Ethical questions about organ transplants

By Phil Lawler ( bio - articles - email ) | Mar 29, 2012

The news that former vice president Dick Cheney has received a heart transplant prompts NPR’s “Morning Edition” to examine one set of ethical issues involving the transplant of vital organs. But there is another deeper, more troubling set of questions to be asked.

The questions that “Morning Edition” did ask revolve around the recipients of unpaired vital organs. Since there is a limited supply of healthy organs available, and a long list of patients hoping for transplants, which recipients should be placed at the top of the waiting list? At the age of 71, with a history of multiple cardiac events and several heart surgeries, Cheney would not appear to be a likely candidate. Recovery will be rough for a man with his medical history, and his prospects for a long life—even with a healthy new heart--are not rosy. Yet Cheney did wait longer than usual for the transplant, and he undertook the operation knowing the likely consequences. So was the operation ethical? Should someone else—someone younger, in better overall health—have been given that heart? Frankly I don’t know how to answer those questions. Because…

The ethical problems that bother me involve the donor of the vital organ. That heart that Cheney received was beating at the time when it was removed from the donor. The donor had presumably been classified as “brain dead,” but doctors had kept his lungs working and his heart beating until they removed the organ. (That was a necessity. Human organs deteriorate quickly after bodily death, and within minutes they are no longer useful for transplantation.) The doctors may even have used sedatives to minimize the donor’s bodily reactions when they removed his heart.

By ordinary standards someone who is breathing (even with assistance) and whose heart is beating (ditto) is classified as alive. But with the advent of modern medical technology doctors have learned to keep the bodily processes going, keeping the vital organs fresh, even after declaring the patient dead. What this means, for practical purposes, is that doctors are treating the donor as a patient—continuing medical treatment—after pronouncing him dead. Is that ethical? Is it morally right for a doctor to give medical treatment to a corpse?

More to the point, is it really a corpse? We know very little about what goes on deep in the brain of a comatose patient. We do know that some patients who have been classified as “brain dead” have awakened and recovered fully. If there is even a sliver of suspicion that human life could still be lurking behind an unresponsive façade, then there is a clear moral imperative not to remove a vital organ, since that operation would obviously kill the patient.

The diagnosis of “brain death” allows for the harvesting of human organs. At the very least, recognition of that grim reality should force medical personnel to be excruciatingly clear in defining what constitutes “brain death,” and ensuring that those standards are met before any transplant is contemplated. But in fact there are many different sets of criteria for “brain death,” and no universally accepted standards. Doctors are generally free to choose the criteria they find most helpful, and for legal purposes the patient is dead when the doctor says it is so. The potential for abuse in this system should be evident, even to someone who is entirely comfortable with the murky concept of "brain death." 

Heart transplants (and transplants of other unimpaired vital organs) are no longer uncommon. Medical procedures have been established to streamline the operations, and ethical norms to encourage transplants. The system is set up to help the recipient of the transplant. But since all the momentum is working in that direction, ordinary prudence—not to mention a reverence for life—cautions us to pause and think about the “other” patient. Of course we care about the recipient, and understand his need. But what about the donor? Are we absolutely certain that he is dead? How could we possibly obtain such certainty? Without it, how could we possibly allow the removal of his vital organs?