Organ Harvesting: How Dead is Dead?

A person must be legally brain dead, but still breathing and have blood circulating, to provide healthy organs. Is this always the way it happens?

After a cardiac arrest on a street in Paris a man was kept alive through heart massage while transplant doctors arrived to remove his organs. As the man’s lifeless body was being prepared for the harvest, one of the doctors noticed he was moving and reacting to pain. The scalpels were put away and the man was walking and talking within weeks. This is not an isolated occurrence and the medical world is continually debating the ethics of organ donation.

Not Dead Yet

The unknown French gentleman was lucky. Although he had been declared brain dead, it became obvious that he was still very much alive before his heart, liver or kidneys had been removed. Laws governing when a person is dead are somewhat open to question, depending on the beliefs of the presiding physician.

This is further complicated by the knowledge that organs must be taken from the body while blood is still circulating. Once circulation stops cells begin to break down and the organ is no longer suitable for transplant.

The Organ Procurement Organization is responsible for “Verifying that death has been pronounced according to applicable laws.” Deep coma can be hard to distinguish from death so there are a number of methods to tell if a person is dead, but organs viable for transplants must be removed as close to the time of death as possible.

Law on Death

The Uniform Determination of Death Act (UDDA, 1981) evolved because states in the US each had their own definition of death, and the American Medical Association saw the need for a federal law.

Previously the law had stated demonstration of “an absence of spontaneous respiratory and cardiac functions." Since doctors gained the ability to provide artificial respiration a new definition, cessation of brain function, has been widely used. The UDDA allows for, “either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”

Determination of Death in Duk Koo Kim

In one high profile case the boxer Duk Koo Kim was knocked out in a 1982 fight against Ray Mancini. Kim never regained consciousness, and after surgery to remove a blood clot from his skull, doctors declared him brain dead. Kim was Korean and the publicity in both countries justified a team of four Korean doctors flying in to give their opinion.

Using acupuncture to elicit a response the Korean doctors also declared the 23 year-old dead. “In the view of our group of Oriental medicine, we can say Kim belongs to the death situation,” said Dr. Chang Bin Lee, who had treated Kim with acupuncture twice in efforts to revive him.

With his mother’s blessing the young boxer was prepared for organ harvesting, and would be kept on life support until the transplant procedure was completed. His body was then flown back to Korea for religious services and burial. All deaths should be so easy to determine.

Need for Organ Donors

Over 100,000 people are waiting for organs and around 15,000 donors are available every year (at current figures). With each donor able to save several lives you would think that the situation would even out … but it’s not that simple. Not all donors have the healthy organs that are needed. Blood types must match. Each donor has one heart and one liver. Other organs are used too, but it is mainly the heart, liver and kidneys that save lives.

This puts pressure on the medical world to find donors and do it ethically. Stories abound of people having organs removed before they are legally brain dead, balanced by the stories of people dying before a donor can be found to save them.

Deciding what is right and wrong for individual situations is challenging at best. It requires the ability to walk in the shoes of a comatose donor, the grieving family members, and the person who needs a heart to live and see their children grow, all at the same time and is perhaps one of the most challenging, and painful tasks doctors face in modern times.

Sources

Boxer ruled dead by judge in Nevada, The New York Times, November 18, 1982.