You probably read about the California transplant doctor accused of trying to hurry up a patient’s death so he could grab the organs.

Yup. I saw that case on “Law and Order” a couple weeks ago too.

But there are a lot of subtle ethical confusions in the case, the main one being that the man was not brain dead when his organs were offered for donation. The family, seeing their loved one’s dying days being prolonged artificially by a breathing machine, agreed to have it removed. This is perfectly ethical according to Catholic bioethics.

But then organ donation was suggested.

I suspect the family thought the patient was “brain dead”, and he was not. And this is where the confusion starts.
You see, there is a new “criteria” for organ donation: it is called  non heartbeat cadavar protocol. This is risky, to say the least.

In traditional brain death, the entire brain is dead, you take off the machine and the heart and lungs stop, and the patient promptly dies. So you take the machine off in the operating room, so as to take out the organs while the heart is still beating, knowing that the “machine” behind the heart and lungs (the brain and brain stem) are dead.
But in this new criteria, you have a person who is not brain dead but whose heart is expected to stop within a half hour after he is taken off a machine…but sometimes that doesn’t happen.

If patient’s living will says they don’t want to stay on machines, or if family feels the machine is only prolonging suffering, there is no ethical reason to restart the machines. One merely places the patient in a room, usually with loved ones, for the death watch. And sometimes the “comfort care” part of the treatment includes small doses of sedatives or narcotics to ease the suffering caused by air hunger.

What got the doctor in the story in trouble is two things: One, he was not treating a symptom, and two he had a medical interest in a dead patient.
As Wesley Smith observed:

The intended donation would have been an example of a “non-heart beating cadaver donor protocol,” under which life support is removed and if a patient goes into cardiac arrest, several minutes after death the organs are procured. However, if the patient doesn’t die within thirty minutes or an hour of life support removal, then the patient is to be reconnected to treatment and removed permanently from eligibility for organ donation. From what I can tell, this may be why the overdose was administered–to get him dead within the time limit–since the patient in this case died eight hours after removal of life support.

One might sympathize with the doctor, but he crossed an ethical line, and will pay dearly for it.

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Nancy Reyes is a retired physician living in the Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays on  Heydoc xanga blog

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