In spite of official acceptance of BD/BSD concepts, serious problems emerge with the medical and philosophical rationales for the neurological criteria for death. These rationales appear in various conflicting versions and this problem... more
In spite of official acceptance of BD/BSD concepts, serious problems emerge with the medical and philosophical rationales for the neurological criteria for death. These rationales appear in various conflicting versions and this problem has never been resolved. Philosophical arguments, which
radically separate the human mind and the body, are self-contradictory. Therefore, a rational justification for the BD/BSD paradigm is lacking. The way how medical professionals interpret the brain-based criteria for death, is very interesting. In general, they accept current practice and guidelines
regarding BD/BSD, but typically, they use the “psychological” rationale for it, and quite often, they do not know the official organismic-unity or biological rationale. Of notice is the fact that those who procure the organs do not want to be organ donors.
Physicians involved in organ harvesting use sophisticated methods to prepare the donors, whichinclude not only maintaining the hemodynamic stability in the donors, but also the application of thyroid hormones and painkillers in order to improve the quality of the procured organs. Some of these methods, especially the use of thyroid hormones are recommended by other physicians who rescue
brain-damaged patients in coma. In addition, these rescuing physicians also use other hormones and medications necessary for the improvement of brain blood flow (BBF) and intracranial pressure (ICP). In some cases, therapeutic hypothermia and craniotomy have to be applied. All these methods drastically improve the state of comatose patients. The problem is that these methods are effective also in reference to the comatose and apneic patients who fulfil the BD or BSD criteria. The data obtained in world centers show that 60 or even 70% of these patients might recover and lead a normal, active life. This situation is creating a serious conflict of interest between brain-injured patients with their right for life and those who are waiting for transplantable organs. New therapeutic modalities and techniques of rehabilitation are changing the situation of comatose/apneic/areflexive patients with extremely low Glasgow Coma Scale scores, destined to be become BD/BSD donors, for the better.
These new methods however, are not routinely applied in every hospital, and, in most countries, strict guidelines regarding brain-injured patients are lacking. The examples of those who fully recovered after the diagnosis of BD or BSD should be a strong argument for a new approach to the whole group
of brain-injured patients as well as for the procurement of organs. One of the possible resolutions of the existing conflict of interests is to restrict the practice of organ procurement to family members.
This is certainly not a fully satisfactory solution for the big business of organ transplantation, but it is morally licit according to most existing religious traditions and ethical systems (but not the Catholic approach). It should always be remembered that the most important rule in medicine, since antiquity is: “Salus aegroti suprema lex esto” (the well-being of the patient shall be the most important law).
Evidently, “salus aegroti” is not necessarily identical with the “salus transplantologiae” (the wellbeing of transplantology).
radically separate the human mind and the body, are self-contradictory. Therefore, a rational justification for the BD/BSD paradigm is lacking. The way how medical professionals interpret the brain-based criteria for death, is very interesting. In general, they accept current practice and guidelines
regarding BD/BSD, but typically, they use the “psychological” rationale for it, and quite often, they do not know the official organismic-unity or biological rationale. Of notice is the fact that those who procure the organs do not want to be organ donors.
Physicians involved in organ harvesting use sophisticated methods to prepare the donors, whichinclude not only maintaining the hemodynamic stability in the donors, but also the application of thyroid hormones and painkillers in order to improve the quality of the procured organs. Some of these methods, especially the use of thyroid hormones are recommended by other physicians who rescue
brain-damaged patients in coma. In addition, these rescuing physicians also use other hormones and medications necessary for the improvement of brain blood flow (BBF) and intracranial pressure (ICP). In some cases, therapeutic hypothermia and craniotomy have to be applied. All these methods drastically improve the state of comatose patients. The problem is that these methods are effective also in reference to the comatose and apneic patients who fulfil the BD or BSD criteria. The data obtained in world centers show that 60 or even 70% of these patients might recover and lead a normal, active life. This situation is creating a serious conflict of interest between brain-injured patients with their right for life and those who are waiting for transplantable organs. New therapeutic modalities and techniques of rehabilitation are changing the situation of comatose/apneic/areflexive patients with extremely low Glasgow Coma Scale scores, destined to be become BD/BSD donors, for the better.
These new methods however, are not routinely applied in every hospital, and, in most countries, strict guidelines regarding brain-injured patients are lacking. The examples of those who fully recovered after the diagnosis of BD or BSD should be a strong argument for a new approach to the whole group
of brain-injured patients as well as for the procurement of organs. One of the possible resolutions of the existing conflict of interests is to restrict the practice of organ procurement to family members.
This is certainly not a fully satisfactory solution for the big business of organ transplantation, but it is morally licit according to most existing religious traditions and ethical systems (but not the Catholic approach). It should always be remembered that the most important rule in medicine, since antiquity is: “Salus aegroti suprema lex esto” (the well-being of the patient shall be the most important law).
Evidently, “salus aegroti” is not necessarily identical with the “salus transplantologiae” (the wellbeing of transplantology).
