© OrganFacts.net

The Nasty Side of Organ Transplanting.

Foreword to the Third Edition

It was Professor Geoffrey Dahlenburg from the South Australian Organ Donation Agency who got me interested in organ transplanting. He said transplant coordinators would no longer be accepting a “soft no” from relatives who expressed reluctance to “donate” their next of kin’s organs. He said, “If a family says no, we need to know why. In the past we haven’t pursued that avenue. We’ve said that’s their right and leave it at that. What we’re doing now is still respecting that decision, but wanting to know why.”^[1]

That was nine years ago. In 2005 Australian state governments tightened the screws further. Relatives can no longer veto next of kin’s organ harvesting unless they have “sincerely held beliefs”. I have not been able to locate a government representative who will define a “sincerely held belief”. Nor will any donation agency say who in the hospital determines whether the belief is sincerely held or not. We have come a long way since Professor Dahlenburg’s “softly, softly” approach. Governments have begun usurping family control of their next of kin “brain dead” bodies.

The increased talk of compensating living people in richer countries for “discomfort and travel expenses” while donating a kidney masks plans for organ selling in these nations. Even benevolent donating is under question when the government of New South Wales advises prospective donors: “Remember that is your decision…It’s OK to say NO!” One says, “no”, when responding to a question, but not when making an unsolicited donation. The hard end of this solicitation to donate a kidney is when relatives take legal action in an attempt to force a person to “donate” a kidney or organ part.

The revival of non heart-beating vital organ donation sounds initially like a return to the good old days when organ removal began well after the donor’s heart ceased beating. The new version is different where organ removal begins without even the fictitious “brain death” diagnoses. The patient is chilled and perfused with potentially injurious harvesting drugs while still being treated therapeutically in a hospital. Life-support (specifically mechanical ventilation) is removed and as little as two-minutes after cardiac arrest the patient is classed as “dead”. Surgery to remove his organs then begins, even though cardiopulmonary resuscitation might very well be successful at that stage. It may, indeed, be performed - for the sake of the organs - and we may then have the strange scenario where the heart is still pumping oxygenated blood throughout the body although it is declared a “corpse” (as is the case when organs are taken after a diagnosis of “brain death”).

Even more horrible is the failure of the heart to stop when the ventilator is disconnected. The patient is then wheeled back into intensive care, put back on life-support and treated for the new problem of being full of harvesting drugs. Later, if recovery isn’t evident the same process repeats itself. Needless to say government health departments are reluctant to speak about this process.

I’ve continued asking questions and the angelic tale of post-mortem benevolence increasingly resembles a cannibalistic saga. Government employees pressure families in their hour of grief to hand over gravely ill, brain-injured relatives for harvesting. Legal and medical definitions of death are increasingly avoided as the hypothesis of “brain death” becomes technically indefensible. There is too much difficulty defending why surgeons can saw and cut into patients with healthy still-beating hearts yet avoid murder charges.

It would be irresponsible to pretend that all forms of body part harvesting and transplanting had the same implications therefore I would like to differentiate between the three different forms.

The first type of harvesting is of tissue from the truly dead bodies of consenting adults who made informed choices. They are given full healing treatment while alive and at a decent interval after death their body materials are taken to be used for effective healing purposes. Bone, skin, eyes, tendons, veins, heart valves are characteristically removed from these bodies.

The other extreme of harvesting - of organs still viable enough to be able to function for years in a different body - begins while the donor is still alive though declared “brain dead”. The patient’s heart continues beating; the body is warm and blood flows throughout the organ removal procedure. It’s the harvest surgeon’s knife that causes death.

The third form of harvesting uses non-heart-beating donors who are dependent on life-support measures - typically mechanical ventilation - but haven’t met the criteria by which they might have been declared “brain dead”. After pre-treatments in the interest of the wanted organs, but which may be injurious to their owners, their life-support is terminated in an operating theatre where everything has been made ready so that organ removal can begin almost as soon as their hearts stop - within a very few minutes of the onset of cardiac arrest in some cases. While those short periods of circulatory arrest are quite inadequate to ensure that irreversible destruction of the nervous system is under way - indeed, resuscitation to the pre-arrest state would be possible in most or all such cases - the removal of their organs does complete the dying process. That looks like an orchestrated “knock them on the head” donor death.