Three bioethicists want to end current 'dead donor rule' for organ donation.

The New England Journal of Medicine (NEJM), one of the most prestigious medical journals in the world, recently published an article by three bioethicists who argued that people should be allowed to be killed prior to circulatory death for the sake of organ donation.

Key Takeaways:

• Three bioethicists, two of whom were educated at Harvard University, published in NEJM deriding the current "dead donor rule" for organ donation.

• Instead, with the rise of euthanasia and assisted suicide, the authors argue people should be allowed to be killed prior to circulatory death for the sake of organ donation.

• The trio called for existing standards surrounding organ donation to be loosened.

The Details:

The article, written by Drs. Carter Winberg, Ian Ball, and Robert D. Truog, bemoaned the current "dead donor rule (DDR)." Currently, organ donors are required to be legally dead before organs can be harvested. Instead, they noted that euthanasia has becoming increasingly acceptable, and suggested the rule be loosened to allow patients to be killed by organ donation. This, then, "aligns with the DDR’s concern for minimizing harm," they wrote.

This would create a better product for organ procurement companies, they argued; not only would it increase the "donor pool," but it would ensure the donated organs are in better condition:

Death by organ donation would enable cardiac donation, typically prohibited with DCD [circulatory death], and improve recipient outcomes by reducing warm ischemia time, thereby lowering primary graft-dysfunction rates to levels similar to those achieved with donation after brain death. In addition, it might substantially increase the donor pool, potentially saving many lives. 

Since death would be a chosen and inevitable outcome in these cases, enabling retrieval under ideal conditions represents a Pareto improvement: no one would be made worse off, and multiple lives might be saved.

They also stated their belief that death by organ donation "creates a rare opportunity to honor end-of-life autonomy, since patients can articulate their own goals, including how their death might serve others."

Zoom In:

Truog further expounded on this recommendation in an interview with NPR. "The problem is that under our current standards, doctors must not cause death in the process of procuring organs for transplant," he said (emphasis added).

He explained the process of death by organ donation: a suicidal patient would be placed under anesthesia, as they would with any other surgery; while unconscious, their organs would be removed, leaving them — in Truog's words — in "ideal" condition.

Johns Hopkins bioethicist Ruth Faden applauded Truog's idea, despite saying it was "creepy" at first.

"But, in fact, if you look at it critically in terms of the foundational ethics considerations, it is not as disturbing as it first appears," she said. "If we're committed to respecting the autonomy of individuals at the end of their life, and if they prefer to maximize the good that their body can do after they die, that's the ethical justification for death by donation."

Two other doctors, Lainie Ross and Lori Andrews, told NPR they remain staunchly opposed to the idea, noting that it would cause greater harm to organ donation, and that there is no true "consent" for "murder."

"This is asking surgeons to take a living person into the operating room and to come out with a dead person, which I think is murder," Ross said. "There are limits to consent, and one of the things we're not allowed to do is consent to saying that somebody else can just murder you, right?"

Andrews added:

You could be doing real damage to both the physician-assisted suicide system and the traditional organ donation system because it might give people the image that these are vultures that no longer wait until you die to attack. Yeah. It does give up visions of body snatching from, you know, prior centuries.

The Big Picture:

While as of now, death by organ donation is still not legal, victims of euthanasia and assisted suicide have begun to have their organs harvested afterwards.

In one instance, an Ontario man's organs were given to an American after he was euthanized. The 38-year-old victim had ALS (amyotrophic lateral sclerosis, or Lou Gehrig’s disease), and wanted to undergo Medical Aid in Dying (MAID). Seven minutes after being given the deadly injection, he was declared dead, and his organs were harvested. A 59-year-old man with congestive heart failure received the heart less than six hours later.

In another, an Australian woman underwent assisted suicide, and her organs were donated afterwards. This woman, who had a motor neuron disease, took a limousine to the hospital, and killed herself; she was immediately wheeled into the operating room, and her organs harvested.

Still another Australian woman with motor neuron disease donated her organs, though she had been euthanized.

While these stories may seem heartwarming — a terminally ill person who is choosing to die selflessly donates their organs — underneath the surface, the reality is far more disturbing.

Organ donation after assisted suicide perpetuates the idea that a suicidal person's life is not only not worth living, but that he or she is more valuable dead than alive. And yet, it is becoming increasingly common around the world.

A review of the program in Australia found that this system makes the coercion often associated with assisted suicide worse:

Some experts added that no information should be given on organ allocation, due to the risk that knowing how many people their organs could help will prevent the MAiD patient from feeling absolute freedom to change their mind right up until the last time they are asked whether they wish to proceed, just before sub-stance administration.

The idea is especially troubling in Canada, where many opt for MAiD due to financial hardship or an inability to access health care. MAiD is being promoted as a way to save money, with doctors openly pressuring patients to choose assisted suicide instead of treatment because it is cheaper. Reports of euthanasia being committed due to poverty, lack of adequate housing, a lack of disability-friendly housing, and more are already common; if valuable organs can be harvested as a result, then these vulnerable populations will undoubtedly be targeted even more.