Why wait until death for organ donation, asks Canadian bioethicist

Michael Cook
23 Mar 2013
Reproduced with Permission

More erosion of the dead donor rule in the latest issue of the Cambridge Journal of Healthcare Ethics. To the public, it probably seems axiomatic that vital organs should not removed until the donor is dead. But an increasing number of bioethicists are questioning this, especially in the light of grave organ shortages.

Walter Glennon, of the University of Calgary, breathes new life into the Epicurean argument that death does not matter: "where death is, I am not; and where I am, death is not. So death is not to be feared, since it is nothing."

Glennon examines the case of a severely brain-damaged patient. He argues: "What matters is not that the donor is or is not dead, or when death is declared, but that the donor or a surrogate consents, that the donor has an irreversible condition with no hope of meaningful recovery, that procurement does not cause the donor to experience pain and suffering, and that the donor's intention is realized in a successful transplant."

Paradoxically, he argues that doctors or relatives could actually be harming a live but brain-damaged patient if they do not allow organ donation. Harm, he says, is thwarting a person's interests. If a patient wanted to donate his organs, he would harmed if they were not donated, or if they were unsuitable for donation because doctors waited for them to die first. "We should reject the view that organ donors are beyond harm only after they have been declared dead and that they are harmed if organ procurement occurs before this time."

If this is true, though, why can't people donate organs when they are well - perhaps as a way of committing suicide? Highly unlikely, Glennon responds. Such people would be irrational and hence not capable of the fundamental criterion, acting autonomously. "It is usually the experience of an irreversible, hopeless condition that makes a person conclude that life is no longer worth living."