Tuesday 11 April 2023

Transplants PART 1


Discussion Document

Organ Transplants and the "Brain Death" Fallacy

David W. Evans

Home Quarterly: A Review of Policies as seen from the home. Vol. XLIII, No. 1. July 1990


Let me say at once that I believe heart, liver and lung transplantation to be Wrong. This is because, to be useful for transplant purposes, these organs have to be removed from living bodies, i.e. bodies which are respiring, pink and warm, and which bleed freely when cut. The donor's blood circulation is maintained by his own heart - right up to the moment when it is stilled by a chemical solution and itself removed.

The body reacts to the trauma of this evisceration just as it would to ordinary, therapeutic, surgery. It has to be paralysed with muscle relaxant drugs to prevent the movements and spasms which, if they were allowed to occur, would make the procedure difficult or impossible. Even so, there may be dramatic increases in blood pressure and heart-rate in response to the incision and the further trauma of organ removal; these responses are identical with those seen in lightly anaesthetized patients undergoing ordinary therapeutic surgery and, in those circumstances, are an indication to the anaesthetist to deepen anaesthesia in case his patient may be feeling pain or, perhaps, have subsequent recall of intra-operative events. It may be that this everyday experience is the reason why some anaesthetists in charge of organ donors give them an inhalational anaesthetic as well as the muscle relaxant; others, being persuaded that the obviously living body is that of a dead person, may aver that they give the general anaesthetic agent only for its effects in controlling the unwanted cardiovascular reaction.

To operate thus, not for the benefit of the life-long inhabitant of the body but to acquire his vital organs for the use of others, might seem an odd thing for a caring surgeon to do. It might even seem a procedure of doubtful legality. It has been made possible in both respects by the invention and successful propagation of the notion that, although his body is undeniably alive, the donor can be regarded (and certified) as already dead before the operation commences because he appears to be deeply unconscious and a few simple clinical tests have indicated that he has no prospect of recovery. This is the syndrome which has—unfortunately and misleadingly—become known as "brain death " or, in this country, "brain stem death."

It is fallacious to equate the state so defined with true and total death of the brain and I am therefore unhappy about the terms used to describe it; this is no mere semantic quibble but a real concern that use of these imprecise terms may manipulate thought. Indeed, I know it has done so in academic circles and I think it likely that a distraught parent who is told that his son—who looks alive—is nevertheless dead, because the tests establish "brain death," will take this to mean that all possibility of residual life in the brain has thereby been excluded. This is, of course, not the case.

It is also basically fallacious to assume that the tests used have the power to forecast, with the absolute certainty claimed,. the true death of the patient (i.e. the final cessation of his circulation) within a few hours or days of the diagnosis of "brain stem death." There are, in some ways regrettably, no absolute certainties in Medicine. And in this context one need perhaps look no further than the reports of "'brain dead " mothers giving birth to normal babies several weeks after the diagnosis to provide food for thought about timed prognoses—and, maybe, about the wider question of live births to mothers allegedly long dead.

Part 1 of 6: to be continued

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