Up until a few years ago, end-of-life medical procedures were focused on the patient’s best interests. Today, the increasing demand for transplant organs has warranted more donors. At the same time, for almost 10 years, non-beating-heart donors have increased the number of potentially viable organs available for “quality transplantation”.
An article published in the Journal of Medical Ethics[1] highlights the “optimal conditions” for preparing a dying organ donor in the case of harvesting organs from dying children. To maximise organ transfer and quality, the authors state that the patient must die in a location close to or even in the surgical unit where the organ will be harvested after death. Finally, therapeutic interventions aimed at improving the quality of organs for transplantation are implemented whilst the donor patient is still alive, e.g. artificial ventilation, sedation and administration of analgesics or even immunomodulating agents and anticoagulants, etc. These conditions are similar to those applied in the case of end-of-life adults except that the parents’ consent is required in such circumstances.
A large number of procedures are carried out before the patient dies. These may cause distress to the patient and his/her family.
The authors of the article, Brierley and Shaw, consider “that these procedures are difficult to justify but the balance between patient distress and the benefit to the recipient means that these interventions should be considered tolerable from an ethical perspective“. The Bioethics Observatory is against this approach, believing that, in their analysis, Brierley and Shaw are ignoring the fact that anencephalic children are living human beings and that the diagnosis of anencephaly is not necessarily associated with end of life but with prolonged survival. “The authors adopt a tolerant attitude towards these pre-mortem procedures and correctly describe the biggest ethical considerations in these cases. However, this positive attitude is not discussed at any great length and it lacks ethical arguments centred on the dignity of the dying person, focussing essentially on their favourable position with regard to these types of procedures“.
Further reading:
Individualism and collectivism: two side-by-side approaches to destructuring the individual
Understanding transplant rejections to avoid them
Organ donation: a change that fuels controversy
Organ donation: the “ethical weakness” of presumed consent
[1] Brierley J, Shaw D. Pre-mortem interventions in dying children to optimize organ donation: an ethical analysis. Journal of Medical Ethics. 2016;42(7):424-8. Epub 2016/04/01
Bioethics Observatory (27/07/2017)