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InsiderOnline Blog: October 2008

Defining Death Down

Upwards of 6,000 people die every year in the United States waiting for an organ transplant. That by itself should cause a reconsideration of the government’s policy of outlawing financial compensation for organ donation.

But here’s something else: The organ shortage may also be encouraging a shift in the definition of death. Economist reports that bioethicists are concerned that “as the demand for organs rises, doctors are under pressure to shift the line that divides life from death, so that they can get hold of organs for transplant at a time when they are more likely to be in a healthy condition.”

Following the 1968 recommendations of a committee at Harvard Medical School, most countries changed the definition of death from cardiac death to brain death. But waiting for brain death can take a few extra critical minutes. The concern is that in some cases doctors may be reverting to the old definition of death in order to hurry things along. That’s the case laid out by Robert Truog of Harvard Medical School and Franklin Miller of the National Institutes of Health in a paper published in August by the New England Journal of Medicine. Economist reports:

Dr Truog and Dr Miller posit the example of a patient who has given informed consent to the withdrawal of life support in the case of his suffering devastating brain injury. The doctors respect his wishes and his heart stops beating. So far, so ethical. But instead of waiting a few minutes for his brain to die as well, they anticipate this inevitability and declare him dead immediately, so that they can hurry along with the business of removing his organs.

Death in such cases is therefore based on a decision not to resuscitate, not the impossibility of resuscitation. And their hypothetical case does seem to be happening more frequently in reality. In America, data from the Organ Procurement and Transplantation Network, an organisation that matches donors to recipients, show that those classified as cardiac-dead but not brain-dead represent the fastest growing proportion of donors, having risen from zero ten years ago to 7% in 2006.

Does this news make anybody more willing to carry a donor card?

Posted on 10/09/08 05:12 PM by Alex Adrianson

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