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Should Doctors Relax the ‘Dead-Donor Rule’ to Increase Organ Transplants?

Should the terminally ill be allowed to end their life by donating their organs?

Theodore Dalrymple


October 22, 2013 - 7:00 am


When I was a student, a trauma surgeon described how, in the early days of transplants, he had to physically restrain the transplant surgeons from “harvesting” the kidneys of potential donors. So enthusiastic were surgeons about this exhilarating technology that they were willing to sacrifice one life for another, for they tended to count a life saved by transplant as being of more than ordinary value, perhaps double; and, no doubt irrationally, I have remained mildly suspicious of them, the transplant surgeons, ever since.

There were two opposing articles in a recent edition of the New England Journal of Medicine about the ethics of transplantation. For a number of years the supply of organs for transplant has not equalled the demand, and one way of meeting it would be to relax slightly the rules governing the removal of transplantable organs from donors. At the moment the dead-donor rule (known as the DDR — an acronym that for me still brings first to mind the German Democratic Republic) prevails, according to which the donation of an organ must not kill the donor.

One of the authors suggests that the DDR is routinely violated in any case and that, in so far as it is obeyed, it limits the number of organs available for transplant and thereby allows people to die who could have been saved. But, says the author, “it is not obvious why certain living patients, such as those who are near death but on life support, should not be allowed to donate their organs, if doing so would benefit others and be consistent with their own interests. … Allegiance to the DDR … limits the procurement of transplantable organs by denying some patients the option to donate in situations in which death is imminent and donation is desired.”shutterstock_82365769

I find this way of putting the matter sinister. When the authors say “donation is desired” I want to ask, “Desired by whom?” Not necessarily by the dying patient, it seems, for the authors cite a case in which “if there [had been] no requirement to comply with the DDR, the family would have been permitted to donate all the patient’s vital organs.” As to consistency with the donor patient’s own interests as judged by the transplanting doctor, one can imagine what a slippery slope that might easily lead down. One cannot but recall that delightful phrase, Lebensunwerten Lebens, life unworthy of life, and all that followed from it.

Alas, nature does not cut reality up into nice neat categories for the benefit of medical ethicists; the natural world is full of ambiguities. Even those who hold to the DDR have difficulty in deciding when death has taken place. For example, according to the DDR an organ may be removed once a dying patient has been without a heartbeat for two minutes: but it might be that he has been without a heartbeat because a decision was taken not to start it again, even though it might be possible to do so, because such an action would be futile, the person being so close to inevitable death. In other words, the two sides — those who believe in the DDR and those who do not — may in practice be less opposed than appears at first sight.

Nevertheless, there is something sinister in the language employed in their article by the opponents of the DDR (at least one of whom is affiliated to the Orwellian-sounding Fostering Improvement in End-of-Life Decision Science Program at the University of Pennsylvania). They say that the views of people who disagree with them should be respected, but there is no reason nonetheless why they should be… well, respected.


image courtesy shutterstock /  karen roach / Sergiy Telesh

Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.

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All Comments   (13)
All Comments   (13)
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People-you need to know what your rights are before you have an emergency situation. It's been almost a year ago that my 16 year old baby boy died in PICU. The doctor and some of the team were horriible excuses for a human being. I did not give them permission nor did they ask nor explain what a brain death test was. I did not give permission nor did they tell me my rights about taking my child off the vent. In my beliefs they murdered him. He had a brain injury and was so perectly healthy other than that. I belive they wanted his organs which they did not get. Decide what you would do before hand and what your rights are or they will run right over you.
38 weeks ago
38 weeks ago Link To Comment
I oppose animal vivisection and experimentation. We have huge buildings filled with unrepentant murderers, rapists, child molesters, drug dealers, and terrorists. I would rather see every rapist in America harvested for his organs. I would rather see murderers forcibly relieved of their eyelids than see a single rabbit, dog, or monkey used to test cosmetics. You see, contrary to liberal belief, which is always wrong, rapists, murderers, child molesters, terrorists and drug dealers serve no useful purpose while alive except as potential test subjects, provided they are guaranteed not to live through those tests. They are also perfectly viable sources of blood, tissue, and organs. They don't even need to be told what is happening. They took what they wanted from the innocent. Let us show the innocent we love them by taking what we need from the scum who would prey upon them.
44 weeks ago
44 weeks ago Link To Comment
You seem to have a lot of faith that the State never, ever makes mistakes, Marshal Right. That the State never ever acts venally, that the State and no functionary of it can or will ever be corrupt.

I do not share this blind, child-like faith of yours. In fact it scares me a little.
43 weeks ago
43 weeks ago Link To Comment
So you'd be for George Washington being harvested since he was a terrorist from the British viewpoint, or perhaps Bush who is a terrorist in some people's eyes. And of course, all the people in prison who are innocent of the crimes of which they're accused. Or the 16 year old who is labeled a rapist because he did it with his consenting 15 y/o girlfriend. Just label them and harvest them. And of course if demand exceeds supply, just label some more. Yeah, that worked so well in the USSR and Communist China. But go ahead and have your Goldstein moment, scream all the evil vile things at the enemy the state has conveniently labeled for you as the source of all your woes. Just remember, a finding of guilt in our court system today or a plea bargain does not always mean the accused is truly guilty. You might want a higher standard of proof of guilt and degree of harm to a victim before you start showing your love of the innocent by committing a degree of atrocity usually reserved for the Nazi's and their ilk.
44 weeks ago
44 weeks ago Link To Comment
Well, how about getting those transplant surgeons working death rows? I'm sure once the lawyers and surgeons and the dead men walking, specifically their estates, all get their cut of the organ proceeds, the states and courts will get on board or organ auctions, I mean donations.
44 weeks ago
44 weeks ago Link To Comment
“it is not obvious why certain living patients, such as those who are near death but on life support..."

Being on life support can ruin the organ, right ? Esp. lungs when you're on a breathing machine. And someone long term terminally ill and/or very old, their organs are viable and positive for transplant ?

I know about this ove-reagerness to "harvest", absolutely appalling in places like China where, not all that long ago, reports of prisoners being forced into involuntary organ donation. Or India where some dirt poor guy would be paid $5 for a kidney.

Bertrand Russell on the subject of animal experimentation/vivisection... Sometimes the act is so macabre to the animal (e.g. removing the larynx in a Beagle) that we're better off not performing it in the first place, no matter what the alleged or potential gains.
44 weeks ago
44 weeks ago Link To Comment
"We're here to take your liver............."

"But I'm using it........."
44 weeks ago
44 weeks ago Link To Comment
Doctors are too free. For example, the author reports some articles in Medical Journals and debates among some surgeons, and positions taken. Who cares their opinions?

We need doctors to do medicine, their opinions are of no matter. You might think this narrow minded but consider - one of the huge pillars of Obamacare rests in reality on the "social" opinions of doctors.

The stringent and evil rationing Obamacare is about to foist on us, could never have come about if it weren't a fact that many many doctors stick their own evaluations as to who should or shouldn't get medical treatment.

And the problem here is this. The only thing a doctor should consider is if they can treat an individual. All questions of the value that treating the individual is to society are misplaced and not the venue of doctors.

We use doctors, and doctors like to think of themselves, as important members and deciders in and of society and as a result their opinions about their role in society is distorting medicine.

Doctor's have many conceits. For example, only sometimes do doctors know when in future a person is likely to get sick. There is no doubt that we need doctors to diagnose a disease or illness when they occur and to effectively treat them.

So we waste precious dollars in Preventive medicine. One reason Catastrophic Health insurance is so inexpensive - besides coverage issues - is that the insurance company spends no dollars on preventative medicine.

Doctors just aren't as good as people think and the "doctor doctor save me" chant unwarranted. That doctors could be as good as they think they are might well be true, but they have to demonstrate that first.
44 weeks ago
44 weeks ago Link To Comment
It isn't the unthinkable, for we can and do imagine such things, rather it's the unutterable because the society rejects even the speaking of it. But in a state where freedom of all things is translated to mean allowing sick souls to have the right to permeate our public discussions with these ideas, without the right to protest them or debate them without threats, as if they were perfectly reasonable alternatives, is to eventually see the state make the unthinkable law. Racial Equality, Religious Equality, Freedom of Speech, Quotas, Equal Opportunity, Freedom to Work, Right to Protest, Freedom from Sexual Harassment, all turned on their heads to mean the opposite of what they should be by a state run apathetic society too enslaved by state created arbitrary rules designed to make things more fair, in the opinion of our leaders who are answerable only to each other (i.e Sebelius of HHS .. 'I don't work for them (public)'). When a people gives up their freedom by giving to a few others the right to govern over them, to make the unthinkable but a decade ago today the law of the land, then watch the demented souls flock to power to enforce their sick desires on the public who are now little more than lab rats and slaves who exist for the pleasure of the state.

What is whispered today in medical circles will become the norm unless we protest loud and decisively. Unless of course you like the state to decide when and how you die. Rest assured though that such organ donations will only go to the most worthiest as determined by the same state that is giving you, not themselves, rationed Obamacare and Death Panels.
44 weeks ago
44 weeks ago Link To Comment
Except it will not be "consent". The consent will be taken by the family, or some third party, after a "bull session" in the waiting room, the same way people today are cavlierly legally murdered by "turning off machines". (In my religion, if a man is taking his last breath, and you close his eyes, you are a murderer.)

I'll tell you one result. It will make people even less likely to sign a donor card.
44 weeks ago
44 weeks ago Link To Comment
We have enough issues with the current situation. Agudath Israel of America actually has a legal "ambulance" corps of lawyers who are called in emergencies to stop a machine from being turned off. Plus, what happens when you beleive the person to be alive (so-called "brain death" is very controversial in our cirlces), but the insurance company and the hospital don't want to deal with a "dead" patient? (NOTE: The boundry between life and death is a moral issue, not a scientific one.) New York State actually has a law to help in this regard, but I don't know about the other 50-odd jurisdictions.
44 weeks ago
44 weeks ago Link To Comment
In a world where the almighty state controls medical care; consent is not a problem. Once you place yourself in the hands of the state, the only consent that is needed is that of the state.

Subotai Bahadur
44 weeks ago
44 weeks ago Link To Comment
To have a life taken for the betterment of one who deserves life more makes that first person Life Undeserving of Life. Where have I heard that term before?
45 weeks ago
45 weeks ago Link To Comment
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