A practice to expand the pool of live donor organs is getting increased attention as doctors and patient advocates say it plays fast and loose with the legal definitions of death.
The practice known as normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD) involves inducing brain death in terminal patients by clamping off their brain stems and restarting their hearts to keep the organs viable. Medpage reported in September that three hospitals in Arizona, Nebraska, and New York are conducting clinical trials to expand the practice.
Patient advocacy groups like Respect for Human Life, however, are warning the public about the ethical concerns surrounding NRP-cDCD. In an article on October 2 in American Thinker, Heidi Klessig, M.D., wrote, “Don’t become a victim of unethical organ harvesting practices. Don’t sign that donor card!”
Potential Conflicts
Patients receiving critical care in hospitals and other medical facilities may not understand the processes by which clinical death is determined or those by which organs of a person declared clinically deceased may be harvested.
Klessig told the Heartland Daily Podcast on November 28 that a revision in 2006 in the Uniform Anatomical Gift Act allows hospital administrators to take organs from incapacitated patients determined to have irreversible brain function and whose family members are not reachable. “…which is terrifying when there is a person whose interest is how much money can be made from your organs, not what is in your best interests.
Live organ transplants can reap millions of dollars for hospitals that procure the organs and centers that transplant them. According to a report by the consulting firm Milliman, the average billed charges for a heart transplant in 2020 amounted to $1,664,800. Lung transplants were billed at an average of $1,295,900 and intestines at $1,240,700.
Unlike tissue from cadavers, vital organs such as the heart, lungs, livers, and kidneys cannot be harvested from a patient whose circulatory system has shut down. “These organs rely on a continuous supply of oxygen and nutrition through the bloodstream to remain viable,” said Klessig. “They are so complex that once the blood flow stops, they very quickly break down and become unsuitable for transplant.”
This reality explains why some 100 thousand patients remain on an organ waiting list despite 1.5 million people willing to donate their organs. “If a dead person could donate organs, that would work out to 15 organs per waiting recipient which is a lot more than we need,” said Klessig. “So clearly, dead people cannot donate organs and we wouldn’t have a waiting list at all but an organ surplus.”
An exception to the rule is a kidney or a lobe of the liver, which can be donated by patients who remain alive.
Expanding the Definition of Death
The current clinical definition of death arises from the 1968 “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that replaced previous standards for determining death based on the failure of the circulatory, respiratory, and neurological systems.
The Harvard report ultimately led to the federal Uniform Determination of Death Act (UDDA), which redefined death as either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem.
Allowing for a clinical diagnosis of “brain death” opened the door for certification of death of a patient whose heart and lungs were still providing oxygenated blood to organs, thereby creating a convenient new avenue to live organ harvesting. While this process may seem reasonable, and while the UDDA requires determinations of brain death to be rendered according to “accepted medical standards,” there is no existing medical requirement for EEG scans or anything beyond basic clinical observation.
“Irreversible cessation of heart and lung function OR irreversible function of the entire brain, including the stem doesn’t sound terribly controversial but the devil is in the details,” said Klessig. “The problem is that doctors are not always able to determine what is irreversible. Doctors are not God. They can’t predict the future. They don’t know for certain that a diagnosis is irreversible.”
All Eggs in One Basket
In an August 2022 editorial published in the Chest Journal, titled “Does Normothermic Regional Perfusion Violate the Ethical Principles Underlying Organ Procurement? Yes,” Matthew DeCamp, M.D., Ph.D., a bioethicist at the University of Colorado, and his co-writers challenged the ethics of the NRP-cDCD procedure.
“NRP is used in cDCD when a patient does not meet criteria for brain death and is receiving cardiorespiratory support,” DeCamp writes. “Life-sustaining therapies are withdrawn consistent with patient and/or family wishes, resulting in the cessation of cardiorespiratory functions. But because the intention from the outset is to restart circulation, and recognizing the possibility of brain viability, active steps to prevent recirculation to the brain (eg, ligation or balloon occlusion of the carotid arteries) are taken. This violates the US standards for determining death.”
Australia banned NRP-cDCD and the American College of Physicians stated in 2021, the procedure raised “profound ethical questions regarding the determination of death, respect for patients, and the ethical obligation to do what is best.”
While Klessig says she has empathy for those waiting for a live organ, medical practice should not condone taking the life of one person to save another.
“I really believe if we hadn’t been pouring all our time, money, and research dollars into the current unethical system, I think we would have found better solutions for people, such as augmenting the heart or providing an artificial one. Those treatments need to be developed and those scientific pursuits are not being funded,” said Klessig.
Organ procurement is big business with less and less concern for donors’ welfare and lives, says Julie Grimstad, a board member and patient advocate at the Healthcare Advocacy and Leadership Organization (HALO).
“There have been efforts to develop animal transplants. None of them have been successful,” said Grimstad. “There have also been efforts to develop mechanical organs, such as a permanently implanted pump that would act as an artificial heart. A wonderful physician, Harold Kletshka, M.D., developed a successful working model decades ago, but it never went to market due to several unsavory efforts to take control of the project.”
A biography on Kletshka, To Change the Heart of a Man, was published in 2009.
Kevin Stone (kevin.s.stone@gmail.com) writes from Arlington, Texas and
AnneMarie Schieber (amschieber@heartland.org) is the managing editor of Health Care News.
Internet info:
“Think Twice Before Signing that Organ Donation Card – Heidi Klessig, M.D.,” The Heartland Daily Podcast, November 28, 2023.
The post Live Organ Harvesting Procedure Raises Red Flags appeared first on Heartland Daily News.
