Ambiguity, death determination, and the dead donor rule

2018 ◽  
Vol 13 (4) ◽  
pp. 165-171
Author(s):  
Will Lyon
Keyword(s):  
Brain Death ◽  
Organ Transplant ◽  
Organ Donors ◽  
Guiding Principle ◽  
Definition Of Death ◽  
Dead Donor Rule ◽  
Transplant Ethics ◽  
The Dead ◽  
Definition Of ◽  
Death Determination

The dead donor rule states that organ donors must be declared dead before any vital organs are removed. Recently, scholars and physicians have argued for the abandonment of the dead donor rule, based on the rule’s supposed connection with the concept of brain death, which they view as a conceptually unreliable definition of death. In this essay, I distinguish between methods of death determination and the question of whether or not the dead donor rule should be a guiding principle of organ transplant ethics. In principle, the dead donor rule does not rely on any one definition of death, but only prohibits the taking of vital organs before a patient is declared dead. In light of this distinction, I argue that even if the dead donor rule is tied to brain death in practice, conceptual disagreement about brain death does not provide grounds for rejection of this rule. I then present evidence in support of the consistency and reliability of the diagnosis of brain death. I show that, when performed carefully and under specific clinical circumstances, the diagnosis of brain death is considered by most neurologists to be reliable. Finally, I argue that, without the dead donor rule, organ transplantation programs would become susceptible to violations of the ethical principle of respect for persons.

Organismal death, the dead-donor rule and the ethics of vital organ procurement

2018 ◽  
Vol 44 (12) ◽  
pp. 868-871 ◽  
Author(s):  
Xavier Symons ◽  
Reginald Mary Chua
Keyword(s):  
Organ Procurement ◽  
Vital Organ ◽  
Definition Of Death ◽  
Dead Donor Rule ◽  
Total Brain ◽  
Brain Failure ◽  
The Dead ◽  
Definition Of ◽  
Donor Criteria ◽  
Human Death

Several bioethicists have recently discussed the complexity of defining human death, and considered in particular how our definition of death affects our understanding of the ethics of vital organ procurement. In this brief paper, we challenge the mainstream medical definition of human death—namely, that death is equivalent to total brain failure—and argue with Nair-Collins and Miller that integrated biological functions can continue even after total brain failure has occurred. We discuss the implications of Nair-Collins and Miller’s argument and suggest that it may be necessary to look for alternative biological markers that reliably indicate the death of a human being. We reject the suggestion that we should abandon the dead-donor criteria for organ donation. Rather than weaken the ethical standards for vital organ procurement, it may be necessary to make them more demanding. The aim of this paper is not to justify the dead donor rule. Rather, we aim to explore the perspective of those who agree with critiques of the whole brain and cardiopulmonary definitions of death but yet disagree with the proposal that we should abandon the dead-donor rule. We will consider what those who want to retain the dead-donor rule must argue in light of Nair-Collins and Miller’s critique.

scholarly journals In defense of a pluralistic policy on the determination of death

2018 ◽  
Vol 8 (3-4) ◽  
pp. 179-188 ◽  
Author(s):  
Vilius Dranseika ◽  
Ivars Neiders
Keyword(s):  
Organ Transplantation ◽  
Peter Singer ◽  
Definition Of Death ◽  
Sanctity Of Life ◽  
Dead Donor Rule ◽  
Reasonable Range ◽  
Definition Of ◽  
Death Determination ◽  
Two Alternatives

Abstract In his paper “The challenge of brain death for the sanctity of life ethic”, Peter Singer advocates two options for dealing with death criteria in a way that is compatible with efficient organ transplantation policy. He suggests that we should either (a) redefine death as cortical death or (b) go back to the old cardiopulmonary criterion and scrap the Dead Donor Rule. We welcome Singer’s line of argument but raise some concerns about the practicability of the two alternatives advocated by him. We propose adding a third alternative that also – as the two previous alternatives – preserves and extends the possibility of organ transplantation without using anyone without their consent. Namely, we would like to draw readers’ attention to a proposal by Robert Veatch, formulated 42 years ago in his 1976 book “Death, dying, and the biological revolution” and developed further in his later publications. Veatch argues for a conscience clause for the definition of death that would permit people to pick from a reasonable range of definitional options. This autonomy-based option, we believe, is more likely to be practicable than the two options advocated by Singer. Furthermore, we present data from a study with Lithuanian participants that suggest that there is quite pronounced variation of preferences concerning death determination.

Ethics of Liver Transplantation: The Role of the Anesthesiologist

2018 ◽  
Vol 22 (2) ◽  
pp. 229-236 ◽  
Author(s):  
James M. West
Keyword(s):  
Liver Transplantation ◽  
Organ Transplant ◽  
Donation After Circulatory Death ◽  
Donor Liver Transplantation ◽  
Definition Of Death ◽  
Life Saving ◽  
History Of ◽  
Definition Of ◽  
Related Liver Disease ◽  
Circulatory Death

Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death. As perioperative physicians and important members of the transplant team, anesthesiologists are expected to participate in all aspects of care including ethical judgments. This article discusses some of the issues that seem to cause the most confusion and angst for those of us involved in both liver transplantation and in the procurement of organs. It will discuss the definition of death, donation after circulatory death, the anesthesiologists’ role on the selection committee, living donor liver transplantation, and transplantation of patients with alcohol-related liver disease.

scholarly journals Practice Current: When do you order ancillary tests to determine brain death?

2018 ◽  
Vol 8 (3) ◽  
pp. 266-274 ◽  
Author(s):  
Nathaniel M. Robbins ◽  
James L. Bernat
Keyword(s):  
Brain Death ◽  
Clinical Examination ◽  
Online Survey ◽  
Mechanism Of Injury ◽  
Preliminary Results ◽  
Definition Of Death ◽  
Primary Mechanism ◽  
Brainstem Injury ◽  
Definition Of ◽  
Case Based

Brain death has been accepted as a legal definition of death in most countries, but practices for determining brain death vary widely. One source of variation is in the use of ancillary tests to assist in the diagnosis of brain death. Through case-based discussions with 3 experts from 3 continents, this article discusses selected aspects of brain death, with a focus on the use of ancillary tests. In particular, we explore the following questions: Are ancillary tests necessary, or is the clinical examination sufficient? What ancillary tests are preferred, and under which circumstances? Are ancillary tests required when the primary mechanism of injury is brainstem injury? Should the family's wishes play a role in the need for ancillary tests? The same case-based questions were posed to the rest of our readership in an online survey, the preliminary results of which are also presented.

scholarly journals Unpacking Robert Spaemann’s Philosophical Contribution to the Brain Death Debate

2019 ◽  
Vol 86 (4) ◽  
pp. 381-393
Author(s):  
Elinor Gardner
Keyword(s):  
Brain Death ◽  
Life And Death ◽  
Definition Of Death ◽  
Ordinary Person ◽  
Definition Of ◽  
Philosophical Contribution ◽  
Sole Criterion ◽  
The Brain ◽  
Philosophical Questions ◽  
Living Being

Questions of life and death are primarily philosophical questions, as philosopher Robert Spaemann argues. Spaemann argues that “brain death” is philosophically unsatisfactory as a definition of death, and as the exclusive criterion for determining death, for two main reasons: first, because it attempts to annul the basic perceptions of the ordinary person in regard to death. Second, because the cause of life and unity in a living being cannot be reduced to the brain. This essay is an explication of Spaemann’s contribution to the “brain death” question, which consists in illuminating the philosophical issues at stake. Summary: This article presents Robert Spaemann’s philosophical case that “brain death” suffices neither as a definition of death nor as the sole criterion of death.

scholarly journals Por que o conceito de morte cerebral é válido como uma definição de morte: declaração de neurologistas e outros

2013 ◽  
pp. 225
Author(s):  
Cleiton Viana da Silva
Keyword(s):  
Brain Death ◽  
Definition Of Death ◽  
Definition Of ◽  
Academy Of Sciences

Why the concept of Brain Death is Valid as a Definition of Death. Statement by Neurologists and Others: THE PONTIFICAL ACADEMY OF SCIENCES. Excerpt of Scripta Varia 110, 2008.

scholarly journals Does It Matter How We Die? Ethical and Legal Issues Raised by Combining Euthanasia and Organ Transplantation

2019 ◽  
Vol 86 (4) ◽  
pp. 359-365 ◽  
Author(s):  
Margaret Somerville
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Human Dignity ◽  
Healthcare Professionals ◽  
Conflicts Of Interest ◽  
Human Life ◽  
Definition Of Death ◽  
Dead Donor Rule ◽  
Ethical And Legal Issues ◽  
Definition Of

If, in jurisdictions with legalized euthanasia, obtaining organs for transplant from euthanized people is allowed, must their organs be taken only after death or should euthanasia be allowed to be performed by removal of vital organs? Asked another way, if “Donation after Death” is practiced, why not “Death by Donation?” The article addresses two questions. First, “What issues does connecting euthanasia and organ donation raise?” They include dealing with uncertainty regarding the definition of death, defining what constitutes conscientiously objecting healthcare professionals' involvement in euthanasia, and whether connecting euthanasia and transplantation makes conflicts of interest for healthcare professionals unavoidable. Additional issues raised by death by donation include breach of the “dead-donor rule”; what would constitute informed consent to it; and what impact its acceptance would have on important foundational societal values, especially respect for human dignity and human life. The second question is “Why might some people who agree with euthanasia and even organ donation after death by euthanasia find death by donation ethically unacceptable?” Considerations again include its harmful impact on upholding respect for human dignity and human life and that the “wisdom of repugnance” could be informing these people's reaction. It is concluded that in order to avoid serious breaches of ethics, organ transplantation and euthanasia should not be linked in any way.

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