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SURGEON RAISES SERIOUS QUESTIONS ABOUT NEW STANDARDS BY WHICH ORGAN DONORS ARE DECLARED 'DEAD'
Recently we ran an article about organ transplants and afterwards were contacted by a Catholic surgeon, Dr. David E. Hargroder, of Joplin, Missouri, who says he left the field due to concern over the actual state -- alive or dead -- of those from whom organs were procured.
In many cases, no one but God knows. The heart can be beating or the person breathing artificially, via a ventilator, and the soul departed, for all we know. The medical profession now defines death as "brain death": when electrical activity ceases, especially in the brain's stem, which controls the body. That's when organs are taken.
Faced with a transplant or death, it is a "tough, tough" decision, as Dr. Hargroder says. After all, the Church currently allows it. Again: who but God knows? A major theologian he consulted said something is not a sin if we have "moral certainty" otherwise: if the collective judgment is death.
But many argue that there are various ways of defining brain death, and that organs are taken by people who are technically still physically there, responding to stimuli -- including, in rare cases, exhibiting pain during the organ removal and even gestating babies while life-support keeps the tissues from decay. Meanwhile, many are those -- perhaps nearly all of us -- who faced with a life or death situation would opt for the medical remedy. Yet we have been spurred to wonder:
Who is dead? Do we take organs from the "nearly dead"? If so, what percentage?
According to Dr. Hargroder, virtually all hearts, livers, and kidneys are taken while a body is still warm, with circulating blood and a beating heart because they are on that ventilator.
There have been problems.
As reported several years ago by the Associated Press, "The parents of an 18-year-old Ohio man who suffered a brain injury while snowboarding claim in a lawsuit filed that doctors at a northwestern Pennsylvania hospital intentionally killed him so they could harvest his organs. The lawsuit claims that Hamot Medical Center doctors and a representative of the Center For Organ Recovery and Education caused Gregory Jacobs' death by administering medication and by removing his breathing tube, causing him to suffocate. The hospital denied the accusations. 'We express our deepest sympathies to the Jacobs' family, but Hamot Medical Center absolutely did not remove Gregory Jacobs' organs while he was alive,' Lucia Conti, a hospital spokeswoman, said in a statement issued Wednesday night. 'Any claims otherwise are completely baseless.' The suit was filed in U.S. District Court in Pittsburgh by Jacobs' parents, Michael and Teresa Jacobs, of Bellevue, Ohio. It seeks more than $5 million for their son's pain and suffering, medical bills and funeral expenses, plus punitive damages. 'But for the intentional trauma or asphyxiation of Gregory Jacobs, he would have lived, or, at the very least, his life would have been prolonged,' the lawsuit said."
There are cases -- extremely rare, but in existence -- in which a person was declared "dead" and readied for organ "harvesting" but came back to consciousness.
The problem, particularly with heart transplants, is that "harvesting" an organ from a person before every single sign of life vanishes increases the viability of the transplant and thus is the way it is currently done in most cases. Hearts typically are good only for four hours after removal, livers for 12 to 24, and kidneys for 72, according to Dr. Hargroder -- which is why doctors keep a ventilator on people who otherwise would be fully dead, maintaining the blood flow to organs until surgeons rush to the scene, often by jet or helicopter.
"I was formerly trained in kidney and liver transplants, and part of the responsibilities of a kidney-liver-transplant surgeon is procuring organs from potential donors," Dr. Hargroder told us. "I was also responsible for removing them. I did this with a good calm conscience and felt that there was nothing wrong with what I was doing until the day I was asked to give a talk in Houston by a Catholic priest and it forced me to revisit the issue.
"As I was discussing the procedure with this priest -- the actual procedure -- he didn't realize this was what happened and one of the things that shocked him was the fact that we were actually taking organs from patients -- brain-dead patients -- but where their skin was still warm, their hearts still beating, but ones we had declared dead. Formerly death was cessation of the heart and breathing. We took these patients to the operating room with beating heart, circulating blood, and in the operating room the anesthesiologist was there and we opened up the abdomen and then one of two things: if you were taking the heart, you would inject a potassium-chloride mixture that made the heart stop beating and then literally drain the blood from the patient and replace it with a fluid that preserves the organs.
"The point of contention is that you actually have a beating heart and you're stopping it.
"They're on a mechanical ventilator, a machine breathing for them, but the heart is still beating. If it's only a liver or kidney, they drain blood and use preservation fluid. We are actually doing something, by the surgeon's action, that causes the heart to cease to beat.
"There's a big distinction between letting nature take its place: while it's okay under certain circumstances to allow a patient to die, for example by removing a ventilator, that would be morally okay; but to go into a patient and actively inject a drug into their veins to make the heart stop -- that's a different approach. The whole concept of 'brain death' [adopted by the medical community as the standard for "death" in the late 1960s] made this acceptable."
The justification: that the heart would eventually stop anyway once the ventilator was off. One can see both sides of this.
"The rationale was: let's at least help somebody else, and maybe even give some redeeming meaning to a person's death," said Dr. Hargroder. "It wasn't until it was pointed out to me that with this approach the problem is that brain 'death' is not a universally-accepted concept. It had been my impression that it was a universally-accepted concept. But there were a vast array of approaches -- to the point where some believed brain death was not even a viable concept at all and that only cardio-respiratory cessation would be valid [as a definition of death]. Meanwhile, at the other end, were those who didn't think we went far enough and argued that even being in a comatose state should be good enough [reason] to take the organs.
"It made me realize this was not a universally-accepted concept. It even varied from state to state: A person could be declared dead in one state and transferred to another and still considered alive. It was this lack of consensus that gave me second thoughts."
Also, in researching, Dr. Hargroder found how little we know about the brain itself.
There are recent studies that have shown patients thought to be in a persistent vegetative state and seemingly totally unaware of their environments can however register activity when examiners use equipment like the functional MRI; if a brain-dead person was asked to imagine a particular activity -- such as stirring a cup of coffee with the right hand, or doing a tennis stroke -- those in a persistent 'vegetative' state showed the same portions of their brain lighting up, in some cases, as did normal, conscious volunteers. "What it suggested was that they were processing the information but not aware enough to express it," says the surgeon.
"Another example: the Bis-Monitor System, sort of like a rudimentary EEG, that measures brainwaves, used by anesthesiologists to determine levels of general anesthesia. It's 0 to 100 on awareness: 0 no brain activity. It measures a certain amount of brain activity and there was a study in 2002 where on a small number of brain-dead patients -- five -- they found three of them had values between 15 and 45 and one had a reading that went up as high as 90 during the apnea test [which tests whether or not a person can breathe when the ventilator is shut off].
"I saw this study and it really was impressive. I called an anesthesiologist who said they were told to stop using the device because it was making people uncomfortable."
"I told the priest what we did and he said, 'I don't think I like that. I don't think I like it all,'" recounts the surgeon. "And then I read Thomas Aquinas who distinguished five genera of powers in the soul -- namely, vegetative, sensitive, appetitive, locomotive, and intellectual." The point: higher forces control the soul which controls the body. And those forces we can't quantify. Any one can indicate the soul is still there.
"I would say it is the norm that most of the patients, that most of the organs are retrieved from the donor who still has a beating heart and circulating blood, with the exception of skin tissue and bone, which can take place even after a body has been in the morgue several hours; aside from that -- functioning organs like kidney, liver, heart and lungs -- are almost all taken from patients who at the time they entered the operating room had warm skin, circulating blood, and beating heart."
After speaking with that priest in Texas, Dr. Hargroder "made a few other phone calls, including to clergy, a moral theologian, prominent in the field," who "didn't have a definite answer; he said you reach a certain point of 'moral certainty'; if it's universally accepted, it's not morally wrong. The problem I had is that it's not very universally accepted. It was very soon after that I'd decided this was not something I could continue to do."
Some who are declared as brain "dead" have gone to live for significant periods of time, says the surgeon; the body disintegrating is an indication the soul has left, said Aquinas; but there are those who exhibit integrated function even after being declared "dead"; a brain-deceased pregnant woman able, for example, weeks after such a declaration, to deliver a child.
It used to be that the test for brain death included the apnea (a test followed twenty-four hours by a repeat of it. Now, many hospitals don't bother, says the surgeon. The "strict criteria (on death) have become less and less and less," he warns (for our discernment).
In many cases, if a ventilator is shut off and the patient can't breathe, and has no detectable electrical activity in the brain, that's it. The organ harvesters are called in.
And let's add, for balance here: lives are saved by transplants.
A single donor can save several people. Who among us would not want the chance to live?
Dr. Hargroder trained and did procurements from 1991 until 1996 but never saw a donor exhibit pain or a reaction. "It's more like heart starts racing or blood pressure goes up," he explains. "There is the 'Lazarus Reflex,' when during the sleep-apnea test they take a patient off a ventilator to see if he/she will breathe on their own and a patient will bend an arm up and cross his chest with it. The argument is that this is not from the brain but directly from the spinal cord. This I have seen."
If his life depended on it, would he choose a transplant?
Dr. Hargroder answers that one can get a single kidney or a portion of a liver from a conscious, living donor.
"It's a tough, tough call. I am not against the transplant field. It's a noble field." But more technology is needed, he says, to preserve organs after total death and even to create organs through adult human stem cells.
When faced with the moral dilemma of needing an organ from a person who was in that twilight zone, the surgeon says, "I can't answer that this question for a person."
There is also a devout Catholic named Dr. Paul Byrne who publicly decries transplants [see below].
Others also weighed in.
"I found your article today very interesting," wrote Angie Romano. "I live just outside of Toledo, Ohio. One of my sisters is a surgical nurse. She told me several years ago she would never want any of her family members to be an organ donor after what she has seen. (We have a brother-in-law alive today because of a kidney transplant he received, so we totally understand the double-edged sword that this presents.) She said that the times when she had been in the surgery room during organ harvesting, she has seen patients in definite pain when the harvesting begins. She said you can see it on their faces and it is horrible. I don't know what the answer is, just that it is a difficult situation. My sister has since transferred to a different hospital where they do not do the same type of trauma level work as was done at the first hospital. It seems like it is a similar situation as hospice care. Another sister is a cardiac nurse. She explained to me how, even though morphine is given to relieve pain in a terminal patient, at some point the medical personnel know that the next dose of morphine will overwhelm the patient's respiratory system and they will die. But we give it to them anyway to keep them comfortable. Modern science is such a blessing, but it comes with so many new sets of moral issues."
Indeed. Another issue to be further explored in the future: how many elderly or "terminally" ill are "rushed off" to eternity at hospices and in hospitals?
Let us emphasize that the Vatican
accepts organ transplantation and even encourages organ donation. Only in
prayer can we determine such a personal decision.
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