Hungry For Organs, Transplant Surgeons Exploit Different ‘Standards’ For Determining Death

When exactly are you allowed to deliberately block blood flow to the brain?

Are you familiar with something called the “partial resurrection” procedure? That’s how MedPage Today referred to it in a recent article. You might suppose it is some kind of transhumanist scheme to bring the dead back to life, but it is an emerging technique used by transplantation surgeons upon organ donors.

Before knowing anything about this procedure, the first thing one notices is the hubris of the terminology – as if it were within the purview of scientists, even surgeons, to deliver some sort of “resurrection”.

Since that is not possible, we may conclude, through elementary logic, that this transplantation procedure is carried out on a person who has not yet died and is therefore still living.

That is indeed the case: in this procedure, physicians declare a patient dead prematurely (shortly after heart failure), then deploy interventions to resume circulation in the patient in order to optimize organ viability. But – get this – they deliberately block the circulation of oxygenated blood from reaching the brain.

Ensuring that the brain is deprived of oxygenated blood while other organs are being perfused with it does two things: it preserves organs for transplantation, and it ensures that the patient dies — at the hands of the surgeons, in a manner other than the patient had already been naturally dying.

What happened to the dead donor rule?

This is complicated stuff with all sorts of physiological and philosophical underpinnings and I may have gotten a bit ahead of myself. (I discuss these matters in depth in my recent book, Determining Death by Neurological Criteria). But one can intuitively grasp that this is a troubling development, since the entire organ transplantation enterprise is predicated upon the “dead donor rule” — the stipulation that vital organ donors must in fact be dead.

A silver lining of this kind of news might be that prospective organ donors and the general public will become more aware of the fact that some organ transplantation procedures commence before a donor has actually died. For now, however, this has only seemed to cause a stir among transplant specialists and bioethicists.

Most people are totally unaware that there are two different means by which death is determined. Roughly speaking, one is based on brain function, the other on cardiac function. These methods are neither identical nor interchangeable, which therefore suggests that one of them may be deficient in particular circumstances.

Problems with using cardiac failure to determine death

So what does this procedure entail? First of all, it takes place in protocols that use the circulatory criteria for determining death. These patients are not brain dead, but have run out of treatment options. They will be removed from life support, with the expectation that cardiac arrest will...

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