Death, Dying, and Organ Transplantation: Reconstructing Medical Ethics at the End of Life

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Thus, mechanical support could not be considered life-sustaining, and the court ordered the hospital to discontinue physiologic support, with which the hospital complied, though by that time 2 months had passed since her initial admission. This case illustrates the conceptual oddity of the brain death concept, in that an allegedly biologically dead body — a corpse — can gestate a living fetus, along with the predictable confusion generated by this seemingly paradoxical circumstance.

Elijah Smith was a year-old man who was hit by a car while riding a bicycle on July 3, He suffered from a severe head injury and was declared dead by neurological criteria the following day, at Grant Medical Center in Ohio. When he was determined to be dead by neurologic criteria, Grant Medical Center notified Lifeline of Ohio, the local organ procurement organization, which took steps to begin the process of organ procurement. According to Mrs Smith, her son did not understand what he was agreeing to when he registered as an organ donor, and that, had he understood that organ removal takes place while on a ventilator and with a beating heart, he would not have registered as a donor.

According to the Columbus Dispatch, 99 , the Smith family wanted mechanical ventilation discontinued prior to organ removal. As this case illustrates, there is continued misunderstanding about the process of organ procurement after brain death, and this public misunderstanding can lead to confusion and, occasionally, conflict. Given the lack of information available on OPO websites, 87 and the use of mass media campaigns as advertisements rather than information sources, 88 it is unsurprising that Mrs Smith alleged that her son, like much of the general public, 86 did not have a reasonable understanding of the circumstances of organ procurement to allow an informed choice, particularly when he registered as an organ donor by checking a box at a motor vehicle agency.

Laws recognizing the determination of death by neurological criteria are well established in the USA and throughout much of the world, and it is unlikely that such laws will soon be displaced. The concept of brain death remains both settled and unsettled. The law and clinical practices in declaring death by neurological criteria are well established, and yet new controversies and challenges to both law and settled practice continue to surface.

These controversies have taken on a new urgency in recent years, 17 not only in academia, but also in the clinic, in the courtroom, and in the public arena. It remains to be seen whether the recently increased scrutiny and debate signals the beginning of a fundamental reassessment of settled laws and practices, or if it is simply another phase of the same muddling through that has prevailed for decades, where brain death is paradoxically both well settled and persistently unresolved.

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[Full text] Clinical and ethical perspectives on brain death | MB

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