| The Nasty Side of Organ Transplanting Second Edition Norm Barber Copyright 2003 Chapter 2 Donors May Need Anaesthetic The residual doubts about the cadaver’s health status increases when it reaches the harvest table. Let us assume it is a twelve-year old girl, diagnosed “brain dead”, after being hit by a car while riding her bicycle. Her body is cleaned, shaved, tubes inserted and hooked up to various machines and everyone pretends it is a plain, dead corpse. Donor Body Registers “Fear” to being Harvested On the harvest table the surgeon draws a deep, clean slice down the middle of her torso cutting through skin, muscle and fat. But then a strange event occurs. Instead of lying dead and still like a corpse her twelve-year-old body registers fear and panic when the knife slices it open. Her heart and pulse speed up identically to a living human twelve-year-old cut with a knife. More violent reactions would occur but don’t because the anaesthetist injects pancuronium or another paralysing drug. This prevents her torso jerking and arms and legs flailing about and what has been rarely described as coordinated attempts to "grab the knife". Anaesthetists trained to prevent pain during surgery may assuage their doubts and the distress of other theatre staff by anaesthetising donors to prevent possible pain. But hospitals and donation agencies bitterly resent medical staff using anaesthetic because they spend their working lives trying to persuade distressed friends and relatives that the patient has actually died. But many medical experts doubt this. Professional Opinion Dr Phillip Keep, a consultant anaesthetist at the Norfolk and Norwich Hospital in the United Kingdom, risked his career by publicly saying what the anaesthetist profession had been debating privately for decades, "Almost everyone will say they have felt uneasy about it. 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. The surgeon always asked us to paralyse the patient." 3 Dr Keep adds, "I don't carry a donor card at the moment because I know what happens," 4 Harvest theatre nurses also express doubt about the health status of the donor. Dr David Hill, also an anaesthetist, checked operating theatre registers at Addenbrooke Hospital in the United Kingdom and discovered that nurses recorded the time of death at the end of harvesting as if the donor had come in to the harvest room alive.5 Dr David Wainwright Evans, a cardiologist, formerly of Papworth Hospital in Cambridgeshire, England observes that, "Nursing staff treat deep coma patients with continuing tenderness and address patients by name, as the coma deepens rather than lightens, perhaps from an intuitive feeling that hearing has been retained." Dr Evans says surgeons tell of persistent uneasiness at the unpleasant job of harvesting organs, particularly the heart. He says they don't get over it despite doing it many times.6 The Swedish medical writer, Nora Machado, quotes one expert as saying, "…Even surgeons are sometimes heard to say that the patient "suffered brain death" one day and "died" the following day."7 D.A. Shewmon, Professor of Neurology and Paediatrics, University of California (Los Angeles) School of Medicine, in his presentation to the Linacre Centre for Health Care Ethics, also says some surgeons feel they are killing the donors.8 When interviewed by the Australian Broadcasting Corporation he indicated a change of mind about brain death being the death of the patient.9 Wendy Carlisle: So is brain death the death of the person, in your opinion? Alan Shewmon: I used to think that it was. But in fact, during the 1980s and early 90s I read a number of articles and gave lectures supporting that idea, and since then I have had to change my opinion about it due to an accumulation of evidence to the contrary.... Wendy Carlisle: I think you’ve actually called somewhere the notion of brain death a medical fiction. Alan Shewmon: A legal fiction. Wendy Carlisle: A legal fiction. What does that mean, then, in your opinion for the whole donor debate? Alan Shewmon: I guess it’s also a medical fiction. You’re right. Dr David Evans is among a number of medical professionals who doubts that all organ donors diagnosed “brain dead” are actually brain dead, "The reason why the heart goes on beating in patients pronounced "brain dead" is, usually, that their brain stems are not really and truly dead but still providing the "sympathetic tone" necessary for the support of the blood pressure. In other words, the state of "shock" (profound hypotension) that characterises the destruction of the brain stem has not occurred in those patients."10 Dr David Hill concurs saying, "A measure of life is the continuing hypothalamic function which controls body temperature. If the patient is warm then that part of the brain is functioning."11 Despite scientific advances there still isn't an absolute determination when a person is finally dead Japanese cardiologist, Dr Yoshio Watanabe adds, "…if the entire brain including the brain stem has indeed sustained irreversible damage, cardiorespiratory arrest would inevitably ensue, bringing about the person’s death. However, the duration of this stage may well last for several days to several weeks when a respirator is used and hence, this stage at best only predicts that death of the individual is imminent, not that it is confirmed. The fact that some brain dead pregnant women have given birth to babies can be taken as strong evidence that the person is still alive, and the use of terms such as biomort or heart-beating cadaver is nothing but a sophism to conceal the contradiction in transplant protagonists’ logic.12 Medical and government authorities in the United Kingdom are now trying to stifle professional debate and public knowledge by telling medical staff in the government health system not to define death and avoid terms like "brain death". The new term is "certified dead" which avoids uncomfortable medical definitions that are difficult to defend or explain. Death is then when a doctor says the patient is dead, regardless. But once an idea based on fact gains credence no power can crush it. It was Drs Basil Matta and Peter Young, who wrote the now famous editorial in “Anaesthesia”, the journal of the British Royal College of Anaesthetists, recommending the use of anaesthetic to prevent possible pain in donors, "The act of organ donation is a final altruistic one and we should ensure the provision of general anaesthesia at least sufficient to prevent the haemodynamic response to surgery."13 |