Once in awhile, something comes along that really surprises me. This is one of those times.
The January issue of Nursing2009 not only has an article harshly critical of organ harvesting regulations and protocols, it has made the article available online.
In Speaking up for organ donors (link to html version, with additional link to pdf on the page), Ellen Bridget Linde, RN, BSN explores the values she and other nurses espouse and how they come into conflict with organ harvesting practices.
From the article:
AS NURSES, WE FACE TOUGH ethical dilemmas as we provide end-of-life care, especially when our patients are candidates for organ donation. In this article, I’ll explore two basic issues: how death is defined and who makes decisions for potential organ donors who haven’t made their wishes known. First, let’s look at some basic ethical principles.
Examining your valuesNurses must consider respect for life and bodily integrity in light of the procedure for recovering organs. Nursing is primarily grounded in beneficence (doing good) and nonmaleficence (not doing harm). But nurses interpret these guiding principles in various ways. Some, believing that removing vital organs is what kills the patient, view organ donation performed under current criteria for pronouncing death as an act of killing. Others suggest that organ donation is a “moral duty, an obligation,” considering society’s lack of alternative healthcare resources. But not all nurses are comfortable with a value system driven primarily by the needs of transplant recipients rather than by the needs of the potential donor.
The middle of the article details the various ways in which death has been defined and redefined, partly in response to the demand for more availability of organs for transplantation. Since the article is freely accessible, I leave it to others to go read the exploration of the complications surrounding brain death, non-heart-beating donation, and other matters affecting organ harvesting practices.
Bottom line: there are non-trivial conflicts between traditional values espoused in the nursing profession and organ harvesting practices to make a number of practitioners a little queasy:
Studies indicate that although nurses generally report positive attitudes toward the idea of donation, their unwillingness to donate their own organs or the organs of their family members suggests either some uncertainty or other barriers to donation. Perioperative nurses involved in organ procurement experience a variety of feelings as they participate in the removal of organs from a body that physically appears the same as that of any other surgical patient. Perioperative nurses have described their participation in organ procurement as disrespectful, traumatic, and emotionally draining.
Where do I stand on organ donation? When I started researching this article, I was an avid, outspoken advocate for organ donation, but I’ve since had a change of heart. Shewmon’s study of 175 patients who met the full criteria for whole-brain death led me to conclude that it’s ethically wrong to recover organs from a person who’s still breathing—regardless of whether or not breathing is achieved through mechanical ventilation. Although I’m no longer a potential organ donor, I’m an avid and outspoken supporter of stem cell research because I believe it’s a realistic alternative to organ procurement.
The Shewmon study referred to showed that many individuals meeting the full criteria for brain death were still alive in ways that this nurse considered meaningful.
Neither the Shewmon study nor this article come close to talking about some even more disturbing aspects of brain death determination.
More about that next week. –Stephen Drake
(thanks to Nancy Valko for pointing this article out)
It’s important to consider the matter of *why* there’s such pressure to snatch organs from the not-dead-yet.
There are plenty of people in the US who die waiting for transplants that never come. I personally am at great risk for becoming one of them someday.
If our organ procurement system was better at reaching out to potential donors, before they are about to die or dead already, this shortage would not exist. And the shortage can be overcome through ethical means.
Anyone here who would like to register as an organ or tissue donor, please do! In the US (among other places), there is a real need for people of color donors. My grandbaby, a person of color, owes his life to a matching tissue donor.
http://nonviolentchoice.blogspot.com/2007/07/organ-and-tissue-donation-how-you-can.html
And if you are concerned about losing your organs while you still need them–a valid concern, to be sure–you can express your wishes in a legally recognized/enforceable document. And make sure you have loved ones who will go to bat for you when/if you become incapacitated.
Marysia,
People have concerns over registering as organ donors. Part of the concern is the move to let the declaration of donation take precedent over other concerns – such as next-of-kin insisting that other life-saving measures be tried.
There’s also the fear that being a declared organ donor might make one more vulnerable to a “rush to judgment” in the case of severe neurological injury.
I’m in my fifties, so the older I get the less danger there is that people will see my organs as valuable. My own concerns are serious enough so that my personal approach has been to refuse to sign the “organ donor” section of my driver’s license.
BUT… My family and durable power of attorney all know that they can give permission *for* me if they are convinced the situation is real and it’s really over for me.
I’ve seen things like this, and I’m a registered organ donor anyway. My reasoning is, first, that my family knows I would much rather live as very disabled than die, and has enough medical knowledge that the doctors couldn’t pull the wool over their eyes. And second, I’ve studied death, and there really isn’t a clear dividing line between alive and dead at all. It’s all philosophy. The most extreme definition of “dead” is the point at which it becomes theoretically (not just realistically) impossible to retrieve information from a human brain… that is, usually several days after the stopping of the heart; indefinitely, if the body is frozen. The definition we use now–the long term flat EEG, the absence of response to even the most rudimentary reflexes–is good enough for me, and I can be relatively sure my family will be sure they follow it.
The definition of “alive”, to me, doesn’t have anything to do with how damaged the body is or isn’t, or even how much of it is left, or how well it works, but with the condition of the brain. If there’s no electrical activity (yes, I know, EEGs aren’t 100% reliable), and no blood flow to the brain, then the person’s dead. A human being is, basically, the brain. The rest of the body can be in full working condition and I’d still consider it death. Conversely, the rest of the body could hardly be working at all, and I’d consider it life, and worthwhile life.
However, I can understand not wanting to donate your organs. People are unscrupulous and not everyone is willing to risk that in the hopes that somebody else might have the advantage of a donated organ.
I’d like to suggest a reasonable alternative that doesn’t require treading the thin line between life and death: Body donation. I’m a student in a medicine-related field, and I’ve taken two anatomy classes already. What we learned from the cadavers has been really valuable, and there’s no way we could have learned it nearly as well from models or diagrams. There is absolutely no substitute for learning from the actual human body. When I’m in anatomy lab, most of the time I’m focused on learning the information, and the philosophy of it doesn’t really come into it much; but sometimes I take time to think, and I feel really honored that these people would make such a personal gift to our little class. Holding a human brain in your hand and realizing that this was once a person, an entire mental universe and like no other, you realize just how complex and fascinating a species we are and how valuable life really is.
If you’re worried about donating organs, I think you should really consider body donation instead. Students like me could use the help, and there’s never enough to go around. Researchers could use the materials, too; there is simply nothing that can substitute testing your ideas or your experimental medical equipment on an actual human body. And there’s no chance of being mistaken for dead–body donation indisputably happens after death. It might not be the immediate good that organ donation is, but in the long-term, it can be just as valuable.
Thanks for the comments to my article. I initially wrote the piece in the hope that it would “get people talking” about a subject that is too often considered taboo. This is important stuff folks!
Ellen Bridget Linde
Usually when an article like this is published (one which goes against the grain somewhat) it is because things have actually slipped much further than the article appears to address as a current concern. If the article is provided by a medical provider it is a bit unnerving.
I have personal experience with the way it truly is in the organ donation milieu at the moment and it’s really ugly.
Many brain ill/injured people are coming into hospitals in very good shape relative to others but where they would have once survived quite nicely, they aren’t these days.
One such case happened at the Toronto Western Hospital. The wrongdoing was the subject of a lawsuit and in the public domain. Here a young man with a tumefactive MS lesion came in for a course of medical steroids to treat the relapse. He’d had one before.
Upon arrival at the TWH he was immediately put under the care of a kidney transplant resident (as if to keep the patient in his grip). The patient was denied his usual care which caused him to become worried. After checking that he indeed was not going to be treated as he had been four years previously he tried to leave the TWH to try another hospital.
He didn’t get far. Yanked back he was was sedated (contraindicated for brain issues) and left to sleep for 14 hours without waking by nurses. When he did awake he was in bad shape and terrible pain.
After abandoning him without any proper care for another 24 hours a neurologist came in and gave the patient a dose of morphine (very contraindicated). In 45 minutes the patient seizured. He was left to seizure for 70 minutes.
Nothing was said about the patients now extremely high ICP.
Eventually his pupils blew and only then was his family notified. Of course they were asked to donate his organs. Fortunately they said no.
The update here is that the era of “brain dead” or “not brain dead” has long passed. We need to look at what is going on now. There are protocols now to make people sick in the hospital… or to lie about their status.
The nurse who wrote this article got one thing very right. Donors ARE designated as probable or not. However this isn’t done after treatments to save their lives. This is done INSTEAD of treatments to save their lives.
Because a hospital can only gamble on near-sure cases, they profile the incoming candidate. If he is white and college educated like this patient at the Toronto Western, he will be gambled on and made sick through denial of care and exacerbation. All the while his deterioration will be covered up especially his pain. This is a diabolical act on the part of greedy doctors.
Another group eyed are the fundamentalist Catholics. These patients are seen as easy prey to the notion of “giving one’s life to save others.”
The reason why these racial and religious profiles are not brought out is because they are clouded by political correctness. However they are real and something has to be done about it.
At the very least, updates must be provided as to how callous hospitals are becoming about simply taking what they want and using hospital infrastructure to kill instead of heal.
If those in the know only tell us what HAS gone on and not what is going on, we will never be able to protect ourselves. I believe the nurse who wrote the article did so with this in mind.
Hi Misterc,
Thank you for posting this, it is truly good to know that others know about this. I’d suggest that you check out the http://www.lifeguardianfoundation.org website, so that you can find out more about this horrible organ harvesting industry. Most people have no idea about this, and they don’t want to know because they fear that they may need an organ for themselves or loved ones, so they’d rather have another person be sacrificed for their well being and lives.