“People who live in glass houses shouldn't throw stones”
“People who live in glass houses shouldn't throw stones”
Dr. Sharif concluded in his “personal view” [1] on low levels of donor registration stating that the correct public message should be that future organ recipients must have verifiable historical proof of willingness to donate (or have their transplant needs reprioritized). As a consequence, “[t]here are no legitimate excuses for hypocrisy”[1].
We are troubled by the word “hypocrisy” which is commonly understood as someone saying one thing while doing the other. With that being the case, we outline some of the concerns we have both in regard to the practice of recruiting potential donors and the novel ways of defining and determining death. One example of the former is the lack of public transparency when “informed consent” for donation was replaced by the word “authorization.” The significance is that authorization does not require full public disclosure of information about harms and benefits [2]. No need for information disclosure at all. The non-disclosure need pertains to the scientific, legal, and ethical controversies about death determination and the consequential harms to donors. In fact, the main supply of transplantable organs comes from heart-beating donors who are determined dead by neurological criteria, commonly referred to as “brain death” criteria. There is no scientific validation of these criteria [3]. There is also no global uniformity in the determination process of brain death [4]. Potentially more harmful to donors is that surgical procurement is performed routinely with neuromuscular-blocking agents administered to induce paralysis but without the necessary general anaesthesia [5].
In an editorial published in 2009, “Nature” outlined the legal noncompliance of death determination by neurological criteria in organ donors: “…time has come for a serious discussion on redrafting laws that push doctors towards a form of deceit” [6]. Two recent legal cases in the United States of Jahi McMath [7] and Aden Hailu [8] illustrate the growing legal discontent with the medical labelling of neurological disorders of consciousness as dead.
We would applaud Dr. Sharif for pointing to the existing “hypocrisy” in organ donation and transplantation if not for the fact that most of that behavior is not attributable to that of potential donors but can be more appropriately ascribed to advocates of current practice. This is illustrated by persistent denial of the growing evidence invalidating brain death as human death and the subsequent ethical and legal problems with organ donation. Based on the existing flaws in the organ donation process, for individuals to agree to donate one’s organs [after death] to save the lives of others seems more in line with a supererogatory act; an act above and beyond with what we could reasonably expect from moral actors.
Mohamed Y. Rady, BChir, MB (Cantab), MA, MD (Cantab), FRCS (Eng & Edin), FRCP (UK), FCCM
Department of Critical Care, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, USA
Joseph L. Verheijde, PhD, MBA, PT
Department of Physical Medicine & Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, Arizona, USA.
References
1. Sharif A. It will take more than an opt-out system to increase organ donation: prioritise donors to receive organs. BMJ 2015;351:h5165
2. Iltis AS. Organ Donation, Brain Death and the Family: Valid Informed Consent. The Journal of Law, Medicine & Ethics 2015;43(2):369-82.
3. Nair-Collins M. Taking Science Seriously in the Debate on Death and Organ Transplantation. Hastings Cent Rep 2015;Article first published online17 JUN 2015-DOI:10.1002/hast.459.
4. Wahlster S, Wijdicks EFM, Patel PV, et al. Brain death declaration: Practices and perceptions worldwide. Neurology 2015;84(18):1870-79.
5. Anderson TA, Bekker P, Vagefi P. Anesthetic considerations in organ procurement surgery: a narrative review. Can J Anesth/J Can Anesth 2015;62(5):529-39.
Rapid Response:
“People who live in glass houses shouldn't throw stones”
“People who live in glass houses shouldn't throw stones”
Dr. Sharif concluded in his “personal view” [1] on low levels of donor registration stating that the correct public message should be that future organ recipients must have verifiable historical proof of willingness to donate (or have their transplant needs reprioritized). As a consequence, “[t]here are no legitimate excuses for hypocrisy”[1].
We are troubled by the word “hypocrisy” which is commonly understood as someone saying one thing while doing the other. With that being the case, we outline some of the concerns we have both in regard to the practice of recruiting potential donors and the novel ways of defining and determining death. One example of the former is the lack of public transparency when “informed consent” for donation was replaced by the word “authorization.” The significance is that authorization does not require full public disclosure of information about harms and benefits [2]. No need for information disclosure at all. The non-disclosure need pertains to the scientific, legal, and ethical controversies about death determination and the consequential harms to donors. In fact, the main supply of transplantable organs comes from heart-beating donors who are determined dead by neurological criteria, commonly referred to as “brain death” criteria. There is no scientific validation of these criteria [3]. There is also no global uniformity in the determination process of brain death [4]. Potentially more harmful to donors is that surgical procurement is performed routinely with neuromuscular-blocking agents administered to induce paralysis but without the necessary general anaesthesia [5].
In an editorial published in 2009, “Nature” outlined the legal noncompliance of death determination by neurological criteria in organ donors: “…time has come for a serious discussion on redrafting laws that push doctors towards a form of deceit” [6]. Two recent legal cases in the United States of Jahi McMath [7] and Aden Hailu [8] illustrate the growing legal discontent with the medical labelling of neurological disorders of consciousness as dead.
We would applaud Dr. Sharif for pointing to the existing “hypocrisy” in organ donation and transplantation if not for the fact that most of that behavior is not attributable to that of potential donors but can be more appropriately ascribed to advocates of current practice. This is illustrated by persistent denial of the growing evidence invalidating brain death as human death and the subsequent ethical and legal problems with organ donation. Based on the existing flaws in the organ donation process, for individuals to agree to donate one’s organs [after death] to save the lives of others seems more in line with a supererogatory act; an act above and beyond with what we could reasonably expect from moral actors.
Mohamed Y. Rady, BChir, MB (Cantab), MA, MD (Cantab), FRCS (Eng & Edin), FRCP (UK), FCCM
Department of Critical Care, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona, USA
Joseph L. Verheijde, PhD, MBA, PT
Department of Physical Medicine & Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, Arizona, USA.
References
1. Sharif A. It will take more than an opt-out system to increase organ donation: prioritise donors to receive organs. BMJ 2015;351:h5165
2. Iltis AS. Organ Donation, Brain Death and the Family: Valid Informed Consent. The Journal of Law, Medicine & Ethics 2015;43(2):369-82.
3. Nair-Collins M. Taking Science Seriously in the Debate on Death and Organ Transplantation. Hastings Cent Rep 2015;Article first published online17 JUN 2015-DOI:10.1002/hast.459.
4. Wahlster S, Wijdicks EFM, Patel PV, et al. Brain death declaration: Practices and perceptions worldwide. Neurology 2015;84(18):1870-79.
5. Anderson TA, Bekker P, Vagefi P. Anesthetic considerations in organ procurement surgery: a narrative review. Can J Anesth/J Can Anesth 2015;62(5):529-39.
6. Nature. Delimiting death. Nature 2009;461(7264):570.
7. Winkfield v. Childrens Hospital Oakland et al . Case No: C 13-5993 In: California Northern District Court Oakland Division.
8. Haliu vs Prime Healthcare Case No. 68531. In: The Supreme Court of Nevada.
Competing interests: No competing interests