Brain Death Organ Transplant 10-15-2008

3 R’s: Rights Rulings Responsibilities

Joseph – 1975

Joseph – 1982

Joseph, Mrs. and children – 2004

Denny

Declaration of Independence July 4, 1776  People. . .the separate and equal station to

which the laws of Nature and Nature’s God entitles them.  These truths are self-evident, that all men are created equally. . .endowed with certain unalienable Rights. . .Life, Liberty and the Pursuit of Happiness

TRUTH ARMOR

EPHESIANS 6: 10-17

JUSTICE

Relationship Special and unique between God and every human person

GOD

♀

One and another

♂

Physician/Patient Relationship Standard of Intrinsic Worth

Protect Life Preserve Life Postpone Death

Living Human Person Life is a reality, a gift, a continuum from its conception to its natural end.  Life is in each cell, tissue, organ and system.  11 systems; 3 major vital systems.  Interdependence of organs and systems to maintain unity. No one organ or system that controls all other organs and systems.  Life is manifest. 

Human Person  God creates the person.  Soul, intellect, and will are con-created.  Conception -

person is manifest.  Unique, unrepeatable, unity of soul and body.

Life on Earth Conception Birth Natural End DEAD

Dead Death is a negative; an absence.  State of the body without life.  In the remains: dissolution, destruction, disintegration and putrefaction; includes not functioning, but more than not functioning.  What is left on earth is a dead body, a corpse, the remains, empty. 

Dead Cold  Stiff  Unresponsive to all stimuli  Not breathing; ventilation does not and will not restore respiration  No heartbeat, pulse, B.P  Poor color – nails/mucous membranes  Not moving  Cessation of vital body functions 

History: Modern Culture of Death         

1954 First kidney transplant 1967 “First” heart transplant: South Africa 1967 “Second,” 3 days later, Brooklyn USA 1968 First article in JAMA on “brain death” 1970 First statute on “brain death” (Kansas) 1970 UAGA, 1972 PVS, 1973 Roe v Wade 1976 Karen Ann Quinlan 1980 UDDA, 1990 PSDA 1987 and 2006 Revised UAGA

Organ and Tissue Transplantation  Tissues from truly dead: skin, bones,

corneas, veins, heart valves and connective tissues. No rejection! Organs from not truly dead, but from persons declared “brain dead” (DBD).  Heart, lungs, kidneys, liver, pancreas, intestines, etc.  Organs from persons declared cardiac dead (DCD) 

Revised UAGA 2006 Presumed intent/consent.  “Sound mind” no longer required.  Lacks full and explicit informed consent.  Procedures and drugs to patients who are alive.  Trumps advance directive, resuscitate!  Technicians can remove organs.  Communicating in any manner is “intends.”  Revocation does not invalidate; not a refusal.  Children, 16, 15 ½, or 14 can donate. 

“brain death” to “heart death” 1968 Harvard Criteria. DBD.  24 hours to 12, 6, 3, 1, 30-60 seconds.  1978, 30 sets criteria, now many more.  UDDA, either 1) or 2), or both.  DCD; get DNR, off life support, no pulse (NOT NO HEART BEAT!) for 5, 2, 1.25 minutes (75 seconds). 

Living Person with injury to his/her brain 



Physician/Patient Relationship  Only a living person can be a patient.  When he is a patient, he is living. Standard of intrinsic worth.  Physician can protect life, preserve life, and postpone death.  Physician must not kill, must not do harm, and must not hasten death.

A Person is Alive Until Dead  Unconscious person in ICU on ventilator

with absence of some tested brain functioning, but many other signs of life, is living. Protect and preserve the life.  “Brain death” was devised to get organs.

Responses and movements in “brain dead” patient Spontaneous jerks of limbs.  Muscle tone.  Arm crossing over the chest and sitting up.  Response to surgical incisions when organs are taken without anesthesia or paralysis.  “Brain dead” patients are given paralysis without anesthesia to take away protests and objections of medical personnel about “brain dead” not being truly dead. 

“Brain Dead” Patient Ventilator moves air.  Exchange of oxygen and carbon dioxide occurs in the lungs.  Circulation via heart and blood vessels to all tissues and cells.  Many other organs and systems are intact, including liver and kidneys. 

“Brain dead” mother  Treatment continued.  Days, weeks, and months later, delivery of

a normal healthy baby. Prolactin: Breast milk production.  It is only a living mother who can support the life of a baby within the womb.

Comparison of living persons, “brain dead” patients and truly dead Living Persons Heart beating Well perfused Warm Respiration Functioning vital organs (liver, kidneys, etc) Growth Healing

“Brain dead”

Dead

Yes Yes Yes Yes Yes

No No No No No

Yes Yes

No No

Apnea Test – Mandatory!  Patient on ventilator.  Ventilator is stopped for up to 10 minutes.  Oxygen is added to prevent low oxygen in

the patient. But low blood oxygen stimulates breathing!  Increase in carbon dioxide (CO2) causes brain swelling.

Apnea Test  Patient must prove he can breathe without

ventilator, or this is signal to first stop, then cut out beating heart.  Test itself could cause further damage to already compromised brain!  Apnea test: not a predictor, but lethal!  Relatives must instruct: no, no Apnea Test.

Apnea test in declaration of “brain death” 

No benefit to patient! And risk of:  Complications during apnea testing: Severe drop in BP 24% - 39%. Cardiac arrhythmia. True death. Without apnea testing, 60-70% might recover.

“Performed in an ethically acceptable manner” refers to the Natural Moral Law:

1.) 2.)

Good ought to be done, evil must be avoided; Evil may not be done that good might come of it.

Organ Transplantation  “Ethically acceptable” cannot include:

Causing “death or debilitating mutilation” (weakening, decreased function);  Moving, grimacing and squirming;  Increase in donor’s heart rate and blood pressure. 

Consent: Fully Implicit & Explicit  Consent

or decline in a free and conscientious manner.  Everyone must be properly informed.

Legal Killing of Vulnerable Persons 

Donors must be alive enough to supply a healthy vital organ but legally can remove a healthy vital organ, which causes death of the donor. But remember: The patient is alive until true death!

World Day of the Sick (Pope John Paul II, 2-4-03)  “It remains a fundamental precept that life is

to be protected and defended, from its conception to its natural end.”  “…every transplant must take into account . . . it is never licit to kill one human being in order to save another.”

Federal Mandate When death is imminent, records are sent to OPO to determine suitability for transplantation.  Prohibits physicians from discussing the topic of organ donation with the patient and family.  This type of communication can only be done by a “designated requester.” 

The Law UDDA: in accordance with “accepted medical standards.”  Transplant centers concur that death is whatever and whenever a doctor says it is.  UAGA, Revised 2006 

Conclusions To say someone with a beating heart, normal blood pressure, normal color , and normal temperature is TRULY DEAD is false.  A person is living and not dead, even an instant before death. 

Conclusions  When there is still doubt about death,

excision of an unpaired vital organ is prohibited.  To devise a fiction for declaration of death is not ethically acceptable, and is morally wrong.

Conclusions (cont’d)



To cut out an unpaired vital organ, e.g., a heart or a whole liver, before death does not respect dignity and value of human person.

Donor must be truly dead with certainty!

Conclusions (cont’d) Cessation of brain-function laws followed by living will laws are all a part of, or lead to imposed death (EPIVALOTHANASIA).  Death ought not be declared unless the circulatory and respiratory systems, and the entire brain have been destroyed. 

Recommended Statute: Byrne + Quay 

“No one shall be declared dead unless the respiratory and the circulatory systems, and the entire brain, have been destroyed. Such destruction shall be determined in accord with universally accepted medical standards.”  Solidly based medically, ethically, and religiously. And unexceptionable.

TRUTH Conformity of mind to reality

Certitude Firm assent of mind to truth Moral, physical, or metaphysical

Definition of Human Person Individual, Substance, of a Nature, Rational (Boethius, 450 AD) Individual - existence Substance - made to the Image of God Nature - made to the Likeness of God Rational - reasoning to do good and avoid evil

Attributes of God in the Human Person  Existence: Living  Conservance: Protect and Preserve  Concurrence: Requirement  Governance: do good, avoid evil

Denny  “On verge of being declared brain dead.

…to bedside to pray for him and release him. Family said goodbyes to Denny. Family has concerns.”

Moral Issues     

Is this person, in fact, dead? Biology, theology, philosophy, legal May a test be done that could cause the condition to get worse? e.g., Apnea Test. No! Are the donors truly dead before the healthy heart and other organs are excised? No. What is the effect of this more lenient standard of death called “brain death”? Culture of Death. Who protects the defenseless comatose patient? You and me!

Brain-related Criteria for Death  More than 30 sets of different criteria

published by 1978. Now, many more.  If this human being is determined to be “brain dead,” which criteria were used to make this determination?  Are the criteria valid for true death?

History: Modern Culture of Death        

1954 First kidney transplant 1967 First heart transplant: South Africa 1968 First article in JAMA on “brain death” 1970 First statute on “brain death” (Kansas) 1970 UAGA, 1972 PVS, 1973 Roe v Wade 1976 Karen Ann Quinlan, 1976 CNDA 1980 UDDA, 1983 UNDA, 1990 PSDA 1987 and 2006 Revised UAGA