How dead are organ donors?

The Independent — 23 de jan. de 2008

Sir: Organs for transplant (letter, 21 January) have to be taken from still-living bodies, bodies still perfused by their naturally beating hearts, warm and so reactive that muscle-paralysing drugs may have to be given to facilitate the surgery.

Their owners will have been certified “dead” on the controversial basis of bedside brain-stem testing, a procedure not sufficiently stringent to exclude some persisting brain-stem function and which includes no test for what may be abundant life elsewhere in the brain.

Many or even most of those who have put their names on the NHS Organ Donor Register may have thereby offered their organs to be taken for transplant purposes on the (mis)understanding that the wording “after my death” on the application forms meant that they would be dead in the commonly understood sense before their offers were taken up.

If so, they have made their offers on a false premise and those offers cannot be regarded as valid. Had it been explained to them that they would be dead in only a notional (“brain-stem death”) sense, at least some of them might have wished to specify general anaesthesia to cover the organ procurement procedure.

David W Evans


(Sometime Consultant Cardiologist at Papworth and Addenbrooke’s Hospitals), Cambridge

Sir: Of course dead people matter (Dominic Lawson, 18 January). No one, certainly not the BMA, is calling for people’s remains to be used disrespectfully or against the wishes of the potential donor or their relatives. This would be deplorable and doctors are not in favour of a system that disregards personal views or family wishes.

Every year, hundreds of people die because they cannot get an organ to save their life. We know most people support organ donation but do not get round to signing the donor register. It is a tragedy that people’s personal wishes about what happens to their bodies when they die are not being respected because often no one is aware of their views about organ donation. We would like to see more families talking about these difficult but important issues so that informed discussions about the deceased person’s wishes can be held with health teams.

The BMA does not believe that a system of presumed consent will be the answer to all the problems we have with organ donation, but, as doctors, we think that it will go some way to increasing the number of organs available. Of course, other factors need to be looked at, for example, the number of transplant surgeons and intensive care beds available.

Dr Tony Calland

Chairman, Medical Ethics Committee, British Medical Association, London WC1


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