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Pro-Life campaigners warn that hearts are still beating as doctors remove organs from donor bodies

7 August 2018


(Photo: Unsplash)

Pro-life campaigners have spoken out against plans to impose a 'presumed consent' system for organ donation.

Most people are unaware that donors' hearts are often still beating when their organs are harvested, they warn.

Concerns about the opt out scheme have been raised by the Society for the Protection of Unborn Children which is the world's oldest pro-life campaign group.

SPUC's Director of Research, Dr Anthony McCarthy, a bioethicist, said the Opt-out Organ Donation System proposed by the UK Government and planned to be in place by Spring 2020 may have laudable intentions, but serious ethical issues of which the public is unaware, such as grounds for doubt sometimes whether the donor has died before organs are taken, are being effectively set aside.

Dr McCarthy has set out a number of key concerns and stated: "This is not scaremongering - we're simply stating the facts and informing the public of the realities.

"Most organ donors, including those who give explicit consent before they die, are unaware that their hearts may be beating when their organs are taken.

"There are varying standards used to determine whether a donor of vital organs is actually dead.

"Some favour simply taking vital organs from those admitted to be still alive though perhaps unconscious and close to death. If such specialists are correct, then we will in some cases be dealing with operations to remove vital organs from what may still be living human beings.

"This is a genuine risk which must be faced in making laws on organ transplantation and promoting organ donation to the public."

Expressing deep reservations, he added:

"Donor hearts, for example, are in practice harvested from so-called 'beating heart cadavers' - something unknown to many members of the public though of course known to transplant teams themselves.

"It is also well-known to transplant teams that heart beating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made.

"Some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved."

Dr McCarthy said that while SPUC recognises the great good that organ donation can achieve, the removal of explicit consent undermines the ethical basis of donation and ignores the genuine concerns around some aspects of organ donation.

Dr McCarthy stated:

"Organ donation can achieve much good and involves generosity on the part of the person willing to donate an organ to give hope and the possibility of health to another.

"However, if the system is to respect the dignity of the person it must be built on consent of the donor. This cannot simply be presumed, as if the state owned our bodies.

"SPUC is concerned about safeguarding the wellbeing of persons and not seeing a system emerge which makes the person a mere instrument to be used for the good of others."

He continued:

"There are complex ethical issues around organ donation that a system of presumed consent does not take seriously. How can the charitable basis of organ donation be upheld if a charitable willingness to donate is not explicitly sought or obtained?

"In view of the uncertainties surrounding diagnosis of death, there are very real dangers in an 'opt out' system: if 'opt out' legislation is set to go ahead, those who recognise these dangers should at least try to increase the opportunity for relatives to object, and for organ harvesting from children and mentally disabled people to be restricted to non heart beating donation, after sufficient time from the last heartbeat has elapsed.

"If it is difficult for potential donors generally to learn of certain facts about organ harvesting from heart beating donors, this will be still more difficult for children and mentally disabled people who will generally have less opportunity to become aware of these facts, and of controversies in this area."

He continued: "A programme to promote organ donation which glosses over these facts is surely irresponsible, as is the presumption of consent, and the harvesting of organs, from mentally disabled people and from children, particularly in cases where it is not clear the donor has died."

He concluded:

"The state should not be presumed to own the bodies of its citizens, whether in life or in death. Rather, its role is to serve the interests of persons whose bodily existence and remains should be honoured. What is taken without explicit consent cannot be said to have been 'donated' as a 'gift'. "

Dr Anthony McCarthy's Full Statement

Presuming Consent for Organ Donation Undercuts Potential Donors Rights and Ignores Serious Ethical Issues

Wales became the first UK nation to introduce such a policy in December 2015. Organ transplantation is potentially life-giving and a very important social contribution. However, it does raise fundamental issues surrounding respect for the human body, the meaning of gift-giving and indeed, diagnosis of death. These are serious issues that need to be faced by anyone wishing to promote ethical forms of donation while protecting donors and the common good. In seeking to benefit patients whose need for organs may be urgent and compelling, the rights of potential donors and their families must always be respected.

Any ethical approach in this area has to rely on scientific data which must not be oversimplified. Attention must be given to serious contemporary debates within the scientific community as well as amongst moral philosophers and bioethicists. Tests for diagnosing death vary from country to country and even within a single country, while a growing body of specialists regard standard tests used as potentially unreliable. Some of the latter favour abandoning the 'dead donor' rule and simply taking vital organs from those admitted to be still alive though perhaps unconscious and close to death. If such specialists are correct, then we will in some cases be dealing with operations to remove vital organs from what may still be living human beings. This is a genuine risk which must be faced in making laws on organ transplantation and promoting organ donation to the public.

Donor hearts, for example, are in practice harvested from so-called 'beating heart cadavers': something unknown to many members of the public though of course known to transplant teams themselves. It is also well-known to transplant teams that heart beating donors move when organs are taken, unless they are paralysed by drugs, and that their blood pressure goes up when the incision is made. It is worth noting that some anaesthetists recommend that the supposed `cadaver' be anaesthetised when his/her organs are retrieved.

Most organ donors, including those who give explicit consent before they die, are unaware that their hearts may be beating when their organs are taken, and that they may be pink, warm, able to heal wounds, fight infections, respond to stimuli, etc. It is also the case that supposedly brain dead people (such as pregnant women who are given high tech medical support) can appear to survive for months while demonstrating integrated bodily activity of a kind that arguably indicates that life still remains.

While not all kinds of organ need be taken from heart beating donors, or after tests for death of a more controversial kind, the fact must be faced that those who might become donors are mostly quite unaware of the state in which their bodies may be when certain organs may be taken. A programme to promote organ donation which glosses over these facts is surely irresponsible, as is the presumption of consent, and the harvesting of organs, from mentally disabled people and from children, particularly in cases where it is not clear the donor has died.

In view of the uncertainties surrounding diagnosis of death, there are very real dangers in an 'opt out' system: if 'opt out' legislation is set to go ahead, those who recognise these dangers should at least try to increase the opportunity for relatives to object, and for organ harvesting from children and mentally disabled people to be restricted to non heart beating donation, after sufficient time from the last heartbeat has elapsed. If it is difficult for potential donors generally to learn of certain facts about organ harvesting from heart beating donors, this will be still more difficult for children and mentally disabled people who will generally have less opportunity to become aware of these facts, and of controversies in this area.

There is also reason for concern over how quickly a medical team might 'move in' following cessation of cardiac functioning (known as 'donation after cardiac death' or DCD). Fears that death is declared too quickly, in order to obtain usable organs, have been expressed and discussed by well-informed commentators.1 One worrying move has been the move from declaring that organ removal must only be attempted after 'irreversible' loss of cardiac function to saying that it must only be attempted after 'permanent' loss of cardiac function, where the latter can include scenarios where a decision has already been made that resuscitation not be attempted. As one report puts it, "One cannot rightly claim that death has occurred if cardiac function could be restored, even if a decision has been made not to do so."2

Even if an adult donor has given fully informed consent to organ donation after death is diagnosed, objections to donation raised by close relatives should be seen as overriding. This is particularly the case with retrieval of organs from heart beating donors, which can be most distressing for relatives who believe - not without evidence - that their loved one may still be alive. However, there are also more general concerns about respect for the feelings of relatives, including in situations where no information exists on the potential donor's wishes, but relatives are reluctant for organ harvesting to go ahead. Relatives should not be asked merely for information on the wishes of the potential donor, about which nothing may be known: organ harvesting should not take place against relatives' objections, as a matter of humanity.

The State should not be presumed to own the bodies of its citizens, whether in life or in death. Rather, its role is to serve the interests of persons whose bodily existence and remains should be honoured. What is taken without explicit consent cannot be said to have been 'donated' as a 'gift'.

Below are some sources on the question of diagnosis of death. It should be noted that the prestigious President's Council on Bioethics in the United States was divided over the question of brain death. Their 2008 report is available here:

https://repository.library.georgetown.edu/handle/10822/559343

D. Alan Shewmon, M.D., Professor of Pediatric Neurology, MDCC 22-474, UCLA Medical School, published the following academic paper on the report:

http://onlinelibrary.wiley.com/doi/10.1353/hcr.0.0122/abstract

More recently, a working party of the Anscombe Bioethics Centre has produced a report on these issues:

http://bioethics.org.uk/Ontheethicsoforgantransplantationfinal.pdf

For a philosophical examination of the issues, the following paper by Professor Josef Seifert of the International Academy of Philosophy usefully sets out the relevant arguments:

http://onlinelibrary.wiley.com/doi/10.1353/hcr.0.0122/abstract

Footnotes

[1] See the discussions of DCD, and also of brain death, in Jason T. Eberl (ed) Contemporary Controversies in Catholic Bioethics Gewerbeststrasse: Springer International Publishing (2017).

[1] http://bioethics.org.uk/Ontheethicsoforgantransplantationfinal.pdf

Contact us

For further information, contact:

Tom Hamilton, SPUC Media Contact
t.hamilton2006@yahoo.co.uk,
Tel: 0141 639 8355
Mob: 07836 603977

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Comments (1)

  • Cole

    18 August 2018, 11:44am

    " This is not scaremongering"
    Yep that is exactly what it is.

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