Organ/Tissue Procurement Archives - Page 2 of 2 - Protection of Conscience Project Library

Whither Brain Death?

James L. Bernat

Abstract
The publicity surrounding the recent McMath and Muñoz cases has rekindled public interest in brain death: the familiar term for human death determination by showing the irreversible cessation of clinical brain functions. The concept of brain death was developed decades ago to permit withdrawal of therapy in hopeless cases and to permit organ donation. It has become widely established medical practice, and laws permit it in all U.S. jurisdictions. Brain death has a biophilosophical justification as a standard for determining human death but remains poorly understood by the public and by health professionals. The current controversies over brain death are largely restricted to the academy, but some practitioners express ambivalence over whether brain death is equivalent to human death. Brain death remains an accepted and sound concept, but more work is necessary to establish its biophilosophical justification and to educate health professionals and the public.

Bernat JL. Whither Brain Death? The American Journal of Bioethics, 14:8, 3-8, (2014) DOI:10.1080/15265161.2014.925153

Changing the Conversation About Brain Death

Robert D Truog, Franklin G Miller

Abstract
We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” demonstrate how we may legitimately choose bright-line legal definitions that do not cohere with biological reality. Not only does this distinction bring conceptual coherence to the conversation about brain death, but it has practical implications as well. Once brain death is recognized as a social construction not grounded in biological reality, we create the possibility of changing the social construction in ways that may better serve both organ donors and recipients alike.

Truog RD, Miller FG. Changing the Conversation About Brain Death. The American Journal of Bioethics, 14:8, 9-14 (2014) DOI: 10:1080/15265161.2014.925154

Conscientious objection to harmful animal use within veterinary and other biomedical education

Andrew Knight

Abstract
Laboratory classes in which animals are seriously harmed or killed, or which use cadavers or body parts from ethically debatable sources, are controversial within veterinary and other biomedical curricula. Along with the development of more humane teaching methods, this has increasingly led to objections to participation in harmful animal use. Such cases raise a host of issues of importance to universities, including those pertaining to curricular design and course accreditation, and compliance with applicable animal welfare and antidiscrimination legislation. Accordingly, after detailed investigation, some universities have implemented formal policies to guide faculty responses to such cases, and to ensure that decisions are consistent and defensible from legal and other policy perspectives. However, many other institutions have not yet done so, instead dealing with such cases on an ad hoc basis as they arise. Among other undesirable outcomes this can lead to insufficient student and faculty preparation, suboptimal and inconsistent responses, and greater likelihood of legal challenge. Accordingly, this paper provides pertinent information about the evolution of conscientious objection policies within Australian veterinary schools, and about the jurisprudential bases for conscientious objection within Australia and the USA. It concludes with recommendations for the development and implementation of policy within this arena.

Knight A. Conscientious objection to harmful animal use within veterinary and other biomedical education. Animals. 2014 Jan 21;4(1):16-34.

The Case for Kidney Donation Before End-of-Life Care

Paul E. Morrisey

Abstract
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor’s death, this approach satisfies the dead donor rule. The donor family’s wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.

Morrisey PE. The Case for Kidney Donation Before End-of-Life Care. American J Bioethics Vol. 12, Iss. 6, 2012

Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation

Dominic Wilkinson, Julian Savulescu

Abstract
There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste. In this paper we consider and evaluate a range of ways to improve the number and quality of organs available from this group of patients. Changes to consent arrangements (for example conscription of organs after death) or changes to organ donation practice could dramatically increase the numbers of organs available, though they would conflict with currently accepted norms governing transplantation. We argue that one alternative, Organ Donation Euthanasia, would be a rational improvement over current practice regarding withdrawal of life support. It would give individuals the greatest chance of being able to help others with their organs after death. It would increase patient autonomy. It would reduce the chance of suffering during the dying process. We argue that patients should be given the choice of whether and how they would like to donate their organs in the event of withdrawal of life support in intensive care. Continuing current transplantation practice comes at the cost of death and prolonged organ failure. We should seriously consider all of the alternatives.

Wilkinson D, Savulescu J. Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation. Bioethics. 2012 Jan;26(1):32-48.

Rights, professional obligations, and moral disapproval

Mark R Wicclair

Cambridge Quarterly of Healthcare Ethics

Extract
The claim that providing post-transplant care to Mr. C would compromise a physician’s moral integrity might have a consequentialist basis or it might rest on a conception of moral complicity. From a consequentialist perspective, it might be thought that refusing to provide post-transplant care would act as a disincentive for patients like Mr. C to go to China for organ transplants. That is, it might be thought that refusing to provide follow-up care will promote a reduction in unethical transplant practices, and transplant physicians might believe that they have an ethical obligation to do what they can to effectuate such a reduction. Alternatively, a physician might believe that to avoid moral complicity in an unethical practice, she must refrain from any direct or indirect participation in that practice, which includes providing post-transplant care.

Wicclair MR. Rights, professional obligations, and moral disapproval. Camb Q. Healthc Ethics. 2011;20(1):144-147.

Ethical issues in living organ donation: donor autonomy and beyond

Aaron Spital

Abstract
Despite nearly 50 years of experience with living kidney donation, ethical questions about this practice continue to haunt us today. In this editorial I will address two of them: (1) Given the possibility of limited understanding and coercion, how can we be sure that a person who offers to donate an organ is acting autonomously? and (2) Do people have a right to donate? The universal requirement for informed consent is the traditional method for ensuring that a person is acting autonomously. But, while obtaining fully informed consent is desirable, it may not always be achievable or necessary. When the recipient is very dear to the potential donor, the donor may base his decision primarily on care and concern rather than on a careful weighing of risks and benefits. I will argue that consent that emanates from such deep affection should be considered just as valid as consent that is fully informed. But consent is not enough. There is no absolute right to donate an organ. If there were such a right, then some physician would be obligated to remove an offered organ upon request, regardless of the risks involved. I do not believe that physicians have such an obligation. Physicians are moral agents who are responsible for their actions and for the welfare of their patients. Therefore, while the values and goals of the potential donor should be given great weight during the decision-making process, physicians may justifiably refuse to participate in living organ donation when they believe that the risks for the donor outweigh the benefits..

Spital A. Ethical issues in living organ donation: donor autonomy and beyond. Am J Kidney Dis. 2001 Jul;38(1):189-195.

Restricting Donative Choice: Fetal Tissue Transplantation and Respect for Human Life

Joanna H Kinney

Abstract
I propose that a woman who becomes pregnant with the intent to abort will be treated as an initial aggressor, and as such she will be denied the “abortion exception” that will be granted to the woman who aborts an accidental, unwanted pregnancy. Moreover, I shall argue that a woman should not be allowed to designate the donee of the fetal tissue from her abortion, even though her pregnancy was accidental. Without this restriction, a woman who intends to become pregnant and abort may simply claim her pregnancy was accidental, and thereby claim the exception. Central to this study is the question of fetal worth, and the value to be ascribed to beings not like us, that is, not like human beings who have been born. Although I argue for a moral justification of elective abortions, I intend to show that such a justification should be a narrowly drawn exception to the prima facie duties neither to harm nor to instrumentalize others. I shall also argue that prohibiting a woman from becoming pregnant in order to abort is necessary because such a situation does not fall within the narrow exception for elective abortions, and that such a restriction is crucial to preserving our respect for those with no voice. Finally, I shall argue that the prohibition against becoming pregnant with the intent to abort does not vitiate a woman’s right to terminate an unwanted pregnancy. Rather, this restriction is a necessary condition of the prima facie duties of nonmaleficence and non-insturmentalization.

Kinney JH. Restricting Donative Choice: Fetal Tissue Transplantation and Respect for Human Life. J. Law Health. 1996;10(2):259-286.

Hospital’s decision to pursue fetal transplantation upsets antiabortionists

Deborah Jones

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Canada’s first research project involving the transplantation of tissue from aborted fetuses into patients with Parkinson’s disease is an issue entirely separate from abortion, the researchers say. However . . . The fetal transplant procedure creates enormous ethical dilemmas for many. Critics state that any use of abortion-related material is wrong because abortion itself is wrong. Some also charge that fetal transplantation will inevitably lead to the “harvesting” of fetuses and make some women “fetus factories”. . . .However, supporters of fetal transplantation state that abortion is an entirely separate issue . . . “We’re simply using the products of women, who have chosen abortion, for research purposes”, said Kathy Coffin of the Canadian Abortion Rights Action League. . . .

Jones D. Hospital’s decision to pursue fetal transplantation upsets antiabortionists. Can Med Assoc J. 1990 Jun 01;142(11):1277.