Posted on 06/28/2006 5:52:02 AM PDT by wagglebee
OTTAWA, June 27, 2006 (LifeSiteNews.com) - In a press conference at the Ottawa Hospital today, doctors announced the first-ever non-heart beating organ donation (NHBD) procedure preformed in Canada.
The procedure, also known as donation after cardiac death (DCD), typically involves a person who requires a ventilator and, although he has measurable brain function, is determined to have no hope of recovery. The doctors then remove ventilation from the patient and wait for the heart to stop beating. If the heart stops for five minutes, death is pronounced and the organs are harvested by another surgical team.
One of the major ethical problems with the procedure is that there are cases where the heart has recommenced beating and circulation after five minutes of stoppage; another is that the stoppage of the heart is caused by the removal of the ventilator.
Organ donation by "brain death" remains controversial after 30 years of the procedure being practiced, but DCD is even more controversial since there is very little time left for ethical considerations. While with "brain death" organs can be harvested at leisure since machines keep air flowing into the lungs and blood circulating, with DCD the stoppage of the heart necessitates very quick harvesting as organs deteriorate without blood flow.
The presentation of Canada's first DCD sounded more like an emotion-laden sales pitch than a medical press conference. The Therien family was on hand to lend support to the organ donation method as their 32-year-old daughter, Sarah Beth, was the first-ever donor in Canada. Sarah's father noted that the family was Roman Catholic and needed to be assured that the procedure was not in violation of the faith. Mr. Therien said that he was assured by hospital staff, "Dr. Kim and his team", that it was not in violation of the Catholic faith.
Those assurances, however, ring hollow. The Catholic Church has not even finally pronounced itself on organ donations by "brain death" let alone the new DCD procedure. In 2003, the Archdiocese of St. Louis condemned the NHBD protocol saying it is "cruel and dangerous and does not meet standards of respect for human life." It called for an immediate moratorium on the practice "until such time as clearer, objective moral standards of determination of death are enacted."
LifeSiteNews.com spoke with Dr. Moira McQueen, President of the Canadian Catholic Bioethics Centre about the matter.
Dr. McQueen told LifeSiteNews.com that waiting only five minutes after cessation of cardiovascular circulation was "frankly . . . not nearly enough." She noted there have been cases of auto-resuscitation after more than five minutes without a heart beat. Even though organs may be harmed by waiting for a sure determination of death, the principal concern is an accurate determination of death, since otherwise the patient is being killed by organ extraction. "The important thing for us is that the person donating has to be dead," explained Dr. McQueen. "The organs are a secondary consideration, that being established first."
Dr. Cameron B. Guest, Chief Medical Officer for Trillium Gift of Life Network, the agency that handles organ donation in conjunction with the hospitals, spoke with LifeSiteNews.com about the controversy over timing. Speaking of auto-resuscitation, he said, "All of the cases that were reported happened in less than a minute."
Dr. Guest, also the Chair of the Organ and Tissue Donation Committee at Sunnybrook and Women's College Health Sciences Centre in Toronto, informed LifeSiteNews.com that Catholic hospitals in Ontario were looking to take on the CDC method.
Dr. Guest conceded however, that "If there were evidence to show that large volumes of patients" were resuscitating after five minutes his team would look into altering their protocols. That concession is not good enough for Catholic hospitals says Dr. John Shea, the medical advisor to Campaign Life Coalition. Where there is a doubt about ending life, Dr. Shea told LifeSiteNews.com, we cannot ethically proceed.
The pro-life movement is opposing CDC for those same reasons.
"The laudable purpose of saving lives does not justify the donation of an organ whose removal could cause the death of a donor," said Jim Hughes, National President of Campaign Life Coalition (CLC). "Harvesting organs just five minutes after the heart stops is just plain frightening. There are cases of people whose hearts have re-started after a longer period of time," he said.
"These situations put the physician in the difficult decision-making position between the care of their patient and balancing that care against the possibility of passing on the patient's organs to someone else," said Mary Ellen Douglas, National Organizer CLC. "The code of the physician is to do no harm and a heart-wrenching decision between two patients places the physician in the role of playing God."
See a short paper by Dr. Shea on NHBD
http://www.lifeissues.net/writers/she/she_21nonheartbeating....
Sorry about your experience. This is not the way things should be adressed. The medical power of attorney of the donor has to speak to several senior staff members before the 'ok' is given to harvest. All interviews must be attended with an outside witness chose by the family. Any red flags by any member of the team is reason to put the kabosh on everything. We have quarterly 'get togethers' for family and friends of donors, recipients are in attendance as well, no vital histories are revealed, and there is an array of spiritual support as well. It's actually a pleasant experience, considering what brings all the people together.
Nurse : More or less.
( Now , on to the next case, a liver transplant with a surgical fee of 70,000 dollars, that will pay for the condo in Florida!!!)
No goober gonna harvest me!
No donating, I will sell the right to have my organs to the highest bidder for the options on Ebay!Then they pay my estate.
the auction.
>> a patient who has been languishing in a hospital bed on a ventilator, showing no signs of awareness, and lots of signs of severe and permanent brain damage.
The picture you painted here is pretty much a dead body. The damage is "permanent," the patient is languid, comatose and presumably brain dead (ventilator). There is no hint of hope. The patient is being kept breathing for no reason. I wondered why? It doesn't ring true. Hospitals as a rule don't waste thousands of dollars a day on futile care.
Bad as it was sending Jews to Hitler, we didn't learn a thing. After the war, literally millions of "displaced persons" were returned to the clutches of Stalin and other communist regimes -- and never heard from again. Boat people fleeing Vietnam and Cuba were picked up at sea and sent back to the tender mercies of Ho Chi Minh and Fidel Castro.
You are a fine storyteller, OP.
Thanks, the story isn't fiction, though.
Severe and permanent brain damage very often doesn't meet the technical definition of "brain death". This article is about a change in Canadian practice which eliminates the requirement of "brain death", if (and only if) the patient is unable to keep his/her beating without artificial assistance.
To use a well-known example, Terri Schiavo was not "brain dead" though she had shown no signs of any cognitive function for years (possibly since her original "collapse", though it's not really clear that she didn't have some cognitive function for some period of time after that). The Canadian procedure described here is such that someone whose brain function was in the condition Terri's was, and ALSO whose heart wouldn't keep beating without mechanical assistance, could have the mechanical assistance removed (to determine if the heart really could or couldn't beat on its own) and if the heart stopped and stayed stopped for 5 minutes, the organs could be harvested.
Hospitals are very often forced to continue utterly futile care, at huge financial cost, and in some cases at the cost of lives that could have been saved if the futile care had been ended and organs harvested from transplantation. Even this Canadian procedure doesn't prevent a lot of futile cases from continuing to receive very expensive, long term medical care, since the portions of the brain that control heart beat and respiration can be present and functioning even when the portions of the brain where cognition and sensory processing occur are utterly dead, missing due to trauma (or even never present in the first place, as in the case of some anencephalic babies, who may have enough brain stem to keep automated physical processes going, in spite of the rest of their brains never having developed at all, resulting in a skull full of fluid where the main, cognitive portion of the brain should be).
We don't need more reasons to ration care and snuff inconvenient patients. That's just socialized medicine at work. We need to get the government out of medicine and to restore free health care markets. Medical decisions should be private.
even then she couldn't move her hands she could only make grunting sounds. (she was always cripped from the waist down). She made it out ok.
I'm totally with you on getting government out of paying for health care. But there do need to be clear laws about when it's permissible to "unplug" a patient, or otherwise hasten death, or there will be an awful lot of private decisions to "snuff inconvenient patients". My personal opinion is that it should be legal to give lethal injections when a decision to stop any support has been reached, after proper legal procedures. The notion that it's okay to slowly starve and dehydrate someone to death, as was done to Terri Schiavo, but not okay to end their lives quickly with no risk of suffering, stikes me as preposterous -- there's always a small risk that the patient has more awareness than the tests show, and even if the patient is utterly unaware it's still an awful thing to put relatives and medical staff through.
I don't think government laws work, and I don't think they will do anything but screw up end-of-life decisions. That's not a prediction, it's an observation -- they screw things up now. Most of the end-of-life problems arise from financial interests. Before we can apply good human sense to these questions, it is necessary to get third-party payers out of the equation and out of the decision process, for they are concerned with the money and not with the patient's best interest.
Financial interests are as likely to be those of relatives eager for their inheritance, and eager not to see their inheritance spent on an elderly relative's medical care, as of third party payers. And while getting the government out of the picture as a payer, and as a regulator of private payers is urgently needed, there will never be a complete elimination of third party payers in a free country. People buy insurance and then the insurer is a third party payer.
I know there is a moral hazard, but the insurance company is obliged to pay according a prior contract. Only insofar as it tries to weasel out of its contractual obligations does it adversely influence the medical decision (or try to). This market solution to the problem is not to patronize unreliable insurance companies. The problem of grasping relatives is likewise to be solved in advance by one's medical directives and one's will.
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