, she was taken to the operating room. Her ventilator was removed and her vital signs dropped rapidly.
“At 2:57 A.M., she had no measurable blood pressure, no oxygen saturation, and no respiration. A physician listened to her heart under the sterile drapes for an additional 2 minutes. During that time, no heart tones were heard. Her pupils were fixed and dilated, and her face was cyanotic/mottled. Her spontaneous respirations halted, and there was no palpable carotid pulse. She was pronounced dead at 2:59 A.M.
After cardiac death was pronounced, an abdominal midline incision was made to begin organ procurement at 3:00 A.M. It was seen that her aortic and renal arteries were pumping and pulsing. The organ procurement surgery was stopped. It was noted that she had spontaneous agonal respiration. Her heart rate was back in the mid-80s to 90, and her blood oxygen saturation levels were back in the 50s. At the time, the patient was given additional doses of Fentanyl and Lorazepam. Subsequently, she was pronounced dead a second time at 3:17 A.M.”
In essence, her heart started beating again and she started gasping for breath while doctors were removing her organs. Her manner of death was determined to be a homicide.
And in the never-ending quest for viable organs, doctors have found a macabre new way to skirt both the brain death and circulatory death criteria. Transplant centers around the country are removing people who have signed a DNR order from life support, waiting for their hearts to stop, and then immediately clamping off the blood flow to their brains to make them brain dead on purpose. Then their organs are resuscitated, but the person doesn’t wake up because the circulation to their brain has been clamped off. The protocol for this procedure, called normothermic regional perfusion (NRP) from the University of Nebraska, notes: “The initial step for ligation of the blood vessels to the head is necessary to ensure that blood flow to the brain does not occur. Once blood flow to the heart is established, the heart will start beating.” How dead are you if doctors can re-start your heart in your own chest?
Lauris Kaldjian, MD, PhD, director of the program in bioethics and humanities at the University of Iowa Carver College of Medicine writes, “NRP represents a technologically elaborate attempt to refashion definitions of death to maximize the number and quality of transplanted organs. It both depends on and violates the circulatory definition of death and arguably employs iatrogenic [doctor-induced] brain death.”
The American College of Physicians recommended in 2021 that the practice of NRP be paused, as "the burden of proof regarding the ethical and legal propriety of this practice has not been met." Other nations, such as Australia, have banned NRP altogether. But despite ongoing ethical concerns, this type of organ harvesting is continuing and expanding in the United States.
How many families would give their loved ones over to transplant teams if they knew the grisly reality taking place behind operating room doors? While professionals debate the ethics of DCD and NRP, people continue to sign their donor cards in ignorance of these facts. Physicians and organ procurement organizations must come clean on the many controversies surrounding both "brain death" and "circulatory death" organ harvesting. It is critical that patients receive a full explanation of the many ethical questions involved before giving their consent.
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