Tuesday, July 26, 2011

I inadvertently opened Pandora's Box :(

The *problem* with the human mind is that is constantly pressing on to greater knowledge and a deeper grasp of truth...well, at least mine does on occasion. If this doesn't sound like a problem to you, than you're probably not currently wrestling with something of which you'd prefer to have remained ignorant.

Because I know that I do not possess one of the great minds of humanity (mine is pleasantly average) I've decided that I must not suffer this alone, so I'm inviting you all to join me in my misery. If you'd prefer to not join in the mental wrestling, I urge you to stop reading right now.

A little background: I've known for the greater part of my life that I'm particularly sensitive to issues regarding/related to the inherent dignity of human life. I can only be grateful for and proud of my Catholic faith, as greater minds than mine have spent centuries on many of these issues and I rest in the knowledge that I need not reinvent the wheel.

Unfortunately, an issue that I assumed was resolved, not only in the medical world but also in the Church, came to my attention and I now know that while there is legal resolution, there is no true consensus among medical or religious voices. As we know well, what is legal is not always what is moral (abortion being a case in point). So where does this leave me? I'm stuck needing to make the most-morally-correct decision that I can based on the little knowledge that I have.

Having said all that, I'm sure you'd like to get to the point already, so here it is, and I'll lay it out for you:


I. Is "brain death" (also known as irreversible coma without respiration) true death?

A. What is death?:
i. irreversible loss of mental faculties? (present in "brain death")
ii. loss of ability to breathe independently? (present in "brain death")
iii. loss of bodily ability to grow and heal? (not present in "brain death" - ie, body still grows, heals, reaches puberty, gestates fetuses, etc. given artificial respiration)
iv. some or all of the above - how many of the above, and which one(s)?

II. Assuming for the moment that brain death is death:

A. How is brain death definitively determined?
i. While there are certainly many tests that must be done to determine "brain death," a close look at actual practice makes me shudder. It appears that the tests are not always performed, performed correctly, and even, in the case of the apnea test, may cause brain death.
ii. It is well-documented that some patients have been diagnosed as brain-dead only to fully recover within days, or to be found at autopsy following organ harvesting (rarely done) to indeed NOT show signs of brain death, but rather brain damage to one extent or another (seen as brain necrosis in the hemispheres with intact brain stem, etc.)

B. What role do spinal reflexes play in the brain dead patient?
i. Organ donors are given muscle-relaxants to prevent movement during harvesting (incidentally, they are not given general anesthesia/pain meds)
ii. There is a spinal reflex to painful stimuli that causes heart rate and blood pressure to rise - this occurs during organ harvesting.

III. Where does this leave me?

A. If brain death is true death:
i. There MUST be a clear, definitive way to determine this which must be correctly and thoroughly assessed 100% of the time.
ii. Since this does not seem to be the case, I can not be ok with organ harvesting as there appears to be a risk of misdiagnosis and/or inadvertently further maiming the patient by the performance of at least one of the tests (apnea test).

B. If brain death is not true death:
i. I hope it goes without saying that mostly-dead or almost-dead is NOT dead and therefore can never justify the taking of organs resulting in the complete death of a person.

IV. Ok, so what do I suggest is done with the brain dead (irreversible coma without respiration) patient?

A. Do we waste these precious organs?
i. YES. As already stated, if there is no 100% guaranteed way to be sure that a person is in fact dead, you must err on the side of life.

B. But they're going to die as soon as you turn off the respirator.
i. YES. But we all must acknowledge that there is an infinite difference between allowing nature to take it's course (via cessation of extreme life-support), and taking someone's organs, in spite of the fact that the end result is exactly the same: death.

C. So, assuming it's been x-amount of time since life-support is removed, the patient is not breathing and there is no heart beat...
i. It depends entirely on the "x" amount. I'm not qualified to define "x" but I would think at least 15 min or so would be required before all bodily systems have been dead enough to be truly irreversibly dead (as opposed to the 2 min rule for non-heart- beating-donors where they wait for the heart to stop and then put the body on life- support in order to obtain organs - this is done in non-brain-dead patients...don't even get me started!)

D. Am I so callous as to not care about the people who need organs to live?
i. I absolutely care. That's why I'm so frustrated that I find myself here. But I can not and will not ever justify taking a life to save a life, and it appears that we don't have an accurate enough and dependable enough system to declare true death prior to organ harvest.
ii. What if it was me or a loved one that needed an organ to survive?
a. See above. I just pray that science gets going real fast on adult-stem-cell organ generation. That would be awesome.
iii. What about people who've had loved ones become organ donors?
a. I will absolutely assume the best - that they were well and truly dead beyond any shadow of doubt or error, that their family made a fully informed and extremely loving, generous decision in allowing their deceased loved-one to contribute to the well-being and life of others.

1 comment:

Robyn DeMars said...

You made some very excellent points. I have to admit that I am scared to think that this could happen to me or a close member of my family. Or, worse yet, be in the situation where myself or someone I love needs a transplant. I don't think I could live with myself if I had doubt in my mind if the donor was "fully" or "legally" dead. Thanks so much for your recent post for this. It does raise some serious issues regarding the sanctity of life. It seems today's society is all too willing to sacrifice one life for the sake of saving another.

God Bless!
Robyn DeMars