“Reanimation” and Taking Organs from Living People

One of the greatest fears associated with organ transplantation is that the person from whom organs are taken is not really dead.

That nightmare was almost realised in France last week when a French patient “came back to life” after 30 minutes of unsuccessfully heart massage. In 2007, in order to address the shortage of organs for transplantation, French authorities allowed the trial of using people whose hearts have stopped beating, but who have not met brain death criteria for being dead, as organ donors. These are called Non-Heart Beating Donors. Organs can also be taken from such donors in the UK. Such patients’ hearts have stopped beating but they have not met brainstem criteria for death.

In the 1960s, the definition of death was changed from one involving absent heart and lung function, to one of brain death. This concept of death was changed to allow the removal of fresh organs capable of being transplanted. Because other vital organs can continue to function, such as the heart, lungs and kidneys, even when the brain is dead, the use of this criteria has allowed millions of lives to be saved and enormously improved.

However, there still remains a serious shortage of organs for transplantation. Thousands die in Britain alone because of a shortage of organs. The use of non-heart beating donors has been one way to address this. But is this slackening the criteria for death?

It is important to remember that prior to the 1960s, the French patient would have been declared dead on the alternative criteria. And he could have been sent off for burial or cremation. All criteria of death are liable to exceptions and require great care and vigilance in the execution to exclude human error.

So this is not a problem of brain death or of organ transplantation. It is a problem of any definition of death and its implementation.

That said, some criteria of death are going to be more robust and less liable to exceptions. Indeed, if some brain death criteria, such as whole brain death with absence of blood flow to the brain, are going to be very unlikely to ever admit exceptions.

My own view is that the best way to deal with organ shortage and save 1000s of lives per year is to adopt an opt-out system of organ donation together with an an absolutely rocksolid system determining brain death that inspires public confidence. According to an opt-out system, people organs would be routinely taken after a professional team expert in determining brain death under appropriate oversight and scrutiny declared the person dead. Relatives could not object. Only the person could opt out by actively registering dissent.

This would likely remove the need to use Non Heart Beating Donors

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