WhiteCoat

Ghoulish or Good Policy?

I read this article and was going to put it in the next healthcare update, but decided to make it a separate post.

Immediate organ donation from the emergency department.

You’re involved in a serious car crash, the trauma team attempts to save you, but you end up dying. Instead of your body getting whisked off to the morgue, they take you to the operating room and harvest your organs.

Ethically, will doctors be doing their best to save patients, or will they be sizing up trauma victims to see which ones would make good organ donors? One ethicist in the article calls the concept “ghoulish.”

This is a tough call, but I lean more to the side of providing more organs.

That’s what I would want for someone else if I was the trauma victim.

35 Responses to “Ghoulish or Good Policy?”

  1. YokelRidesAgain says:

    The concern here is what this would do to the public perception of physicians and the organ donation process. It could, as Art Caplan implied, do more harm than good by leading people to question whether physicians had really tried everything in their power to save their loved one, thereby undermining trust in the medical system, etc., etc.

    In reality, I can’t imagine many physicians being more concerned about a patient on renal dialysis who can bloody well wait for an organ to become available or a patient with end-stage liver disease whose prognosis is worse than a young otherwise healthy trauma victim regardless of transplant than the patient in front of them.

    I personally favor the policy, as in several European countries, that the bodies of brain dead patients become the property of the state for appropriate distribution of organs unless there is evidence that the patient had a philosophical objection to donation in life (i.e., membership in a religious group that usually does not allow donation).

  2. Gert says:

    If we’re nothing more than pieces of meat, then there’s no reason not to do this.

    I think we’re more than that.

    I agree that on the surface it seems as though we should err on the side of saving life. I have nothing against organ donation. But how would you reallyl feel knowing that you have no say whatsoever in whether or not your organs are donated?

    Does my body belong to me? Yours to you? Or is it just so much protoplasm to be used up by the community?

    I know that many won’t agree with my point of view but I think that we are more than just random bits of protoplasm……so it does matter, how we treat ourselves, our bodies, and each other.

  3. As a prospective organ donor, I’m delighted with the idea that my organs will be harvested while still viable should I meet an unexpected violent end.

    Frankly, if I arrive in an ER (excuse me, ED) in sad enough shape that there is doubt that I /can/ survive the experience, odds are that if I did survive, what’s left wouldn’t be having a lot of fun.

    Since my driver’s license (and living will and durable power of attorney) all say “organ donor”, if I’m not going to make good use of my organs, find someone who will. If that reduces the chances that I’ll end up spending my final months (and dollars) hooked up to life support equipment, all the better.

    Look at my driver’s license and harvest away!

  4. NurseBeth says:

    Could we please encourage the use of “recovered” rather than “harvested” organs? As a former transplant coordinator, “harvest” is a word used by the lay people and media/hollywood to sensationalize the whole process. I don’t usually defer to the more “politically correct” term, but in this case, it definitely affects the public perception in cases like the one referenced above.

    • I usually avoid or mentally roll my eyes at the ever changing PC vernacular–however, NurseBeth, you make an excellent point. “Recovered” is a much better word and describes the process more accurately.

      That said, my family and boyfriend know to recover as many bits as possible for donation/medical science should I meet an early grave. (I think I freaked my boyfriend out after only dating for a few months and making those wishes very clear–my family lives on another continent so it had to be done!!)

    • WhiteCoat says:

      Hadn’t heard the term “recovered” before, but I agree.
      By the way, you *do* call it the emergency department, don’t you? ;-)

      • One of the reasons you might like Ireland, WhiteCoat!

        It’s an A & E department here…no one calls it the “ER”. :D

      • Felix Kasza says:

        “Recovered” implies that you had the organs in question in your possession, lost them, and now found them, O Happy Coincidence, in the corpse of the current trauma victim.

        In short, “recovering” organs means blatantly lying about it. What’s wrong with “harvesting” them? I am an organ donor, and I sure hope that they’ll check and harvest my organs should it come to that.

        Oh, and I see a massive conflict of interest if an organ harvesting team is on standby next to the A&E charting station. If the A&E physician or the trauma surgeon is expected to perform the harvest himself, I’ll try to kill him before he can help me into the better world that organ donors go to. Or have we all forgotten about the myriad sold body parts, including a few thousand corneas (in Israel and Germany, in independent scandals) and such?

        Aghastly yours,
        Felix Kasza.

  5. WarmSocks says:

    That’s what I would want for someone else if I was the trauma victim.

    I was involved in a freeway-speed car crash, and that is not what I would want. Had I been in worse shape, it would have been a crime to have been rushed off for organ harvest since I’m not eligible to donate. That would make things even harder on the survivors, knowing that (on top of the trauma) their loved-one’s final wishes had been violated, and all for naught.

    • WhiteCoat says:

      I don’t think that anyone should be compelled to donate their organs if they don’t want to do so. That wasn’t the point of the post.
      For those who do want to give a gift of life to someone else, I think that we should err on the side of obtaining more organs. Perhaps that becomes one of the decisions on a potential donor’s license – immediate donation requested.
      I agree with Tarl. I’d rather someone else have my organs than be kept alive by ventilators and medications that end up ruining the chance of recovering any of my organs.

  6. KT says:

    Personally, I think people should elect to NOT donate organs, rather than the other way around.

  7. Joe says:

    What? I thought that was already how it worked. No wonder we’ve got an organ shortage.

    The idea that a doctor would harvest my organs while there was still a reasonable chance of saving me is ludicrous. That’s just not what doctors do.

    I think the best way to increase the rate of donation is to give those willing to donate priority on the transplant list. (But I expect such a program would REALLY upset those who are unnerved by recovering organs from trauma cadavers.)

    • WhiteCoat says:

      I like that policy! A win-win proposal.

      • Katherine says:

        The problem with implementing this policy is ensuring that those who would be willing to donate their organs but who are ineligible are not put at the bottom of the list with those who are unwilling to donate.

  8. It states in the article no one would know the donor staus of the patient till after death which would seem to eliminate the perception of the ER “sizing” up candidates. As for the survivors being shocked that their family member’s orgons were recovered, if someone choses to sign the card, it’s their wishes and not the families. Many times on the floor, I see a patient’s very clearly written wishes not to have a feeding tube and the medical POA trumps it and has one placed because it’s makes the living uncomfortable not to do it. It seems that these choices are very personal and individual. Even if the family isn’t aware of their member’s decisions, the patient’s final wishes should be respected. It’s their body, their life and their death. And nobody else’s.

    • Gert says:

      midwest woman; I answered based on WC’s post and didn’t actually read the article until I read your comment. Of course, what’s wrong with medical care (one of the things) is that families are able to override proper medical decisions….this leads to all manner of futile ‘life-saving’ actions and accounts for so much money spent/wasted that could be used to help others. If someone comes in who has clearly chosen organ donation, I don’t have a problem with recovering their organs (do I need to clarify, not unless they are truly, actually, really gone?).

  9. Well, we ARE just pieces of meat. There are several problems with this proposal: the interference with the legal system and disruption of evidence from trauma–a tremendous amount of my work involves vehicular homicide, the fact that your body belongs not to you, (because you’re dead) but is the property of your next of kin, which makes your own wishes irrelevant. Finally, there’s the dirty little secret of compensation–everyone makes money on organ donation except the recipient and the donor. If something is “free”, whatever it is, it is valued less than something that is costly.

    • then signing the back of your driver’s liscence seems like an exercise in legal futility.

    • Leslie says:

      I don’t see any dirty little secret here…the recipient gets something better than money.

      And as for the doctors, nurses etc that do “make money”, would you expect them to work for free? Do you get paid to do whatever you do for a living? Do you do any volunteer work? And if so, does it require the skill that being a doctor or nurse does?

  10. PJ says:

    William is (largely) wrong about the legality of who owns the body for the purposes of organ donation. Under the Uniform Anatomical Gift Act, a gift made by the donor cannot be revoked by anyone else, and that gift survives the death of the donor.

    There have been several (<100, I believe) cases where families have challenged the validity of their loved one's anatomical gift decision. None of these have stood up in court. In some cases, because of the time-sensitive nature of donation, some donations have failed because hospitals and/or organ procurement agencies have not proceeded with donation based on the family's objection, but those groups place themselves at significant legal risk by *not* proceeding (how? if a transplant candidate can demonstrate that he would have received organs from a "failed" donor like this).

    Furthermore, no medico-legal death investigation has ever been compromised by organ donation. The National Association of Medical Examiners has come out in full support of donation, encouraging its members to allow donation of every organ, every time.

    All that being said, it will be interesting to see if this program is successful. As the reporter points out, a similar program was tried in DC in the late 1990s, with very little success.

    • You are incorrect. Organ donation is not entirely benign. I have had cases in my practice where prosecutions have been hindered because of organ donation, where bodies have been mutilated by organ harvesting and people’s funeral wishes have not been able to be fulfilled by organ donation. –different cases, true but sometimes you just have to say–the pathology was in the heart, and the heart is in another patent. I don’t know why your loved one died.

      • PJ says:

        Many different people have claimed this (donation hindering prosecution) has happened or could happen, but no one has ever been able to direct me to a published primary source. If you can, please do so.

      • As I have said, I witnessed several things including
        1. Pre-cadavers being taken out of one coroner’s jurisdiction to another county to evade/circumvent the first coroner’s authority
        2. Bodies being withheld from the families while the donation people got their acts together
        3. Bodies being damaged by the donation people
        4. Bodies where the cause of death was in the explanted organ.

        These occurred in two North East Ohio counties from 1999-2007. No, they were never written up in any journal article. I doubt that the custodian of the records in those jurisdictions will allow any reporting. Particularly in view of pending litigation, it depends on the outcome of the suits.

  11. Leslie says:

    I’m an organ donor and I am for it. If I have to die, I like to think that my death could have some meaning i.e. help give someone else life.

    That said, because I am taking Warfarin, would they accept my organs? I can’t donate blood…

  12. Canuck says:

    What about standardizing organ donation like some European countries? Quite a few state that unless you agree to be an organ donor yourself, then you cannot yourself benefit from an organ donor.

    I bet if people realized they needed to be willing to donate in order to be recipients then this idea of organs being recovered in the ER wouldn’t make so many people uncomfortable.

    • Katherine says:

      I replied to a similar post above before I got to yours. My response:
      The problem with implementing this policy is ensuring that those who would be willing to donate their organs but who are ineligible are not put at the bottom of the list with those who are unwilling to donate.

      Not permitting people to recieve an organ because they choose not to donate seems a little harsh to me though (even though I realise that putting non-donors at the bottom of the list is fundamentally the same).

      • Felix Kasza says:

        @Katherine — “Willing to donate” means having the “organ donor” box ticked on the driver’s licence. Ineligibility for medical reasons is then essentially a free pass (the harvesting team would have to reject the organs); ineligibility due to moral, philosophical, or religious concerns is the same as unwillingness.

        And I have no problem with reserving the benefits of organ donation primarily to those who are willing to keep the transplant mill going. The selfish ones can have the left-overs.

        Cheers,
        Felix.

      • Joe says:

        Why is that a problem? We merely ask, (a) “Are you willing to donate?”, and (b) “Is there any reason why your organs might be unsuitable?”.

        Everybody who answers “yes” to (a) goes to the front of the line. Problem solved.

        Upon our eventual deaths, doctors look at (b) and weed out any organs with cooties.

  13. Ian Random says:

    Simple if you are on medicaid and die, automatic donor.

  14. CrankyLitProf says:

    No one has addressed the religious concerns here.

    The first time an Orthodox Jew, or a Muslim, or a Jehovah’s Witness or a Christian Scientist has various organs sliced and diced, there will be a lawsuit.

    The .gov takes violations of religious freedom — such as the strict religious rules on burial and the handling of the body — seriously.

    Perhaps the sue-ee can petition for a replacement rectum after they’ve been sued out the ass?

    • Guiac says:

      Well that’s easy, per-se exemption for organs procured in good faith.

      • Guiac–fuggedaboudit. The folks in N.Y.C. pretty much have to determine the person they are going to autopsy is NOT an Orthodox Jew before they start to cut. That would not fly past the legislature.

      • Guiac says:

        Does that include homicides?

      • William the Coroner says:

        I’ve had Muslims and Orthodox Jews who refused permission for homicides. When we pointed out that this was a homicide and refusing made them the prime suspect, permission was granted rapidly.

  15. Don Salva says:

    I’m no doctor, nor do I have a very well tuned moral and ethic compass so I say: F–K THE ETHICS!

    If the organs can and will save somebody, I s–t on ethics! I know, I know but then I’d have to ditch Ethics altogether because I can’t just ignore Ethics when its convenient.

    Well, Convenience vs. Saved Life, ain’t a hard decision to make.

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