The Nasty Side of Organ Transplanting Second Edition Norm Barber Copyright Chapter 5 Harvest Time Battle For The Body The fight between the relatives and harvesters over the dead body begins with who gets in first. The person lawfully in possession of the body can authorise harvesting of organs and other parts. But who actually has legal possession? In the first instance it is pro-harvest hospital staff that want to begin harvesting. Next of kin can gain possession by entering the hospital and legally take possession of the body. In some countries, like the United Kingdom, the body remains legally in the possession of the hospital while it is located therein which makes it more difficult to obtain it for cremation or burial or to avoid harvesting.29 Generally, in other countries, to gain possession one doesn�t run into the room, punch out the doctors and grab the body. It simply requires stating one�s next of kin status, mum, dad, child, spouse, etc and ordering what one wants done with the body.30. The hospital will send the body to the funeral parlour of your choice or, with your permission, consider it for harvesting. They may also request consent for a post-mortem to examine cause of death, which is frequently a ploy to remove parts as the autopsy consent form may have a tiny clause within, authorising organ and body parts donation. You can refuse this autopsy. If death has been sudden, unexpected or mysterious the Coroner can order a compulsory coronial post-mortem though this is relatively rare and may occur days later in a separate building. You can insist at this autopsy that no parts be removed for transplant purposes. Some Coroners act strictly as researchers trying to discover the reason for the sudden death while others are sneak thieves for the harvesters or medical schools. Human Rights of the Heart-Beating Dead The question of human rights for brain dead patients has never been fully determined by Australian courts. It is generally believed the corpse has no rights and that being brain dead is identical to being a corpse. It is under control of whoever has possession of it. As stated above hospital staff initially retain control until next of kin or, the person with designated power of attorney can be located. If neither party can be contacted within a reasonable amount of time the hospital can decide if the patient will be harvested even if they haven�t registered as a donor. The hospital merely needs to say they have no reason to believe the patient was against being harvested. Australian transplant legislation rarely specifies what a reasonable period of time is though the 1964 Tasmanian legislation considered it six hours and this was before mobile phones were invented. In parts of the USA it is a more generous 24 hours. In some circumstances transplant coordinators or hospital intensive care staff may locate grieving relatives and persuade them to sign consent forms even before the patient has been declared brain dead for the second time. Different Versions of Brain Death The procedures used to determine brain death are by no means universally agreed upon. In Japan loss of blood pressure is required to determine brain death because the brain stem regulates blood pressure. If the patient�s circulation is still good the patient is considered to be alive. In Britain the blood pressure can be normal and the same patient declared brain dead and harvested. Bad luck. Electroencephalography Some of the states in the United States and some European countries require an electroencephalography (EEG) test to show that all electrical activity in the brain has stopped. Spain, on which the South Australian harvest and transplant program is based, requires two EEG tests twelve hours apart for adults and twenty-four hours for children. Two tests separated by time is protection against an initial mistake and the fact that brains don�t stop like car engines but frequently re-start by themselves. This careful Spanish approach contrasts with Australian practice where a person can be harvested within twenty-four hours of even turning up at a public hospital so there isn�t time to do a second EEG. But that doesn�t matter because Australian hospitals don�t use EEG testing using the argument that it is unreliable because a decomposing dead brain may give off flickers of electrical activity. Another argument, perhaps more true, is that an EEG may indicate the brain is still alive but this fact is irrelevant. Why? The key factor for declaring brain death is function, that is, whether the brain and the brain stem (section between the top of the spine and brain) can manage all the functions of the body. If it can�t then the person will probably die sooner than later so we might as well cut out their organs while the body is still healthy, or so their argument goes. This utilitarian view operates using the premise that serious brain damage causing loss of bodily function is, for practical purposes, identical to death. Another factor worth considering is the wide variety of techniques used to determine brain death. Highly skilled medical experts using the latest equipment still can�t agree on the best way of determining when a person with a beating heart is actually brain dead because, apparently, they don�t know. Horrible Smell Thus the possible consciousness of the patient is beside the point and, in any case, medical technology still can�t determine the point when the consciousness of the human is completely gone and the person completely dead so we consider loss of bodily function the criteria for brain death. Less technological societies have perhaps a safer way of determining death. They initially consider loss of heart beat as death but keep the body safe for a few days until the odour of decomposition becomes apparent. Then they know the person is really dead. Other countries don�t consider any of the above brain death criteria valid. Pakistan and Romania and Orthodox Jews don�t recognise brain death saying the person is still alive. Thailand doesn�t accept the concepts of "whole brain death" or "brain stem death" and any doctor caught harvesting a beating heart is charged with murder that carries a death penalty. Kidneys From Really Dead Donors The irony is that the most commonly harvested vital organ, kidneys, are still usable from completely dead donors whose hearts have stopped. In Japan, where harvesting from beating-heart donors is extremely rare, kidneys are harvested from fully dead people. Graft survival rate is slightly lower at 84.2 percent at one year and 72.7 percent at five years. Kidneys from fully dead organ donors aren�t used in Australia but if they were there wouldn�t be a donor kidney shortage. In Sweden, lungs are harvested from donors whose hearts have stopped for one hour alleviating the need to begin lung harvesting while the donors� hearts are still beating as is presently done in Australia and most other countries. |