Editorial: Organ donors should be dead first
It's hard to imagine the desperation of living with a ticking clock and not knowing whether your number will get pulled for a transplant. We recognize the anguish of the families living this horrible reality.
But the quest to solve this problem may create perverse incentives.
Several days after a drug overdose, Kentuckian TJ Hoover was declared brain dead. Doctors prepared him for organ removal surgery, and as the procedure was about to begin, Hoover woke up. Reports indicate that hospital professionals allegedly disregarded signs that Hoover was still alert, and opted to move forward with harvesting anyway until it was undeniable that their patient was not dead.
As outlying as it may be, this 2021 incident is the stuff of nightmares. Such stories are among the main reasons people hesitate to sign consent forms at the DMV.
Still, the problem of organ shortages persists for people with organ failure.
There are some who are advocating a radical notion to solve the organ shortage: Broadening our definition of 'death.'
That's the crux of a recent commentary that appeared in The New York Times, authored by Dr. Sandeep Jauhar, a cardiologist, and Snehal Patel and Deane Smith, directors of the Center for Heart Failure, Transplant and Mechanical Circulatory Support. In some corners of the internet, this commentary is being shared with curiosity; in others, with revulsion.
The authors are thoughtful experts, and they back up their thesis with compelling statistics, noting that 'an estimated 15 people die in this country every day waiting for a transplant,' which means we need to find more healthy donor organs.
But what they propose next crosses over into unsettling territory. They suggest that our definition of death should also include irreversibly comatose patients on life support. Even if a machine could restore the beating of their heart.
'The brain functions that matter most to life are those such as consciousness, memory, intention and desire,' they write. 'Once those higher brain functions are irreversibly gone, is it not fair to say that a person (as opposed to a body) has ceased to exist?'
Although none of this is a laughing matter, we can't help but be reminded of 'The Princess Bride's' Wesley, who after barbaric torture is left 'mostly dead,' a term that just as easily could be applied to 'irreversibly comatose patients on life support.' And, remember, Wesley is revived before the end of that film.
In all seriousness, we can appreciate the authors' position and their genuine real-life concern for those waiting on lifesaving organs.
But as Hoover's story proves, miraculous recoveries, while rare, can occur even when a person has been on life support for days. Health Resources and Services Administration reviews found more cases where donation protocols may not have been appropriate — 28 of which may have involved patients not legally dead at the time procurement began.
If the goal is to keep as many people alive as possible, we should first exhaust all other avenues of scientific advancement and preventive treatment before redefining what it means to be alive.
This editorial board likes exploring new ideas. That said, some suggestions are so wrong that they need to be extinguished before they get off the ground.
This is one of them. We stand with the living.
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