"The nasty side of organ transplantation"

As you might know, bioethics law is currently being revised in France. Not sure, however, that anything will change, regarding organ harvesting. 5.000 transplants should be done in 2010… Presumed consent should, most likely, prevail in the new law as well. And, as usual, promotion of organ donation is called “information”. Dead donor rule (a legal fiction) will remain standard. But some surgeons and physicians in France begin to be willing, just like Dr David W Evans, a British physician, to publicly say that the donor is not a dead person. Of course, the question of pain remains unspoken, that is: publicly unspoken.

You may be aware that in France prevails a law on end-of-life patients’ rights: end-of-life patients should be granted a terminal sedation, in order to ease moral and physical pain and distress. (Leonetti Law of April 11, 2005, a law on the end of life and care). This law encourages the broad public to reflect upon the end of life theme. However, this reflection should not include the organ donor, as the dead donor rule still prevails. An organ donor is not a patient anymore, he is not a person. Because of the dead donor rule, reflecting on the organ donor’s end of life is merely impossible, absurd. Since a dead person experiences no pain. According to some transplant surgeons in France, public debate on the organ donor’s end-of-life is not likely to happen any time soon. This situation is hypocritical. A potential organ donor’s end-of-life should be “managed” just as prescribed by the law regarding end-of-life patients’ care. Once medical treatment has shown to be futile, and there is no treatment alternative left, and after a terminal sedation, if we have a potential organ donor there, then, let’s discuss the question of pain, first of all. Will the donor experience any pain? Do we have rock solid evidence he will not? In this situation, informed consent, based upon a clear appreciation and understanding of the facts, should prevail. This, however, should be a team decision, this team including medical staff as well as the potential organ donor’s family.

But in France, this situation (typically happening in the US and in Japan) is said to be unethical: “there is confusion and ambiguity between two distinct matters: medical care and treatment abandonment may interfere with the intent of retrieving organs, leading to organ retrieval conflicts, that is: a moral conflict of organ retrieval.” However, in France, the intangible dead donor rule is also unethical: a dying person is being deprived of a human person’s rights for the sake of organ donation. In this situation, informed consent, though prescribed by law, does not mean a thing…

Seems that we are not out of the ethical woods yet, neither in France, nor in the US (or UK, or Canada, or Japan) …

Rethinking the dead donor rule ?

"In the August 14, 2008 issue of the New England Journal of Medicine, Boucek et al. report on three cases of heart transplantation from infants who were pronounced dead on the basis of cardiac criteria. Moderator Atul Gawande, of Harvard Medical School; George Annas, of the Boston University School of Public Health; Arthur Caplan, of the University of Pennsylvania; and Robert Truog, of Harvard Medical School discuss key ethical aspects of organ donation after cardiac death."

==> Download transcript of the discussion (PDF)
==> View video : debate.

"The Nasty Side Of Organ Transplanting. The Cannibalistic Nature of Transplant Medicine". Author: Norm Barber.

==> Third Edition 2007 (PDF, 180 Ko, full version): download

“Transplant technology may be compared to an evil genie let out of a bottle and now won’t return.” (Nancy Scheper-Hughes, Organs Watch)