scholarly journals Acts that Kill and Acts that Do Not

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Cheng-Chih Tsai
Keyword(s):  
Waiting Time ◽  
Philosophy Of Language ◽  
Organ Procurement ◽  
Truth Condition ◽  
Definite Description ◽  
Vital Organ ◽  
Determination Of Death ◽  
Dead Donor Rule ◽  
Reduction Problem

In response to recent debates on the need to abandon the Dead Donor Rule (DDR) to facilitate vital-organ transplantation, I claim that, through a detailed philosophical analysis of the Uniform Determination of Death Act (UDDA) and the DDR, some acts that seem to violate DDR in fact do not, thus DDR can be upheld. The paper consists of two parts. First, standard apparatuses of the philosophy of language, such as sense, referent, truth condition, and definite description are employed to show that there exists an internally consistent and coherent interpretation of UDDA which resolves the Reduction Problem and the Ambiguity Problem that allegedly threaten the UDDA framework, and as a corollary, the practice of Donation after the Circulatory Determination of Death (DCDD) does not violate DDR. Second, an interpretation of the DDR, termed ‘No Hastening Death Rule’ (NHDR), is formulated so that, given that autonomy and non-maleficence principles are observed, the waiting time for organ procurement can be further shortened without DDR being violated.

Difficulties of Determining Death

2020 ◽  
pp. 155-176
Author(s):  
James F. Childress
Keyword(s):  
Organ Donation ◽  
Vital Organ ◽  
Determination Of Death ◽  
Life And Death ◽  
Ethical Implications ◽  
Legal Fiction ◽  
Dead Donor Rule ◽  
Deceased Organ Donation ◽  
The Dead

This chapter considers what we should do with the “dead donor rule” in transplantation in light of controversies about different ways of determining death. The system of voluntary deceased organ donation depends on public trust, based in part on adherence to the “Dead Donor Rule” (DDR). However, this rule presupposes that the line between life and death can be reliably drawn for purposes of removing vital organs for transplantation. Different but serious conceptual, scientific, and ethical questions surround deceased donation after neurological determination of death and after circulatory determination of death in either controlled or uncontrolled forms. This chapter examines the ethical implications of different approaches to the DDR and asks which public policy should be adopted: (1) abandon the DDR and move to living vital organ donation; (2) retain the DDR but view the determination of death as a legal fiction; (3) retain the DDR but expand individual/familial choices of conceptions of and criteria for determining death; or (4) retain and strengthen the DDR and ethically improve its operation. This chapter argues for the fourth option and for improving the process of individual and familial informed consent to deceased organ donation.

Non-Heart-Beating Organ Donation: A Defense of the Required Determination of Death

1999 ◽  
Vol 27 (2) ◽  
pp. 126-136 ◽  
Author(s):  
James M. DuBois
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Function ◽  
Medical Treatment ◽  
Organ Donation ◽  
Organ Procurement ◽  
Determination Of Death ◽  
Heart Beating ◽  
The Family ◽  
Transplant Team

The family of a patient who is unconscious and respirator-dependent has made a decision to discontinue medical treatment. The patient had signed a donor card. The family wants to respect this decision, and agrees to non-heart-beating organ donation. Consequently, as the patient is weaned from the ventilator, he is prepped for organ explantation. Two minutes after the patient goes into cardiac arrest, he is declared dead and the transplant team arrives to begin organ procurement. At the time retrieval begins, it is not certain that the patient's brain is dead or that cardiac function cannot be restored. Procurement follows uneventfully, and two transplantable kidneys are retrieved.Many people now consider such cases of non-heart-beating organ donation to be ethically permissible. However, widespread disagreement persists as to how such practices are to be justified and whether such practices are compatible with the Uniform Declaration of Death Act (UDDA). In this paper, I argue that non-heart-beating organ donation can be ethically justified, that in the justified cases the patients are in fact dead, and that the early declarations of death required for such donation do comply with the UDDA.

scholarly journals Organ Procurement Organization Survey of Practices and Beliefs Regarding Prerecovery Percutaneous Liver Biopsy in Donation After Neurologic Determination of Death

2017 ◽  
Vol 101 (4) ◽  
pp. 821-825 ◽  
Author(s):  
Joseph Benton Oliver ◽  
Andrea Fleisch Marcus ◽  
Mark Paster ◽  
Joseph Nespral ◽  
Advaith Bongu ◽  
...  
Keyword(s):  
Liver Biopsy ◽  
Organ Procurement ◽  
Determination Of Death ◽  
Percutaneous Liver Biopsy ◽  
Organ Procurement Organization

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 Thoracic Organ Procurement during Multi-Organ Retrieval

2021 ◽  
Author(s):  
Suresh Keshavamurthy ◽  
Vipin Dulam ◽  
Eros Leotta ◽  
Mohammed A. Kashem ◽  
Yoshiya Toyoda
Keyword(s):  
Brain Death ◽  
Organ Procurement ◽  
Determination Of Death ◽  
En Bloc ◽  
Arterial Revascularization ◽  
Organ Retrieval ◽  
Donation After Brain Death ◽  
Donor Shortage ◽  
Thoracic Organ

Procurement of thoracic organs can be divided into two major categories- donation after brain death (DBD) or donation after circulatory determination of death (DCDD). In this section we will focus primarily on DBD, which is the commoner of these two or at times referred to as standard procurement. DCDD is a relatively new and promising field that has helped ameliorate donor shortage, aided by the latest advances in medical technology. However, DBD continues to be the major avenue of organ donation. There are several different combinations of thoracic procurement surgeries: heart, double lung, single lung/ 2-single lungs, heart-lung en bloc for transplantation, Double Lung procurement for Bronchial arterial revascularization, Heart and Lung procurement in DCDD donors with the OCS, NRP or Lungs for EVLP.

Determination of Death in Execution by Lethal Injection in China

2018 ◽  
Vol 27 (3) ◽  
pp. 459-466
Author(s):  
NORBERT W. PAUL ◽  
ARTHUR CAPLAN ◽  
MICHAEL E. SHAPIRO ◽  
CHARL ELS ◽  
KIRK C. ALLISON ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Medical Science ◽  
The United States ◽  
Determination Of Death ◽  
Brain Functions ◽  
Common Criteria ◽  
Level Data ◽  
Postmortem Blood ◽  
Lethal Injection

Abstract:Since 1997, execution in China has been increasingly performed by lethal injection. The current criteria for determination of death for execution by lethal injection (cessation of heartbeat, cessation of respiration, and dilated pupils) neither conform to current medical science nor to any standard of medical ethics. In practice, death is pronounced in China within tens of seconds after starting the lethal injection. At this stage, however, neither the common criteria for cardiopulmonary death (irreversible cessation of heartbeat and breathing) nor that of brain death (irreversible cessation of brain functions) have been met. To declare a still-living person dead is incompatible with human dignity, regardless of the processes following death pronouncement. This ethical concern is further aggravated if organs are procured from the prisoners. Analysis of postmortem blood thiopental level data from the United States indicates that thiopental, as used, may not provide sufficient surgical anesthesia. The dose of thiopental used in China is kept secret. It cannot be excluded that some of the organ explantation surgeries on prisoners subjected to lethal injection are performed under insufficient anesthesia in China. In such cases, the inmate may potentially experience asphyxiation and pain. Yet this can be easily overlooked by the medical professionals performing the explantation surgery because pancuronium prevents muscle responses to pain, resulting in an extremely inhumane situation. We call for an immediate revision of the death determination criteria in execution by lethal injection in China. Biological death must be ensured before death pronouncement, regardless of whether organ procurement is involved or not.

scholarly journals Controversy in the Determination of Death: The Definition and Moment of Death

2019 ◽  
Vol 86 (4) ◽  
pp. 366-380
Author(s):  
Frederick J. White
Keyword(s):  
Organ Transplantation ◽  
Deceased Donor ◽  
Determination Of Death ◽  
Bodily Integrity ◽  
Donor Organ ◽  
Definition Of Death ◽  
Dead Donor Rule ◽  
The Moment ◽  
Definition Of

This essay reviews recent controversy in the determination of death, with particular attention to the definition and moment of death. Definitions of death have evolved from the intuitive to the pathophysiologic and the medicolegal. Many United States jurisdictions have codified the definition of death relying on guidance from the Uniform Determination of Death Act (UDDA). Flaws in the structure of the UDDA have led to misunderstanding of the physiologic nature of death and methods for the determination of death, resulting in a bifurcated concept of death as either circulatory/respiratory or neurologic. The practice of organ donation after circulatory determination of death (DCDD) raises a number of ethical questions, most prominently revolving around the moment of death and manifested as an expedited time to determination of death, a departure from the unitary concept of death, a violation of the dead donor rule, and a challenge to the standard of irreversibility. Attempts to redefine the determination of death from an irreversibility standard to a permanence standard have significant impact on the social contract upon which deceased donor organ transplantation rests, and must entail broad societal examination. The determination of death is best reached by a clear, strict, and uniform irreversibility standard. In deceased donor organ transplantation, the interests of the donor as a person are paramount, and no interest of organ recipients or of the greater society can justify negation of the rights and bodily integrity of the person who is a donor, nor conversion of the altruism of giving into the calculus of taking.

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