"Should we scrap the dead donor rule?"

From Michael Cook, BioEdge Editor:

Hi there,
Our lead stories this  week deal with donation after cardiac death. Frankly, I find this a bit perplexing, as there are several schools of thought on whether it is ethical to remove organs from someone after his heart has ceased to beat. Passions run high when lives are at stake. The donor's life, first of all. Is he dying a natural death or is he being killed for his organs? And then all those thousands of people whose lives could be saved if they get kidney or a lung.
The premise of these debates is a fundamental principle, "the dead donor rule". Surgeons agree that vital organs can only be taken from donors who are dead. Otherwise they would be murderers.
But no principle is so fundamental that bioethicists somewhere will not challenge it. Writing in the latest Journal of Medical Ethics, two Americans argue that the revered dead donor rule ought to be scrapped. They contend that "killing by itself is not morally wrong although it is still morally wrong to cause total disability". Their point is that simply being alive is no big deal. If you are alive, but cannot move, speak, think, or feel, the notion of "life" is meaningless. So why not transfer your organs to someone who can make better use of them?
On the other hand, several doctors in Canada and the US argue that donation after cardiac death is so controversial that transplant surgeons ought to declare a moratorium until these ethical issues have been settled once and for all.
It's a fascinating topic. I hope that you will take time to comment on the articles.
Cheers,
MC, BioEdge

Alarm at proposal to scrap dead donor rule

"Let's scrap the fiction that most patients are dead when their organs are removed and allow doctors to take them from people who are still living. This is the provocative proposal by doctors from Canada and Spain which is creating a stir in bioethics circles.Speaking at the American Society of Bioethics and Humanities annual conference in Minneapolis earlier this month, Dr Neil Lazar, of Toronto General Hospital, Maxwell J. Smith, of the University of Toronto, and David Rodriguez-Arias, of the Basque University, argued that it is more important to know whether the patients are comfortable and 'beyond harm' than whether they are alive.
Like conservative critics of organ transplants, they stress the ambiguity determining death no matter which the two criteria for death are used. 'Cardiac death' (DCD) could be reversible and 'brain death' is not always verifiable. They realise that scrapping the 'dead donor rule' (DDR) will seem ghoulish to the public. For this reason, they call for an extensive public education campaign so that people will continue to donate their organs.
Their ideas were published earlier, in the August issue of the American Journal of Bioethics. They wrote:
'Rigorous informed consent, protection from harm, and transparency toward the public could constitute a threefold pillar on which organ procurement of vital organs could operate in an ethically acceptable and socially responsible way.'
However, other doctors disagreed strongly. Mohamed Y. Rady and Joseph L. Verheijde, of Arizona State University, said that abandoning the dead donor rule is impossible unless society legalises physician-assisted suicide. Two doctors from National Taiwan University Hospital observed that 'DCD without respecting the DDR will inevitably discourage DCD, and thus will shrink the supply of organs.'
A philosopher, Stephen Napier, of Villanova University thinks that the proposal is illogical: 'How could not knowing that the DDR is satisfied entail abandoning it?' Another bioethicist, James Dubois, of St Louis University, suggested that it was unethical to publish a proposal which could damage public confidence in organ donation.
The proposal rattled transplant surgeons. 'In the overwhelming majority of cases, the concept of death is easy, obvious and not really subject to any complex interpretation. It's very clear,' said Dr. Andrew Baker, a surgeon in Ontario, told the National Post. 'They're dead, you can see it, there is no return of anything.'"

http://www.bioedge.org/index.php/bioethics/bioethics_article/9823