What is organ donation?
Organ donation is the act of giving your organs to support the life of another person. Vital organs are organs such as lungs, heart, liver, pancreas, both kidneys etc. Non-vital organs are organs such as one kidney while living, or skin, bone, eye membranes etc. after deceased. For vital organs to be donated, blood and oxygen must flow through these organs at the time of collection from the donor.
Why is organ donation controversial?
Organ donation is controversial because vital organs can be removed from a patient before his or her life has ended thus disrespecting the dignity of human life. The controversy currently hinges on a disagreement on what method is appropriate to determine final death.
There are two ways a patient can be declared dead: cardiac arrest or brain death.
The controversy surrounding this method is that in order for vital organs (lungs, heart, liver, both kidneys, pancreas etc.) to be donated, organs must be collected between 90 seconds and two minutes following the cardiac arrest. A protocol called Donation After Cardiac Death (DCD) was developed to teach physicians how to swiftly determine death and collect vital organs before they expire. Donation after Cardiac Death (DCD) is a protocol used to obtain organs when the criterion for declaring brain death is not present.
The problem: Patients can medically recover (be brought back to life) for up to about 5 minutes after cardiac arrest. (While it is not medically impossible for recovery even after 5 minutes of cardiac arrest, the chances are very remote and not normally in a hospital setting). If organs are collected between 90 seconds and 2 minutes following cardiac arrest, final death cannot be fully determined, increasing the risk of collecting organs while the patient is not dead. As a result, death would not occur naturally but it would occur because of the removal of vital organs. Waiting the proper 5 minutes to ensure final death for the patient means the vital organs are damaged and cannot be donated. This situation is why the DCD protocol was established: to address the needs of organ donation, not to assure the certainty of a patient’s death. Since there are cases where a patient’s heart stopped for longer than 90 seconds to 2 minutes and then restarted as long as 5 minutes after cardiac arrest, the assumption that the patient is dead before then suggests that expediency to preserve the organs for one patient wins out over certainty about death for another patient. This is a dangerous notion as every life is deserving of love and respect and no life should be treated with more worth than another.
The life-affirming final death determination is to wait a minimum of 5 minutes following cardiac arrest to ensure final death. This does make vital organ donation impossible.
Donation after brain death: After a doctor declares a patient brain dead, the process for collecting organs can begin. Cardiac arrest is not necessary under this determination of the death and therefore the heart could be beating during the organs collection. If a patient is declared brain dead, the ventilator is not removed and no attempt is made to see if the heart will stop because the patient is already considered dead. Steps to begin removal of organs will include stopping the ventilator immediately before the organ removal. Thus, for organ donation, brain death is preferred over DCD because the risk of damaging the organs is less.
The problem: This determination of death has been found to be dangerously inaccurate. Countless stories found here, here and here, have occurred where a patient makes a full recovery after being declared brain dead by doctors. These patients narrowly escaped with their life because doctors rushed the patients’ determination of death to collect their organs.
If a patient is declared brain dead and the family chooses to remove the patient from the ventilator, the life-affirming final death determination is for the doctor to wait until cardiac arrest takes place – at which time vital organs will not be able to be donated.
Background on Organ Donation
Until recent history, organ donation was a rare heroic gesture. Organs were typically only donated from a living person who was a biological match to the sick patient that needed a kidney, part of a liver, or other non-vital organ. Often the donor was a relative who was willing to make a tremendous sacrifice. Occasionally, an unrelated person – perhaps even a complete stranger – who was a biological match to the ill patient, made a heroic sacrifice to help save the person’s life. Most of these heroic organ donors survived because the operation to remove the organ was successful, and a vital organ such as a heart was not considered an option.
Organ donation began to change in 1968 when heart transplants first started to become successful. The concept of brain death was established as the criteria to determine the quickest point at which a heart could be removed because the donor was dying. This criterion was called the Dead Donor Rule. Organ donation became more common as means were developed to allow people to declare themselves to be organ donors on their driver’s license. Everyone was encouraged to become an organ donor as a last heroic act upon his or her death. And quickly, the organ donation industry was born.
Laws were passed to create agencies to handle matching of potential donors with a growing list of people who needed one or more organs to survive. Reports showed many people were dying while awaiting the opportunity to receive an organ. This situation drove attempts to expand organ donation because not enough people were declaring themselves organ donors. With a long list of people awaiting organs, the view that an organ donation was a heroic gift began to change into something an ill person deserved and was being denied because people were not fulfilling the duty to be organ donors.
We expect the future of the organ donation conversation to explore deeply the ethics of donating vital organs before a donor is dead – a concept that is a direct violation of human dignity.
Should I Become an Organ Donor?
Illinois Right to Life supports the heroic donation of non-vital organs as a tremendous gift. Non-vital organs can include one kidney while living, or skin, bone, eye membranes etc. after deceased. Such organ donations do not raise ethical issues about whether a person is truly dead.
The controversy surrounding organ donation is laid out above. We believe all life is sacred and should be treated that way even through final determination of death. Generously becoming a non-vital organ donor is a way to respect all human life. Illinois Right to Life does not recommend the donation of vital organs.
How do I make my organ donation wishes clear?
NOTE: The fact that you declined to be an organ donor when renewing your driver’s license at the Illinois BMV is not recorded by the State.
Step 1. Complete and carry in your wallet an Organ Donor Refusal Card.
Step 2. Specify your choice as part of your Durable Power of Attorney for Health Care.
If you do not have a durable power of attorney for health care or some other official document that specifically states your intent not to be an organ donor, efforts to make you an organ donor will be pursued both by taking steps to preserve your organs and by seeking organ donation consent from your relatives while you are in critical condition.
Step 3. Discuss your organ donation desires with your healthcare agent.
Many tissues remain viable after traditional death including skin, bone, eye membranes. Ensure your healthcare agent fully understands your organ donation wishes. Following death, your agent can request to donate the non-vital organs you desire without concern of any ethical violations.
Even if a patient is not shown in the Illinois Organ Donor Registry as an organ donor, attempts will be made to convince relatives to donate the patient’s organs. Specially trained organ donation advocates are used to appeal to the emotions of relatives to sell them on organ donation. If your organ donation wishes are not clear, the State can claim “presumed consent to donate” which can allow organ donation to proceed.
Only clear and definitive evidence that you have chosen not to be an organ donor will prevent these efforts from occurring.
Recoveries after Physicians Declare Brain Death
On August 6, 2012, Zach McDaniel, 12, was shot in the head as a bystander caught in the crossfire of a drug deal gone bad. After emergency surgery in Abilene, Zach was placed in a drug-induced coma and transferred to Cook Children’s Medical Center in Fort Worth on a ventilator. Cook Children’s staff claimed that Zach’s prognosis was poor, and that part of his brain had been removed during surgery. They pressured Zach’s parents to sign an organ donation consent form. Zach’s parents resisted, and a brain scan later revealed that Zach’s brain was intact.
However, even that news did not stop the hospital staff from declaring further treatment futile. When the ventilator was removed, Zach was able to breathe on his own. Yet, on that same day, the doctor secretly withdrew Zach’s food and water and placed a “Do Not Resuscitate” order into his chart without his parent’s knowledge or consent.
Fortunately, Zach’s mother, Jessica, discovered the DNR and realized that her son wasn’t receiving food and water. After consulting Texas Right to Life for help, Jessica confronted the doctor, who reluctantly reinstated the food and water and removed the DNR order, but claimed that Zach was in a “persistent vegetative state.” He made it clear that he no longer wished to treat Zach, and advised Jessica to find another place to take her son.
With help from John Seago at Texas Right to Life, Zach was moved to the Children’s Medical Center in Dallas. Doctors there were hopeful and viewed Zach’s injury as survivable. Once doctors slowly weaned Zach off the sedatives to bring him out of his drug-induced coma, he became fully conscious and began talking and receiving physical therapy.
Zach has now had successful brain surgery and reconstructive surgery to repair his skull. He has regular short term and long term memory capacity. Zach’s doctors expect him to have a full physical recovery, with the only lasting damage being weakened vision in his left eye. Zach’s first doctors had proceeded with the organ donation, Zach would have died as a result of the organ donation removal.
While touring on mopeds in 2011 with her husband and two sons in Hawaii, Shelli Eldredge had a terrible accident that caused her spine to be broken in numerous places, her pelvis to be shattered, and her skull and facial bones to be fractured. Her legs and hips were also severely disfigured.
After being taken to a Hawaii hospital, Shelli quickly slipped into a coma. Even though Shelli’s husband, Stephen, a doctor himself, thought it was “pretty apparent that she wasn’t going to wake up,” he decided to give her some more time and to “move forward at all costs.”
Stephen noted, “The brain injury and the testing that demonstrated a loss of typical brain architecture was not consistent or compatible with life or return of function. It was very disheartening to face the […] likely possibility of her never being able to wake up or function.”
But Stephen recalled how one day, when Shelli was a few weeks into the coma, he walked over to her side and was amazed to discover that she “tracked” him with her eyes. “She actually followed my path.” Another day, Stephen told her a joke and recalled with delight how Shelli “laughed.”
Within days of this turn of events Shelli began to show distinct signs of reviving, such as moving her body and speaking. Shelli continued her recovery and has returned to her home in Utah where her family is helping her in reaching her goal of full recovery. For now, Shelli, needs a wheelchair to get around.
The gift of extra time was what Shelli needed for a sequence of events to unfold that Stephen says defies medical justification. If Shelli’s vital organs had been donated, she would have died as a result of the organ removal.
Sam Schmid, an Arizona college student believed to be brain dead and poised to be an organ donor, awoke from a coma just hours before doctors were ready to shut off life support and take his organs. He was able to hold up two fingers on command. Later, he started walking with the aid of a walker. Now, his speech is improving and doctors say he will have a complete recovery.
Two-year-old Kaylen Torres was declared brain dead within a few days after a gun accident at her home in Ocoee, Florida. Later, doctors backed away from that diagnosis after her parents said Kaylen showed signs of life, moving when tickled and responding to family members. Christine Aguirre, a family friend, said the infant also squeezes their hands and responds when they ask if she wants her teddy bear.