by Paul Byrne, MD
Vital distinctions in transplantation 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 all non-informed professionals. 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 and many physicians, clergy and legislators are continually misled.
To stop a ventilator to get organs for another person is clearly evil actions.
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 or organs. 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 and oneness 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. When patients declared "brain death" 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, “Now we 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 is 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 laboratory tests. Clearly there are many signs present in “brain dead” patients, including the 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. Imposed death in Greek is (epivalothanasia.) 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 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.
© Paul A. Byrne, M.D. 577 Bridgewater Drive Oregon, Ohio 43616 (419) 698-8844
I would like to share a story which seem apropos here. One night a number of years ago, my husband and I enjoyed the company of a man who spoke at our church. He told the congregation that five times he was declared dead, each time the doctors pleaded with his mother if she would please consider donating his heart and kidneys. Each time she told the doctors simply but firmly, "No! God told me my son is going to live."
Today, Harry Middleton is not so-called "brain dead" - Harry is very much alive, and one of the most charismatic people I've ever met. . However when his doctors were finally convinced he was going to live, doctors said his prognosis was not good. They said he had suffered serious brain injury and would probably have the mind of a six year old. He has a child like manner about him - like a very gentle, happy content child - but I am speaking of his 'manner' not his abilities. He proved doctors were very wrong about his prognosis, competency, and intellectual ability just as they were about his chances of survival. You don't give a drivers license to six year olds.
Harry's survival is certainly a miracle, especially after hearing the details of his accident. The 16 wheeler he was passenger in accidentally hit a guard rail and plunged over and down the overpass. Police report said the forty foot trailer crushed the cab "like a pancake." Harry was in the sleeper of the cab and is believed to have been thrown to the floor, which no doubt spared his life. Harry's life would be forever changed, because he had simply volunteered to go along for the ride just to keep his friend company. His friend arrived at the hospital and was pronounced DOA. Jaws of life saved Harry, but it took hours to do so. He remained in a coma for 6 months.
To hear him speak you would think you are listening to Billy Graham as their voices are so similar, only Harry's sounds a bit more Southern. He told us he lost a great deal of his memory. After he had 'come back', the second time, he asked his mother "where is daddy" and why hadn't he come with her to visit him. She said "Harry, don't you remember, we lost your father 2 years ago." Three more times Harry would be declared dead, but would 'come back again. Three more times he would have to mourn the death of his father as if it were the first time.
Due to the severity of his brain
injuries, most of Harry's memory and what had happened to him before the
accident was erased. He had to relearn how to do the simplest things as well as
relearn words. After he was stronger, he became a "Ambassador for Christ." He
said he just went where the Holy Spirit would take him. After he gave his
talk, we asked him if he would join us for a home cooked meal, and he graciously
The memory of that evening still lingers with us. We thoroughly enjoyed his quick wit, and stories of his new adventures. However, we soon observed he had a quirky little habit of calling people a jerk! Never did we sense he was being disrespectful - it was a peculiar appellation that only the ones he was really fond of, would overtly be christened jerk. For instance, he would tell us how a friend had helped him with this or that, and then he would add, "he is such a jerk. "After I served the dessert he thanked us for the good old fashioned home cooking which he said was such a treat. Then he smiled and in his wonderful southern drawl said, "You are a jerk." I, not one to be out witted - winked and said, "Harry, you can't call me a jerk, I am female!" Without missing a beat, he winked back and said, "I see! Of course, you are so right - you're a Jerk-ess!"
I love to tell that story in person, just to see peoples reaction. Harry is one of those people you can not help but love. We did have our serious moments, I being a anti-euthanasia activist wondered how he felt about doctors wanting his organs. There was no doubt his mother was pressured to seriously consider donating his viable organs, but he said each time she was steadfast, telling them her son was going to live, so therefore, he would be needing every organ God gave him. How many sons or daughters might have survived had they been given the chance to recover but someone agreed to let them have the organs .. without ever knowing it might have ended differently.
I realize there are countless heart wrenching stories which some claim have incredibly happy endings all because someone who needed a new heart, became the recipient of a heart donation. I can not rejoice for that person, whether it be a child or adult. It is just not my personal belief. I have made a decision in life, and agree with Dr Byrne that "Every time a heart is taken for transplant, it is a beating heart that is stopped by the surgeon just prior to excision." Death was hastened for one person, so that another could live.
I know Harry is very grateful to his mother for
believing and trusting our Creator, rather than trusting the doctors who on five
separate occasions told her "we are sorry, it's hopeless."
Harry Middleton has a most wonderful warm loving heart, and I am so grateful his heart remains exactly where God intended it to remain.
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