Saturday, September 24, 2011
Catholic ethicist calls for transparency in organ donor controversy
A top Catholic ethicist is calling for donor guidelines that are clear to the public after a proposal was made to allow surgeons to retrieve organs from donors less than two minutes after their hearts stop beating.
“The tendency to want to shorten the waiting period, admittedly out of a desire to help those in need of organs, raises the danger of using the dying to benefit others,” said Dr. John Haas, president of the National Catholic Bioethics Center in Philadelphia, Pa.
“It is important that the facts of the case are clearly and consistently articulated by the transplantation community,” he underscored. “There will be no organ transplantation without the trust of the public.”
On Sept. 19, the Washington Post highlighted the United Network for Organ Sharing's new proposed rules that would permit surgeons to proceed with organ removal before the current deadline of two minutes after a donor’s heart stops beating. The move would decrease the chance that a patient's heart could spontaneously restart.
Supporters of the new rules argue that the guidelines will ensure that a patient's wish to donate his organs will be respected. Critics, however, state that the proposed changes run the risk of dehumanizing patients into mere sources for materials.
In an interview with CNA on Sept. 21, Haas was wary of media hype potentially obscuring the real facts in the situation. He said that the Catholic Church and organ transplant professionals in the U.S. have been very clear about the importance of maintaining the “Dead Donor Rule,” which states that there must be “moral certitude” that a person is dead before the removal of organs for transplant.
However, he also said that the National Catholic Bioethics Center sides with the Institute of Medicine, which recommends waiting five minutes after the heart has stopped beating to declare a patient's death.
“It is critically important to develop consistency with respect to the waiting period after the cessation of heart beat,” Haas said, adding that some transplant centers in the U.S. are pushing for the waiting period to be shortened to as little as 75 seconds.
“The greatest bioethical danger in our day is the tendency to depersonalize and dehumanize the individual person,” he noted, “particularly the weak and vulnerable, so that they become the source of biological material for research or for the benefit of others.”
Haas explained that the Church and all 50 states hold that death can be determined using cardio-pulmonary or neurological criteria.
“Traditionally a person was declared dead when the heart stopped beating and he or she stopped breathing,” he said. “A person could also be declared dead if it was determined that the brain had died, that is, there was no blood flow or electrical activity.”
However, because of highly controlled situations in hospitals, Haas said there was an eventual return to the traditional cardio-pulmonary criteria for declaring death.
“If life support was removed from a person who was dying and could no longer be helped by it, physicians would wait until the heart stopped beating, wait a specified period of time and declare death.”
Haas said that the new proposal to change the language in the guidelines is actually more in line with the statutes defining death as the “irreversible cessation of circulatory and respiratory functions.”
“The old language 'Donation after Cardiac Death' was a bit of a misnomer because the heart was not dead,” he said. “Otherwise it could not be transplanted and restarted.”
“The death of the person can occur without individual organs being dead,” he explained. “Otherwise, life-saving organ transplantation could not take place. The proposed change of language is actually more consistent with the facts of the case and of the law.”
However, in his view, the new language proposals are “not entirely satisfactory,” given that the term “Donation after Cardiac Death” is now redefined as “Donation after Circulatory Death.”
“Organisms and organs die,” Haas observed, “Circulation doesn't die. One can understand the desire to have the terminology shortened for practical purposes but it seems it would be more accurate to speak of 'Death by Cardio-Pulmonary Criteria.'”
Ultimately, Haas said, it's “absolutely essential that the transplant community adhere resolutely to the 'Dead Donor Rule' and not engage in practices which suggest that they are ready to sacrifice the weak and the dying for the benefit of others.”
“Even if the changes reflect the reality of the situation more accurately,” he added, “there is the danger of misunderstanding on the part of the public if the language and terminology keep changing. It can raise suspicions that there are hidden agendas at work.”