Dead enough(aeon.co)
aeon.co
Dead enough
http://aeon.co/magazine/philosophy/we-should-harvest-organs-from-patients-before-death/
15 comments
> It was a collision with mortality because the people I knew never talked about death as a part of life.
In the tech scene there is a particular aversion to facing up to the realities of life. People tend to think that waiting for technology to improve will take care of all of life's problems and death is just another one of those, so if they just hold out long enough death will surely not happen to them.
In the tech scene there is a particular aversion to facing up to the realities of life. People tend to think that waiting for technology to improve will take care of all of life's problems and death is just another one of those, so if they just hold out long enough death will surely not happen to them.
Why not just let the patient choose, set a restrictive default and allow individuals to relax this default. So in the case of assisted suicide, it seems more reasonable to surgically remove the heart, than to first use poison and then remove the heart.
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This makes perfect sense. I know people who would be terrified of the thought that their organs could be harvested while they might yet recover, but also people who be horrified that their perfectly good organs are just laying there, unused, after their brain has died, but with artificial respiration/circulation keeping some of the rest of their body going.
I think a sane default is to require opt-out for organ donation after brain death (what Europe does now, I believe) with an opt-in "sliding-scale" for the rest of the possibilities.
I think a sane default is to require opt-out for organ donation after brain death (what Europe does now, I believe) with an opt-in "sliding-scale" for the rest of the possibilities.
I am an organ donor. I think the chances of a scenario in which I am at death's door and a doctor decides not to treat me solely in order to obtain my organs for donation is so far removed from reality that it's not worth considering, at least in this country.
Several European countries have an opt-out system, i.e., everyone is a donor by default. Mixing that with a "dead enough" system would ethically be extremely dangerous. (I am an organ donor and would in principle have no problem if this were done to me.)
No more dangerous that just taking them off of life support.
We're talking about people in permanent, machine supported comas. If a doctor offs someone that the doctor knew had a chance for survival the doctor should get tried for murder.
We're talking about people in permanent, machine supported comas. If a doctor offs someone that the doctor knew had a chance for survival the doctor should get tried for murder.
Once we're able to pull depositions right from the minds of defendants, we might actually be able to try him/her, too.
My mind first goes to all of the things that could go wrong.
That's precisely why I am not an organ donor.
I don't want to put anyone in the position of making these decisions based on probability and likelihood. Harvest the organs of the willing only after clinical death has occurred.
I'm concerned that one day a poor person could sustain a traumatic brain injury and just so happens to be a tissue match for someone who is rich, famous, politically connected or influential who needs an organ.
That's precisely why I am not an organ donor.
I don't want to put anyone in the position of making these decisions based on probability and likelihood. Harvest the organs of the willing only after clinical death has occurred.
I'm concerned that one day a poor person could sustain a traumatic brain injury and just so happens to be a tissue match for someone who is rich, famous, politically connected or influential who needs an organ.
> I'm concerned that one day a poor person could sustain a traumatic brain injury and just so happens to be a tissue match for someone who is rich, famous, politically connected or influential who needs an organ.
The chances of that happening to any one particular person are quite small.
The wealthy in the current system already have an unfair advantage by being able to 'multiple list', a path not open to those of lesser means. It's all perfectly legal, of course.
The chances of that happening to any one particular person are quite small.
The wealthy in the current system already have an unfair advantage by being able to 'multiple list', a path not open to those of lesser means. It's all perfectly legal, of course.
As others have commented here, this is also exactly why I am not an organ doner. There are cases where people have went into cardiac arrest, where their heart stopped and everything, only to wake up and make a full recovery. "Is he dead?" is not always a well defined state with a binary True/False answer. The fact that this article is pushing for harvesting organs before death, and people who actually think this way, only serves to turn me off to it even more so.
Call me selfish, antithetical to society, or whatever. If I really was in a state where there was no chance I could recover, I would gladly give my organs to help save someone else. As it is, I don't think a random E.R. doctor should make that determination based on a note found in my wallet.
Call me selfish, antithetical to society, or whatever. If I really was in a state where there was no chance I could recover, I would gladly give my organs to help save someone else. As it is, I don't think a random E.R. doctor should make that determination based on a note found in my wallet.
>As it is, I don't think a random E.R. doctor should make that determination based on a note found in my wallet.
I don't think live harvesting is common (or allowed) in the US.
I don't think live harvesting is common (or allowed) in the US.
Should not we already get artificial organs out of the door?
To do so, first we should revisit all that stem cell debate.
It's kind of hard to argue that stem cells are more sacred than organs harvested from still breathing body.
To do so, first we should revisit all that stem cell debate.
It's kind of hard to argue that stem cells are more sacred than organs harvested from still breathing body.
The successes in engineered organs are coming from adult stem cells so far, which don't come with an ethical debate. We can't get there fast enough if this ghoulishness is really what doctors are proposing.
"which don't come with an ethical debate"
I would not be so sure. I don't think that laymen understand the difference between evil baby-harvested stem cells and my rightfully own adult stem cells, and that hurts research & funding.
I would not be so sure. I don't think that laymen understand the difference between evil baby-harvested stem cells and my rightfully own adult stem cells, and that hurts research & funding.
Having been around a lot of people who care about this issue growing up, I can tell you there is a lot of loud trumpeting of every advance in adult stem cell research, specifically for this reason. I'm sure there are still some out there who have ethical concerns about adult stem cells, but that is a separate issue.
One example from a quick google search: http://www.ncregister.com/daily-news/adult-stem-cell-therapi...
One example from a quick google search: http://www.ncregister.com/daily-news/adult-stem-cell-therapi...
There were impressive results (quite a huge step) with ECM scaffolds producing tiny hearts, kidneys and such. More and more we're able to handle things at the sub-molecular level, so it's probable that soon we'll have spare organs.
It will be a milestone, not having to wait for someone to die to get a functioning heart or liver. Maybe no more immuno-suppressant therapies for transplantations. Questioning ourselves too.
It will be a milestone, not having to wait for someone to die to get a functioning heart or liver. Maybe no more immuno-suppressant therapies for transplantations. Questioning ourselves too.
And this is why I'm not an organ donor, because I knew it would eventually be pushed to this and beyond.
A friend of mine was a nurse who worked in an ER. I expressed similar concerns of yours to her, "organ donor might mean that the doctors don't try and save me as hard because hey, good organs!" and she was emphatic that the doctors wouldn't do this.
I think the worry is that even if the particular doctors in her ER would always try their hardest, there might be other doctors in other ERs who might not.
What's difficult is that there's really very little way to truthfully ascertain if someone did in fact try hard enough. How do you really quantify effort? It's very similar to programming, if someone creates a bug was it an accident or was it on purpose? You'd like to believe that it was always an accident but you can never really know for sure.
What happens when organ donation is seen as a moral imperative and only a few percent of people choose not to participate? Might doctors not try as hard to save them as "punishment" for being "anti-social" or something?
There are a lot of thorny ethical questions surrounding organ donation, death, and drawing hard lines where things are squishy.
I think the worry is that even if the particular doctors in her ER would always try their hardest, there might be other doctors in other ERs who might not.
What's difficult is that there's really very little way to truthfully ascertain if someone did in fact try hard enough. How do you really quantify effort? It's very similar to programming, if someone creates a bug was it an accident or was it on purpose? You'd like to believe that it was always an accident but you can never really know for sure.
What happens when organ donation is seen as a moral imperative and only a few percent of people choose not to participate? Might doctors not try as hard to save them as "punishment" for being "anti-social" or something?
There are a lot of thorny ethical questions surrounding organ donation, death, and drawing hard lines where things are squishy.
I think that one risk being a organ donor is quite the opposite: Over-treatment.
It might not be in your best interest (a painless death) to be painfully cooled down by a freezer to reduce the fever that can occur after severe aneurysms - while waiting for the brain infarct that will induce a "brain death."
The cynical might say that it's for saving your organs rather than for your survival, and it's hard to tell how much pain is experienced, but looking at the reaction of the body,it's apparent that it hurts as hell.
It might not be in your best interest (a painless death) to be painfully cooled down by a freezer to reduce the fever that can occur after severe aneurysms - while waiting for the brain infarct that will induce a "brain death."
The cynical might say that it's for saving your organs rather than for your survival, and it's hard to tell how much pain is experienced, but looking at the reaction of the body,it's apparent that it hurts as hell.
> What happens when organ donation is seen as a moral imperative and only a few percent of people choose not to participate? Might doctors not try as hard to save them as "punishment" for being "anti-social" or something?
IMO, if you want to opt-out of donation, doing so should opt-out of the receipt of donated organs as well.
IMO, if you want to opt-out of donation, doing so should opt-out of the receipt of donated organs as well.
Fair enough, though it's trivially gamed. Don't be an organ donor. Get sick and become an organ donor. Receive transplant. Go back on your organ donor status. The rules to more properly regulate this would be a total disaster and would ultimately end up screwing some people unjustly and giving others organs unjustly too.
More what I was trying to talk about was the idea that organ donors and non-donors might receive different standards of care "because organ donors are better people" in a future where almost everyone is an organ donor and societal expectations have shifted significantly.
More what I was trying to talk about was the idea that organ donors and non-donors might receive different standards of care "because organ donors are better people" in a future where almost everyone is an organ donor and societal expectations have shifted significantly.
What about people who don't donate blood? No blood for them?
No, I think that'd cross a major ethical line.
First, there's not an ongoing, nationwide shortage of blood - we have enough of it, so people aren't dying needlessly because they can't get it.
Second, requiring an invasive medical procedure on a live subject is hugely different to cadaver organ donation.
We already have an ethical framework in which the government at least partially controls post-death use of the body - autopsies, regulation of burials, etc.
First, there's not an ongoing, nationwide shortage of blood - we have enough of it, so people aren't dying needlessly because they can't get it.
Second, requiring an invasive medical procedure on a live subject is hugely different to cadaver organ donation.
We already have an ethical framework in which the government at least partially controls post-death use of the body - autopsies, regulation of burials, etc.
I wonder what keeps US blood stocks healthy. Here in the UK there seems to be an alarming story every few months about how we barely have more than a few days' stock. Even just recently: http://www.theguardian.com/uk-news/2015/jun/05/sharp-drop-ne... .. no-one gets anything for donating blood here though, if The Simpsons is even slightly realistic (!) sometimes people in the US give blood for cash?
> Here in the UK there seems to be an alarming story every few months about how we barely have more than a few days' stock.
That's how they drive up supply. When it gets too low here in the US they'll actually use phone banks to call regular donors to ask them to come in. I'd imagine the UK has something similar.
> if The Simpsons is even slightly realistic (!) sometimes people in the US give blood for cash?
I believe it's illegal to pay donors for blood, but plasma donation can be paid. It's problematic. http://www.theatlantic.com/health/archive/2014/05/blood-mone...
That's how they drive up supply. When it gets too low here in the US they'll actually use phone banks to call regular donors to ask them to come in. I'd imagine the UK has something similar.
> if The Simpsons is even slightly realistic (!) sometimes people in the US give blood for cash?
I believe it's illegal to pay donors for blood, but plasma donation can be paid. It's problematic. http://www.theatlantic.com/health/archive/2014/05/blood-mone...
If an ER doctor is actively trying to save your life (i.e. you are an unstable patient in an ER), it is _very_ unlikely that they would have any idea if you're a donor or not.
Ultimately, if a loved one's life could be saved by an organ donation, I would want it to be, and therefore I cannot ethically and logically not be on the organ donation list myself. Any other conclusion is, to my mind, selfish and antithetical to the society I want to live in. So it's really as simple as that.
I understand fears such as your own from a human point of view, and they should absolutely be addressed if they're stopping people from becoming organ donors, but I do think it's unfortunate. So many lives could be saved... Hopefully more and more countries will adopt an 'opt-out' system going forward, because it seems to make a huge difference. And as for this article, I have no problem with clarifying the definition of death. If there's no electrical activity in my brain, I see no harm (literally "no harm" in the Hippocratic sense) in removing my organs before I'm taken off life support.
I understand fears such as your own from a human point of view, and they should absolutely be addressed if they're stopping people from becoming organ donors, but I do think it's unfortunate. So many lives could be saved... Hopefully more and more countries will adopt an 'opt-out' system going forward, because it seems to make a huge difference. And as for this article, I have no problem with clarifying the definition of death. If there's no electrical activity in my brain, I see no harm (literally "no harm" in the Hippocratic sense) in removing my organs before I'm taken off life support.
I don't quite see the logic here. What does the medial professional gain from letting you die to try save someone else?
If there is nothing to gain (no financial reward, or reputational bonus, or so on) or there is but they have the appropriate morals to turn it down, then they aren't going to risk the nagging of their own conscience and/or looking bad by letting you die.
If there is something to gain (and they are mentally capable of letting themselves take advantage of that) then it is going to happen whether you are a registered donor or not. If they can convincingly let you die without recompense they can hide your organs in the paperwork so it doesn't look like a non-donor organ has intentionally been used.
So whether or not you are screwed in a situation where this discussion is relevant is not at all determined by whether or not you are registered as a donor. By choosing not to donate you are not controlling any such situation in the way you hope you are.
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance - then things get a but more tricky depending on your paranoia level, though IMO the chance of that is rather small (the chance of getting hit by a bus on your way home from work or shot by some loon in a movie theatre is so much higher that it doesn't make sense to be committing time to thinking about this) and to be honest I'd probably not mind all that much if it did happen... Then again some might discount my opinions here because many don't seem to understand my reasoning in the following point of view: If I were in a permanent vegetative state or riddled with dementia or similar I'd gladly shuffle and donate my organs to help several others (who still have a chance of some desirable quality of life) on the way out. The only thing stopping me registering as "FFS just let me go when I get close to that sort of state, because I'm no longer me and there is no point throwing time and money at keeping the husk that is no longer me going" is that there is no legal way of doing so.
If there is nothing to gain (no financial reward, or reputational bonus, or so on) or there is but they have the appropriate morals to turn it down, then they aren't going to risk the nagging of their own conscience and/or looking bad by letting you die.
If there is something to gain (and they are mentally capable of letting themselves take advantage of that) then it is going to happen whether you are a registered donor or not. If they can convincingly let you die without recompense they can hide your organs in the paperwork so it doesn't look like a non-donor organ has intentionally been used.
So whether or not you are screwed in a situation where this discussion is relevant is not at all determined by whether or not you are registered as a donor. By choosing not to donate you are not controlling any such situation in the way you hope you are.
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance - then things get a but more tricky depending on your paranoia level, though IMO the chance of that is rather small (the chance of getting hit by a bus on your way home from work or shot by some loon in a movie theatre is so much higher that it doesn't make sense to be committing time to thinking about this) and to be honest I'd probably not mind all that much if it did happen... Then again some might discount my opinions here because many don't seem to understand my reasoning in the following point of view: If I were in a permanent vegetative state or riddled with dementia or similar I'd gladly shuffle and donate my organs to help several others (who still have a chance of some desirable quality of life) on the way out. The only thing stopping me registering as "FFS just let me go when I get close to that sort of state, because I'm no longer me and there is no point throwing time and money at keeping the husk that is no longer me going" is that there is no legal way of doing so.
>I don't quite see the logic here. What does the medial professional gain from letting you die to try save someone else?
Cost benefit analysis to save the most people.
"He is already pretty much dead. We could keep trying and maybe damage the organs, or go ahead and call time of death and get these organs to save 3 other people."
For me, the bigger issue is that of the 'beating heart donor' where your organs are harvested while you are brain dead but your body is still alive. I don't trust our understanding of brain death enough to say that pain isn't felt (consider the rare cases of people who are anesthetized enough they appear unconscious to the instrumentation but are able to recall parts of the operation including sometimes feeling pain).
Cost benefit analysis to save the most people.
"He is already pretty much dead. We could keep trying and maybe damage the organs, or go ahead and call time of death and get these organs to save 3 other people."
For me, the bigger issue is that of the 'beating heart donor' where your organs are harvested while you are brain dead but your body is still alive. I don't trust our understanding of brain death enough to say that pain isn't felt (consider the rare cases of people who are anesthetized enough they appear unconscious to the instrumentation but are able to recall parts of the operation including sometimes feeling pain).
I don't quite see the logic here. What does the medial professional gain from letting you die to try save someone else?
Prestige and money. When a millionaire is dying of heart failure, do you think s/he goes to whichever doctor has an opening on the schedule or do you think that s/he will seek out the doctor who has the best record for saving people in his/her position?
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance
There's nothing grey about it. Unless the donor explicitly authorized the removal of the organs before the onset of clinical death it's unethical.
I don't care if it's 1% versus 99.99%, my organs are mine.
Prestige and money. When a millionaire is dying of heart failure, do you think s/he goes to whichever doctor has an opening on the schedule or do you think that s/he will seek out the doctor who has the best record for saving people in his/her position?
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance
There's nothing grey about it. Unless the donor explicitly authorized the removal of the organs before the onset of clinical death it's unethical.
I don't care if it's 1% versus 99.99%, my organs are mine.
Its an old philosophy problem. Expand it - a healthy person walks into a hospital (to change the water bottles on the water cooler). They are kidnapped and taken into a back room, and their organs are 'parted out' to save 10 people.
A definite Win! for society, right? In a utilitarian sense.
A definite Win! for society, right? In a utilitarian sense.
Only if people are fungible. What if the healthy person was about to invent __ that would improve __ survival rates?
> I don't care if it's 1% versus 99.99%, my organs are mine.
Morally, yes. Legally, no. You can't sell your organs because you don't own them. You don't own yourself because who knows why? It's the government's way of solving a variety of problems regarding people who aren't exactly in their right mind.
Sadly it has some other unfortunate outcomes as well, like you can't legally take your own life no matter how much you're suffering.
Morally, yes. Legally, no. You can't sell your organs because you don't own them. You don't own yourself because who knows why? It's the government's way of solving a variety of problems regarding people who aren't exactly in their right mind.
Sadly it has some other unfortunate outcomes as well, like you can't legally take your own life no matter how much you're suffering.
You can't sell your organs because you don't own them.
That's not entirely accurate. I can give them away, because I do own them.
I could give someone one of my kidneys. I could give someone a lobe of my liver. I can and one day may give someone some of my bone marrow. I can and have given away some of my blood.
That's not entirely accurate. I can give them away, because I do own them.
I could give someone one of my kidneys. I could give someone a lobe of my liver. I can and one day may give someone some of my bone marrow. I can and have given away some of my blood.
A simple separation of concerns could solve a portion of the ethical and pragmatic problems people have brought up in this discussion. The treating doctor does not get to know the donor status of the patient and has nothing to do with extracting the organs once the patient is either dead or "dead enough".
The doctor reports on the patients chances of survival/waking up etc and this is checked against the patients donor status including any permission to harvest organs if there's no or only a tiny chance of survival.
Of course there's a number of hypothetical situations where this falls apart - if there's only one qualified doctor available in a tiny hospital or if there's no access to patient records/pre-recorded desires. However, it's a place to start.
Until there are better options available or a series of well publicized abuses I will continue to be an organ donor because, to put it simply, the golden rule.
The doctor reports on the patients chances of survival/waking up etc and this is checked against the patients donor status including any permission to harvest organs if there's no or only a tiny chance of survival.
Of course there's a number of hypothetical situations where this falls apart - if there's only one qualified doctor available in a tiny hospital or if there's no access to patient records/pre-recorded desires. However, it's a place to start.
Until there are better options available or a series of well publicized abuses I will continue to be an organ donor because, to put it simply, the golden rule.
Honestly I don't believe I'd have a problem with this. If the odds of my living are less than the odds of my organs allowing someone else to survive…
There is of course the issue of trusting people to make that call for me, but I'm pretty sure I trust an awful lot of people to not kill me unreasonably.
There is of course the issue of trusting people to make that call for me, but I'm pretty sure I trust an awful lot of people to not kill me unreasonably.
> If the odds of my living are less than the odds of my organs allowing someone else to survive…
One of the big problems really is to determine the odds.
One of the big problems really is to determine the odds.
As a prospective organ donor, I am comfortable with "dead enough" organ harvest for myself as long as my living will and my family's wishes (subordinate to the living will) were respected.
I can't draw that line for anyone else, though. From my perspective, the moral thing for the government to do is to make it legal and require an extra opt-in above and beyond the typical DDR version of organ donation enrollment we have now.
I can't draw that line for anyone else, though. From my perspective, the moral thing for the government to do is to make it legal and require an extra opt-in above and beyond the typical DDR version of organ donation enrollment we have now.
That's a very big "if."
Why not just grow organs in petri dishes. Then you don't have the problem of the immune system rejecting these foreign organs?
I'm all for organ donation, medical euthanasia, and other issues that are related to this but I feel a little uncomfortable about being considered "Dead enough". I guess I would need a little more definition about what is actually considered "dead enough".
Disclaimer: I didn't read the entire article so my concerns may have been covered.
Disclaimer: I didn't read the entire article so my concerns may have been covered.
I'm certainly capable of making up a slippery slope argument where people are being off'd for their organs. It just doesn't seem like people willing to do that would be detoured very far by someone's lack of organ donor status and even if nobody but organ donors were to be off'd prematurely, it's probably low down on the likely reasons I'll get off'd for someone else's benefit.
I figure I'm much more likely to die waiting for an organ than to be off'd for mine even well into the gray zone of organ harvesting.