Organ Donation and Declaration of Death: Combined Neurologic and Cardiopulmonary Standards

Abstract

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. Summary: Before a person’s organs can be used for transplantation, he or she must be declared “brain-dead.” However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.

Organentnahmen nach Herz-Kreislaufstillstand: Wo stehen wir?

“…Sie verlangen aber eine präzise, klare und einfache Sprache bei der Erklärung der jeweiligen Todesfeststellung. Beispielhaft kann der Vorschlag zur Einführung neurorespiratorischer Kriterien als neue Art der Todesfeststellung vor Organentnahme gelten [31,32]. Diese werden definiert als das Vorliegen einer schweren Gehirnschädigung mit der Symptomkombination des Verlusts des Bewusstseins, der Spontanatmung und der Hirnstammreflexe als Bedingung für die Beendigung der Therapie und Zulassen des Herz-Kreislaufstillstands.…”

Double Effect Donation

“…And that [uncertainty]…is enough to withdraw the endorsement [of the UDDA]. (Doran and Vukov 2019, 291)Put differently: while there is room for good faith disagreement as to whether the brain death criteria provide a reliable guide to natural death, the very fact of disagreement should lead us to be suspicious of adopting the UDDA. The metaphysics of brain death are complicated.…”

“…And that [uncertainty]…is enough to withdraw the endorsement [of the UDDA]. (Doran and Vukov 2019, 291)…”

“…In what follows, we therefore call the position Donation Revisionism . As we discuss below, Donation Revisionism avoids the problems of both Business as Usual and Donation Pragmatism and has been advocated for by several Catholic authors, including one of the authors of the current paper (Doran and Vukov 2019). However, we now believe there are serious problems with Donation Revisionism, since any wholehearted endorsement of the position entails a significant loss of life and a large number of people denied the chance to save their lives.…”

Traditional Cardiopulmonary Criterion of Death is the Only Valid Criterion of Human Death

“…The combination of WBD and IHB&BC criteria has been accepted into the legislation of many countries. Some authors combine WBD and CC/CD (e.g., Doran and Vukov, 2019).…”