In the “good old days”, your heart stopped, and you were declared dead.

Then came machines to keep the lungs breathing, so the heart went on and on and on…but no one wanted to turn off the machine, so doctors devised a new criteria: Brain death. In Brain Death, you turn off the machine, and there is nothing moving, and so the heart quickly stops.

Brain death allowed doctors to take organs out of people while their hearts were still beating.

But then came a huge increase in the demand for organs.

So doctors tried to figure out how to get more organs to save these patients (and like most docs, I’ve had patients who were alive and well due to transplants, so support organ donation).

The latest “twist” to get more organs is to take organs from those whose heart has stopped. Big deal, you say. Ah, but that’s the problem…it can be.

Well, the heart stops and you’re dead, right? But you might not be brain dead. Or you might be handicapped, and decide to remove unwanted treatment instead of burdening your family.
” After family members have made the difficult decision to discontinue a ventilator or other life-sustaining treatment, organ-bank representatives talk to them about donation.”
Other life sustaining treatment? Like a feeding tube? a cardiac pacemaker? IV feeding?

And are the family aware that often sedatives are given to a person needing a ventillator? The reason is so they don’t “fight” the ventillator. And some people need pain medicine for other injuries. So if the family is told it is hopeless, and see an unconscious patient on a machine, are they making a flawed decision? And if the person is removed from the breathing machine, does the medicine contribute to his not breathing enough to keep his heart going?

Sometimes, the donor is suffering from an incurable disorder such as Lou Gehrig’s disease and wants to donate his or her organs after deciding to forgo further care.

Yes, let all these paralzed people know they can “help” others by stopping all that care that costs a lot of money and burdens their family.
In the USA, a lot of the elderly are supposed to be independent, and would be ashamed to ask for help. Many of the “assisted suicides” are requrested for this shame, not because the person is in pain.
And a person with Lou Gehrig’s disease is alert. So if you stop the breathing machine, either you allow them to suffocate –a horrible death– or give them a sedative so they aren’t aware of the fact. But again the sedative will cut any ability to breath. (breathing is not “all or nothing”….that’s why the article mentions that if a person doesn’t die as expected within an hour, they are taken back to their room…

Once the decision has been made, a transplant team waits nearby so surgeons can begin removing organs soon after the heart stops. Because the heart can sometimes restart spontaneously, doctors wait a few minutes after pronouncing death before allowing the surgeons to begin. If the heart does not stop quickly, usually within an hour, the procedure is aborted and the patient is taken back to his or her room until death comes.

So how long do the docs wait?

most doctors wait five minutes after the heart stops before pronouncing patients dead. But doctors at some hospitals wait three minutes, others two. In Denver, surgeons at Children’s Hospital wait 75 seconds before starting to remove hearts from infants, to maximize the chances that the organs will be usable.

The series Law and Order is on our Asian cable, and they had a case where a surgeon “hurried up” such a death…nah, it’s fiction…right?

Ah, but check this case: LINK and the article by medical ethicists Arthur Caplan and Michael Devita, discussing a case where a transplant surgeon was accused of prescribing drugs to haten the death so his organs could be tansplanted more quickly.

Caplan and Devita point out that most people support organ donation, but that a climate where jokes about taking your organs are heard on the radio, and where Law and Order has TV shows about similar cases, the fact that the story of a real live case could be devestating to the public’s trust of the organ donor system.

To make it worse, as these ethicists point out, the California Legislature is considering a law saying that the organ donor permission should outrank a person’s living will.

Why is this important? Well, some people want everything done for them, but don’t object to their organs being donated if they are truly dead. (Some Ethnic groups are especially paranoid about doing everything possible…with good reason. But that’s another story).

Now, how do you treat a dying patient? By the Hippocratic oath, doctors treat the patient in front of them to the best of their ability. Most doctors will do ordinary treatment, but when even the Pope acknowledges that some extraordinary treatments are optional, then what this means is that everyone–family, doctor, ethics committes, knowledgable neighbors, and patient’s previous wishes– try to find the best treatment that the patient would wish. And the “living will” or other guidelines are usually what we follow.

But the California law mandates that the caretaking doctor to take the state law on organ donation into account when treating a patient.

Usually there is a strict line between the caretaking doctors and the decision on how much to treat a person. Once the family decides to let the inevitable death happen, then you call in the transplant person to discuss it with the family. Without this strict division of labour, there is danger of a conflict of interest by the one helping make the decision (which is why paying families for their loved one’s organs would be a similar conflict of interest).

The ethicists ask the same thing:

“..People have clear opinions on their end-of-life care, including preferences for advanced life support and palliative medications, but also, organ donation. When making organ donation consent at a motor vehicles licensing office in San Jose, Los Gatos or Hollister, people are not asked whether the organ donation should nullify their living will. To assume otherwise makes no sense…. it is essential that the line between caring for the dying and obtaining organs for those in need remain sharp and bright. One of the biggest barriers to obtaining consent for organ donation in California and around the nation is the fear that the consent will lead doctors to make end-of-life decisions based on what is best for organs rather than patients. ..”


Nancy Reyes is the pen name of a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes essays to HeyDoc Xanga Blog 


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