Could ‘Death by Organ Donation’ ease shortage of organs for transplant? : NPR

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Should surgeons be permitted to conduct euthanasia by extracting patients’ hearts and other organs while they are still alive?

The concept, called “Death by Organ Donation,” would allow euthanasia patients to donate organs in a way that increases the likelihood of their usability, but it would also result in their death.

“It would be an ethical move because this choice is made by the patients themselves,” explains Dr. Robert Truog, a Harvard Medical School physician and bioethicist who co-authored a paper on Death by Organ Donation in the New England Journal of Medicine. “They are thinking generously: ‘How can my death benefit others?’ It’s a very altruistic, generous act.”

This proposition is contentious for several reasons, mainly because it contradicts longstanding principles in organ donation. The Dead Donor Rule states that patients must be deceased before organs are harvested. Furthermore, doctors are prohibited from causing death during the organ removal process.

This rule has sparked significant debate, including discussions on accurately determining death and new methods for extending the lives of dying patients to harvest viable organs for transplants.

Meanwhile, countries like Canada, the Netherlands, and Spain have legalized euthanasia.

“What if these patients chose to be organ donors? Under current standards, doctors must not cause death when procuring organs for transplant,” Truog states.

Currently, hearts, lungs, livers, and kidneys can only be taken from euthanasia patients after they have been given a lethal drug dose, which diminishes the organs’ usefulness, especially hearts, for transplantation.

“Why can’t patients say, ‘I’ve chosen to die by lethal injection. Can I help others?’ They should have the option to donate organs as a lasting gift. Denying them this seems illogical,” Truog argues. “A more suitable framework would allow euthanasia patients to link their choice with organ donation.”

A “creepy idea” that might have merit

Euthanasia involves doctors administering lethal drugs to end a patient’s life. While it is illegal in the U.S., assisted-suicide, where doctors provide lethal drugs for patients to take at home, is legal in some states.

In Death by Organ Donation, instead of administering lethal drugs, the patient’s life would end by anesthetizing them and then removing their organs while still functional.

“The organs would remain in optimal condition,” Truog notes.

Some bioethicists believe this idea has potential.

“Death by donation is initially unsettling. It’s a creepy concept,” says Ruth Faden, a bioethicist from Johns Hopkins University. “However, if critically examined, it may not be as disturbing as it seems.”

This is due to the growing acceptance of euthanasia and the desire of some patients to donate organs.

“Respecting individuals’ autonomy at life’s end and maximizing their body’s potential good is the ethical basis for death by donation,” explains Faden. She emphasizes the necessity of strong safeguards to ensure informed consent and prevent abuse.

A shift could undermine patient trust

However, some bioethicists find the concept appalling.

“This involves taking a living person into surgery and leaving with a dead one, which I consider murder,” argues Lainie Friedman Ross, a bioethicist at the University of Rochester. “There are limits to consent. You cannot consent to be murdered by someone else.”

Others are concerned that this approach might damage trust in both organ donation and end-of-life care, especially when potential donors are wary due to debates about organ procurement practices.

“This could harm both the physician-assisted suicide and organ donation systems,” warns Lori Andrews, a bioethicist and professor emerita at the Chicago-Kent College of Law. “It might create the perception that these are vultures preying before death. It evokes images of body snatchers from the past.”

Critics worry that permitting Death by Donation for euthanasia patients could eventually lead to its acceptance for physician-assisted suicide and possibly hospice patients.

Yet, some argue that this method could be considered for certain euthanasia patients.

“For those wanting to donate organs, this could fulfill their altruistic goal to help others,” suggests Dr. Carter Winberg, a Canadian critical care physician pursuing a master’s in bioethics at Harvard, who co-authored the New England Journal of Medicine paper. “These patients are already consenting to euthanasia and organ donation. It’s a conversation worth having about its ethical viability.”