Humans, like cars, wear out with time. The difference is that spare parts for humans aren't as readily available.To get one, someone else often has to die.
If you need a new heart, for example, your only hope is that someone whose driver's license is marked "organ donor" dies in a fatal car accident nearby. But chances are you will die first.
According to the Richmond-based non-profit group United Network for Organ Sharing, as of September 2002, 80,167 people were on the transplant waiting list. Last year, 6,124 people died awaiting transplants.
"Someone dies every 90 minutes because they do not get the organ they need," UNOS Ethicist Gloria Taylor said.
Given these statistics, it is not surprising that there exists a strong push encouraging the public to donate organs. Such a push, to clarify, refers to posthumous or "cadaveric" organ donations, and not the "living" donation, which is a separate and somewhat less controversial issue.
The motivation prompting people to become organ donors offers a rare example of altruism -- such individuals believe if they do not need their organs anymore, then others should benefit from them instead.
"I feel organ donation is important because even in death I want to be able to touch someone's life," fourth-year College student Ryan Lipford said.
Potential donors should seek honest answers to questions about what the "gift of life" entails. Unfortunately, as one begins to ask straightforward questions, it grows uncomfortably clear that the issue is much more complex than people tend to believe when they check off the "organ donor" boxes on various forms.
For example, while treating a critically injured person, when exactly should the decision be made to stop resuscitation and begin organ removal?
The answer lies in the definition of "brain death," a term coined at the Harvard Medical School in 1968 and is equivalent simply to "death" throughout the nation's hospitals.
Although some indications of brain death seem unequivocal -- such as inability to breathe without assistance, absence of pupil response to light and absence of response to pain -- the exact criteria have been debated for decades. The medical world still lacks a universally accepted view on what constitutes brain death.
"We have to concede that there's a controversy -- brain death is not uncontroversial," said James Childress, director of the University's Institute for Biomedical Ethics and an expert on the ethics of organ donation.
"Many people are less troubled by the absence of certainty that the person is dead than by the criteria," Childress said.
Indeed, in examining the precise procedure of organ removal, even more unsettling facts come to light.
According to the University of Buffalo Center for Clinical Ethics and Humanties in Health Care, "the guidelines for determination of death include spontaneous slow movements of an arm or leg. Bizarre movements of entirely spinal origin may sometimes occur in brain dead patients. Also, coordinated movements can occur with shoulder elevation and adduction, back arching and the appearance of muscle contraction." Additionally, the guidelines say that "in a few patients, the 'Lazarus sign' may develop when the ventilator is permanently disconnected; the head and torso may flex and for a few seconds rise from the bed with arms outstretched, then falls back and the dead body remains permanently flaccid in the supine position."
Sound like a scene from a bad horror movie? Some doctors are just as skeptical.
Two years ago, doctors in Britain debated whether brain-dead patients can feel pain. Such doubts often necessitated the administration of anesthetics prior to organ removal.
"Almost everyone will say they have felt uneasy about" removing organs from brain-dead patients, said Philip Keep, and anesthesiologist at the Norfolk and Norwich Hospital in England, in a BBC interview. "Nurses get really, really upset. You stick the knife in and the pulse and blood pressure shoot up. If you don't give anything at all, the patient will start moving and wriggling around and it's impossible to do the operation."
Donors also should understand the system of organ distribution and allocation. Contrary to popular thought, organs might not go to the people who need them most.
"Need is only one of the considerations," Childress said. "The other criteria include the probability of success, time waiting, as well as logistic considerations, such as the time of a particular organ survival outside a body."
In medical circles, many physicians disagree about such a system.
"As the list of patients waiting continues to grow and outpaces the people we can transplant by at least two to one, things will always be in a crisis," Taylor said. "There will always be people who feel the sickest patient did not get transplanted."
Taylor, however, explained methods behind such difficult decisions.
"Some of our sickest patients need a younger, more healthier organ to survive, and transplanting an older, more marginal organ would do them no good," she said. "So there are many reasons why the sickest patient might not get transplanted in theory and practice."
With American life expectancy hitting a new all time high of 76.9 years, and with continuing medical advances, the demand for organs is unlikely to ebb.
Despite all the staggering advances in medical technology, the best source of transplant organs is still humans.Artificial organs, such as Abiomed's "implantable replacement heart" are too new to be used routinely. And transplantation from other species is in the rudimentary stages as well.
"I don't see that happening for awhile," Childress said about using genetically altered animals as donors.
Considering the thousands of lives donated organs save each year, critics could consider it morally wrong to discourage people from donating. But the process can be fair both to donors and recipients, and it is important people ask their doctors for more information.
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