Vital distinctions in transplantation (used
Vital distinctions in transplantation
July 9, 2007
Paul A. Byrne, M.D.
Organ and tissue donation can be divided into four general categories:
(1) A living person can give nonvital organs and tissues to another person
without causing death, severe injury, or disabling mutilation to self. For
example, one might give one of two kidneys, or bone marrow.
(2) Tissues including corneas, heart valves, bones, skin, ligaments and tendons
can be taken after death--that is, after the heart is no longer
beating and there is destruction of the vital systems, including circulatory,
respiratory, and central nervous systems.
(3) Vital organs, such as the heart, liver, lungs, pancreas, and intestine, are
harvested from persons declared "brain dead." Such persons are beating-heart
"donors." Calling such living persons "Heart Beating Cadaver Donors" misleads
the public and even members of the medical community. Can a cadaver have a
beating heart and circulation?
(4) Organs are taken from "non-heart-beating donors (NHBD)." A NHBD is a living
person with normal vital signs and a brain that is functioning. These persons
are first taken off all life support, including the ventilator. When the pulse
is no longer palpated, the organs are taken. After the organs are taken, the
patient is dead. The public are continually misled. To stop a ventilator to get
organs for another person is clearly an evil action.
The first two categories encompass organ and tissue donation that may constitute
charitable acts, even commendable gifts of life. The latter, however, constitute
a form of epivalothanasia ("imposed death") in which the "gift of life" is the
immoral taking of the life of the "donor" through the excision of a vital organ
Note that organs are taken after a declaration of "brain death"--not
after factual, true death, which is the end of natural life. The person from
whom a beating heart is taken could well have been a person not very different
from you and me. Most likely, he or she was able to walk and talk, but then
something happened--possibly, brain injury from an accident, a
stroke, or decreased oxygen to the brain. Now he or she is in an intensive care
unit (ICU) and a ventilator is assisting breathing.
The ventilator--commonly mislabeled a "respirator"--is
a machine that moves air into the lungs. It can be effective only if there are
functioning respiratory and circulatory systems to add oxygen to the blood and
carry the blood to and from the tissues of the body. The heart is beating; there
is normal blood pressure. Intact internal organs and systems maintain the unity
of the body. When a light is shined into the eye, the pupil response is not
seen. When ice water is put into the ear, there is no response. No cough or gag
would be observed. Other brain stem reflexes might be evaluated. A neurologist
makes a declaration of "brain death" using one of many different sets of
criteria. The neurologist or hospital can use any of these divergent sets.
Thus, a person could be declared "brain dead" if one set is used, but not be
declared "brain dead" if another set was employed.
Every set of criteria for "brain death" includes an apnea test. ("Apnea" means
the absence of breathing.) This test, which has no benefit for the comatose
patient and, in fact, aggravates the patient's condition, is done without the
knowledge or consent of family members. The apnea test, during which the
ventilator is turned off for up to 10 minutes, can induce "brain death"
or cardiac arrest. Its sole purpose is to determine the patient's inability to
breathe on his own in order to declare "brain death."
When patients declared "brain dead" are treated, instead of having their beating
hearts cut out, they can continue to live. Pregnant women have given birth
months after having been declared "brain dead." Thus, the editor of the
Journal of the American Medical Association wrote,
are told a brain dead patient can nurture a child in the womb, which permits
live birth several weeks "post-mortem." Perhaps this is the straw that
breaks the conceptual camel's back. Death of the brain seems not to serve as
a boundary; it is a tragic ultimately fatal loss, but not death itself.
In the case of transplantation, after "brain death" has been declared, the
ventilator and other life support are continued until it is convenient to
harvest the "donor's" organs. Everyone present can witness the intact
circulatory system via the beeping of the heart monitor and the visual display
of the signals from the beating heart, as well as the recordable blood pressure.
The intact respiratory system is manifest through the normal color of the skin.
The exchange of oxygen and carbon dioxide can be verified by determining blood
gasses (pH, pCO2, and pO2). The intact interdependence of circulatory and
respiratory systems can be readily observed by applying pressure to the skin,
resulting in blanching, which will be followed by return of normal color within
a few seconds after removal of the pressure. Through more sophisticated means,
an intact endocrine system (pituitary, thyroid, and adrenal hormone production)
can be demonstrated. An intact functioning liver can be documented through
Clearly, there are many signs present in "brain dead" patients, including vital
signs that physicians and laymen are accustomed to associate with being alive.
After the beating heart is excised, however, findings more commonly identified
with the fact of death--that is, no circulation or breathing--can
be observed. Deprived of organs needed to sustain life, the "donor" will be
cold, blue, pale, and stiff--in short, dead.
Are we not being asked to accept two medically distinguishable situations
as legally equivalent? To say that a patient with a beating heart, normal
pulse, normal blood pressure, normal color, and normal temperature is "dead" is
a lie. The force of law will not make it true.
Great care must be taken not to declare a person dead even one moment before
death has occurred. Death should be declared only after, not before,
the fact. To declare death prematurely is to commit a fundamental injustice. A
person is living even a moment before death and must be treated as such. Every
time a heart is taken for transplant, it is a beating heart that is stopped by
the surgeon just prior to excision. It takes about an hour of surgery to remove
the heart. During this time, it is common for the so-called "donor" to be given
a paralyzing drug, but not an anesthetic. It has been reported that when the
incision is made to take the organs, there is an increase in heart rate and
blood pressure. Could this occur if the person were dead? The answer is no. A
doctor or other medical personnel must never impose death on a patient.
It is easy to move one's emotions with images of organ recipients resuming
"normal lives" after they have received a heart, but what about the life of the
donor? Was the donor in fact dead? If there is any doubt about the fact of
death, may one rightfully carry out an action that will impose death on another?
Who sheds tears for the victims of utilitarian euthanasia?
It is wrong to impose death on an innocent human being and to participate in its
imposition. Likewise, we should not encourage others to participate in organ
transplantation unless all doubts about death have been removed. Everyone
getting a driver's license ought to be informed of the truth about "brain death"
and organ transplantation before answering the question "Do you want to be an
organ donor?" After all, your life may well depend on your answer.
Dr. Paul A. Byrne, a Neonatologist, is Director of Neonatology and Director
of Pediatrics at St. Charles Mercy Hospital in Oregon, Ohio, is Clinical
Professor of Pediatrics University of Toledo College of Medicine, Board
Certified in Pediatrics and Neonatal-Perinatal Medicine, Member of Fellowship of
Dr. Byrne is past-President of the Catholic Medical Association (USA), formerly
Clinical Professor of Pediatrics at Creighton University School of Medicine in
Omaha, NE, and at St. Louis University School of Medicine in St. Louis, MO. He
is author and producer of the film "Continuum of Life" and author of the books
"Life, Life Support and Death," "Beyond Brain Death," and "Brain Death Is Not
Dr. Byrne has presented testimony on "life issues" to eight state legislatures
beginning in 1967. He opposed Dr. Kevorkian on the television program
"Cross-Fire." He has been interviewed on Good Morning America, public television
in Japan and participated in the British Broadcasting Corporation Documentary
"Are the Donors Really Dead?" Dr. Byrne has authored articles against
euthanasia, abortion, and "brain death" in medical journals, law literature and
Paul was married to Shirley for forty-eight years until she entered her eternal
reward on Christmas 2005. They are the proud parents of twelve children and
grandparents of twenty-six grandchildren.
distinctions in transplantation
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