A July 2023 Op-Ed about organ donation published by The New York Times has social media users in a frenzy. The title went viral after screenshots of the Op-Ed made its rounds on X on April 6.
Written by cardiologists Drs. Sandeep Jauhar, Snehal Patel and Deane Smith, the guest essay stressed that “Donor Organs Are Too Rare. We Need a New Definition of Death.”
Death in the medical field follows two criteria: the heart stops beating or the brain ceases function (even if the heart is still beating). Only then can transplantation begin. Per U.S. law, transplant specialists cannot interact with a patient until declared deceased. The timer starts here.
A far more common cause of death is circulatory death: when the heart stops beating. Organ damage can occur with the current organ donation protocol in mere minutes. When a patient is off life support, medical professionals must wait until death, which can take up to 5 minutes.
Once a heart stops beating, organs can become irreversibly damaged—completely unusable for donation. This is because oxygen and blood are no longer pumped throughout the body, providing no nutrients to the organs.
A newer procedure called normothermic regional perfusion provides an effective way to collect organs from patients experiencing circulatory death and minimize organ damage.
By circulating oxygen-rich blood through the body, doctors can transplant more and healthier organs. Ethics become blurry here because this procedure reanimates the heart. This reverses heart failure, which “seems to nullify the reason the donor was declared dead in the first place.”
By re-animating the heart, patients’ loved ones may oppose the procedure. When there is a heartbeat, many believe the patient is alive again and object to the organ donation.
Brain death is far less common. The NYT Op-Ed mentioned “In New York, with a population of 20 million, there are on average fewer than 500 cases suitable for organ procurement and transplantation each year.”
Many state laws define brain death as “a condition of permanent unconsciousness with no spontaneous breathing, no response to pain and no primitive reflexes.”
A patient’s heart is still beating through brain death, and bodily function stays active through life support. Though this is (for lack of a better term) ideal for organ donation, there are still ethical issues.
Where controversy gains traction is when authors Jauhar, Patel and Smith call for expansion on the medical definition of death.
In 1968, a Harvard committee of doctors defined brain death, which structured current state law definitions. An ethical discussion concerning the definition brought about the importance of organ donation while also considering patient loved ones: “there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.”
In The 50-Year Legacy of the Harvard Report on Brain Death, doctors reinforce the original 1968 definition as still effective. “Brain death represents a state of very severe neurological injury with no evidence, to date, that anyone correctly diagnosed will ever regain consciousness or breathe without a ventilator.”
They believe including patients that are “irreversibly comatose on life support” will tackle the larger issue of “organ scarceness” and make donation more viable. This means that patients who are still not legally brain dead can donate viable organs. They have a heartbeat, but no higher brain function.
Social media users were quick to point out the danger of human error or outside pressures leading to malpractice or violation of protocol.
While many users touted the concern as fear-mongering and false, others pointed out how capitalism and loss of human agency is associated with the American healthcare system.
What's Your Reaction?
