The Nasty Side of Organ Transplanting : The Cannibalistic Nature of Transplant Medicine

The website http://www.geocities.com/organdonate/index.html shows various "nasty" sides of organ transplant - called "nasty", since they reveal the cannibalistic nature of transplant. A nature we don't want to be reminded of. We'd rather just look at the bright side of transplants: don't they just save people's life? So why show this nasty side ? The medicine transplant community sure cannot be charged with cannibalism. But organ retreaval does mean an intrusion in someone's dying process. This intrusion is necessarily having some consequences for the dying person. Are we so sure the dying patient won't be harmed by this intrusion? Up to date, the international medicine community has not been able to reach an agreement on this question. We cannot reasonably assume we can answer this question for certain. So, if we cut it short: uncertainty regarding the dying patient; however: certainty regarding the patient waiting for a new organ: the transplant could save his life! Why not keep both aspects in mind (uncertainty and certainty), since a transplant means both. Why ?! Well, if we take into account all the people involved, we will have to think also about the dying patient, whose body is trying to die, but who's being kept alive artificially. As puts it an experienced nurse in her testimony (see "The Nurse's tale" below): "After all, he [the dying patient] has been kept alive artificially, and his body has been trying to shut down naturally". Thinking "only" about the patient waiting for a new organ would not be fair, would it?

This website "only" shows the nasty side of organ transplantation (=organ retrieval and grafting), fair enough, but you'd better take a closer look at it all the same, if you want to gain a deeper insight into this whole transplant thing. That's why you'll find below a recap of this web site. You can also download a copy of the book "The Nasty Side of Organ Transplanting" (second edition) as a PDF Doc.

The aim is to make you aware of both sides of organ transplantation: the brighter and (unfortunately) the darker one.

"THE NASTY SIDE OF ORGAN TRANSPLANTING": website recap:

==> "Kidney Donation and Harm to the Donor" (13 May 2006)

Article by Michael Potts, Associate Professor of Philosophy, Methodist College, Fayetteville, NC USA 28311. Published in : http://bmj.bmjjournals.com/

"No one can deny the tragedy of those who die prematurely from kidney failure or live debilitated lives due to complications from dialysis. Although kidney transplantation offers a more effective form of treatment than dialysis, medical personnel must take care not to harm the donor. A recent BMJ editorial (1) calls for more transplant organs (to be better allocated) from two sources: the 'brain dead' and 'non-heart beating donors'."

"Removal of organs for transplant from the 'brain dead' is morally problematic, for it is not at all clear that individuals diagnosed as 'brain dead,' especially under the UK 'brainstem death' criterion, are really dead. These individuals still function as organic wholes at the physiological level, retaining circulatory and respiratory functions (the ventilatory function is taken over by a machine but oxygen and carbon dioxide exchange continue at the cellular and tissue level in just the same way as before) (2). In addition, as Evans (3) and Hill (4) have both noted, it is not clear that the brainstem, much less the rest of the brain, is dead. If such donors are not dead, removing vital organs harms them, violating nonmaleficence.

Removal of organs from 'non-heart beating' donors is morally problematic for other reasons, as Renée Fox (5) notes. 'Treatment' is not oriented toward the patient but toward the goal of preserving organs. Proper comfort care for the dying patient may be omitted because the donor is considered as a repository for organs rather than as a person. The patient may be pronounced 'dead' prematurely after circulatory cessation and the place and timing of its certification may be orchestrated in the interests of the organs to be removed. This is a form of technological death befitting 'things' and not 'persons' in which dying individuals are 'treated' solely on the basis of their utility for others.

Non-heart beating donation may be morally acceptable if the patient receives standard care (as for any other patient dying of the same condition) beforehand, there being no non-therapeutic interventions for the sole purpose of protecting the wanted organs, and if the patient is pronounced dead according to the same circulatory-respiratory criteria applied to other patients in similar situations (and in general use). Then, if warm ischemic time has not been too long for the kidneys to be of use, they may be removed without harming the patient — even then, care must be taken to avoid even a remote potential for the patient to experience distress. Only when no harm is done can the removal of organs from donors be considered morally justifiable."

(1) Geddes CC and Roger RSC. Kidneys for transplant: more of them, better allocated (editorial). BMJ, doi:10.1136/bmj.38833.785984.47 (published 27 April 2006; accessed 11 May 2006).

(2) Potts M. A requiem for whole brain death: a response to D. Alan Shewmon’s ‘The brain and somatic integration.’ J. Med. Phil. 2001;26:479- 91.

(3) Evans DW. The demise of ‘brain death’ in Britain" In Beyond Brain Death: The Case Against Brain Based Criteria for Human Death, ed. M Potts, PA Byrne, and RG Nilges, pp. 139-58. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000.

(4) Hill DJ. Brain stem death: a United Kingdom anaesthetist’s view. In Beyond Brain Death: The Case Against Brain Based Criteria for Human Death, ed. M Potts, PA Byrne, and RG Nilges, pp. 159-69. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2000.

(5) Fox RC. An ignoble form of cannibalism’: Reflections on the Pittsburgh Protocol for procuring organs from non-heart-beating cadavers," Kennedy Inst of Ethics J 1993;3: 231-39.

Competing interests: None declared

Source :
http://bmj.bmjjournals.com/cgi/eletters?lookup=by_date&days=14#132141

==> Here is a testimony from an experienced nurse, highly polemic as well :

"The Nurse’s Tale"

"Transplant coordinators and donation agencies never tire of emphasising that the donor family’s loved ones will be treated with dignity and respect. It is a comfort to think unaffected people with a higher cause dismantle the bodies. But an American nurse who has worked thirteen years in the transplant field in the United States says :"

"The families are led to believe they are doing such a noble and wonderful thing by donating their loved ones organs. I tend to believe, in their moment of grief, they are not thinking clearly. This is what happens.

A patient is declared brain dead. The family gives consent to remove organs/tissue/etc. This body is trying to 'die', but we keep it alive artificially till suitable donors can be found. Sometimes this can take many hours, as precise tissue matches are not always at the ready. Meanwhile, the body is deteriorating.

My role in all this was waiting in the operating room. 'Are they ready to start this retrieval yet? No, they can't find anybody to take the heart (just an example).' So when they finally do find a recipient, teams come in from various parts of the country to harvest the various organs. The patient is brought to the operating room, and the procedure is begun. The heart is removed first, followed by the other organs. Sometimes an organ is not taken because there was no recipient, or it is taken just for research. Occasionally an organ is deemed unusable due to a disease process. Immediately after the organs are removed, the various doctors whisk them away in coolers, never giving a thought to the person who just died or the grieving family. They have no idea of even the person's name. So one by one, these ghouls leave the operating room till all that is left is the body, laying WIDE open, quiet, and cold, and the nurses.

Usually some underling of a resident is left to sew the body shut. It is a hideous sight. And the smell of death is starting to permeate the room. Nauseating! So the body is closed, and that doctor leaves and all we have is the body and the nurses. It's left up to the nurses to clean up one holy hell of a mess, and take care of this body that has been defiled and forgotten. We must pull all the various tubes and lines out of the body to make it presentable for the family. As the tubes are pulled out, this horrible stench exudes from the depths of this former person. After all, he has been kept alive artificially, and his body has been trying to shut down naturally. (...). Sorry to sound so glum, but I can't help but think if families could see how their loved ones were treated, they would never consent to the taking of organs."

Source:
http://www.geocities.com/organdonate/AAACh7TheNursesTale.html

==> "Does it matter that organ donors are not dead? Ethical and policy implications."

Article by Potts M (1), Evans DW (2). (1)Philosophy and Religion Department, Methodist College, Fayetteville, NC 28311-1498, USA ; (2) Dr. David Wainwright Evans, Cardiologist, Queens College, Cambridge, United Kingdom (retired physician):

"The 'standard position' on organ donation is that the donor must be dead in order for vital organs to be removed, a position with which we agree. Recently, Robert Truog and Walter Robinson have argued that (1) brain death is not death, and (2) even though "brain dead" patients are not dead, it is morally acceptable to remove vital organs from those patients. We accept and defend their claim that brain death is not death, and we argue against both the US 'whole brain' criterion and the UK 'brain stem' criterion. Then we answer their arguments in favour of removing vital organs from 'brain dead' and other classes of comatose patients. We dispute their claim that the removal of vital organs is morally equivalent to 'letting nature take its course', arguing that, unlike 'allowing to die', it is the removal of vital organs that kills the patient, not his or her disease or injury. Then, we argue that removing vital organs from living patients is immoral and contrary to the nature of medical practice. Finally, we offer practical suggestions for changing public policy on organ transplantation."

Source:
http://www.ncbi.nlm.nih.gov/

==> "Brain death is a recent invention":

Article by Dr. David Wainwright Evans, Cardiologist, Queens College, Cambridge, United Kingdom (retired physician): BMJ 2002;325:598 ( 14 September ) : click here.

==> Download full book (PDF Version) : click here.