Excuse me doctor - are you sure I'm really dead?

Thomas Secrest's picture
Showdow of death: Image by Thomas Secrest
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When an organ transplant can be the difference between life and death, do we have a system that fully protects donors from the greed and immorality of those rich enough to buy anything they want.

For those of you following this series, this is the 3rd and final installment and will discuss the definition of death and the role of medical technology. For new readers this extended article started with a strange case of a woman who was pronounced dead and was about to undergo an organ harvest when she opened her eyes, and in so doing, declared that she was not quite dead yet.

The 2nd article was a look at the dark side of organ transplantation. Organs give life and life is a commodity for which some people are willing to pay handsomely. Those burdened with money, influence and a unique lack of morality, don’t ask any questions regarding who provides the organs and under what circumstances.

In this article I want to share the meaning of death and some of the technical issues modern medicine has created.

When I started researching this I assumed that I would find a fairly long and complex definition of death. Considering the complexity of length of the waiver you sign to get a flu shot, I thought the document describing the criteria for pronouncement of death would be pages and pages of complex tests, procedures, examinations and consultations. Turns out I was wrong.

The national guidelines has a wordy preamble that is philosophical in nature, but the criteria section was surprisingly short. It is shown below.

§1. [Determination of Death.] An individual who has sustain ­either (1) irreversible cessation of circulatory and respiratory­ functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, are dead. A determination of death must be made in accordance with ­accepted medical standards.

If you’re thinking “is that all?” so was I. The last part is what really makes it a bit open-ended, since accepted medical standards are not well document either. The act is called the Uniform Determination of Death Act (UDDA). I have to admit, I certainly assumed that an act with such an impressive name, would at the very least include the word physician somewhere in the criteria section.

What this means is that each state and each hospital within each state can interpret this act a little or perhaps a lot differently. Therefore if you have a hospital where you fully expect all your medical care will be administered, I would strongly suggest that you find out what their exact criteria are for pronouncement of death.

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I examined several hospital web sites and found that none had anything approaching a published clear statement regarding their pronouncement of death protocol. It could be that they don’t want this information on the internet or it could be they don’t have one.

Next let’s turn to a problem created by technology. As you know, it is now relatively easy to keep a person metabolically viable (I want to say alive, but you see the problem) even after one or both of the UDDA criteria are met. This is a bit of a creepy situation from a personal point of view, but from an organ transplantation point of view it is very pragmatic. Fresh organs are much more successful in their new host than ones that are stored, even for short periods of time.

I think that you can see that technology has created a potentially sinister incentive to time the death of organ donors in order to best exploit their internal organs.

Consider this example: a patient appears to meet the UDDA criteria and DNA matching is done to see if they are a suitable potential donor. It turns out that there is a match. Someone in Saudi Arabia or South Africa or Russia needs a new heart and is willing to pay cash, make a sizable contribution to the hospital, buy some new piece of expensive equipment, fund some research, etc. They will need 72 hours to get to the hospital.

It is unlikely that this donor patient will be pronounced dead and removed from life support and the heart harvested and stored for 72 hours. Instead, a more likely scenario is that the patient will be diagnosed in critical condition with a poor prognosis. Seventy-one hours later the patient will take a turn for the worse and will then be pronounced dead. The heart is harvested and transplanted immediately.

Now the consider this: during that 72 hours period, the patient begins to show signs of being not dead (as in the case of the woman I wrote about in part 1). There is big money on the table and a living patient, who 3 days ago, appeared dead.

In theory, the organ donor programs in the U.S. are not subject to the whims of those with money, power and influence. However, people with money, power and influence are very often where they are because they were willing and able to corrupt the incorruptible.

For those, rich and poor, with integrity, this is not an issue. However, for a few, and I don’t know how many, they will not hesitate to use their money to get what they want and if they need a transplant, they’ll have no trouble putting a price tag on your organs.

In this world we live in, money talks and people we would never expect, sometimes listen.

If you are able to get Death Pronouncement protocols for your local hospital, I hope you will share them with me. ([email protected])
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