The new guidelines would do away with a specific amount of time that transplant surgeons must wait to declare cardiac death, leaving that determination to the doctors on a case-by-case basis.
Gail Van Norman, who is a bioethicist at the University of Washington, said that according to the new UNOS guidelines, “every hospital in America can now develop its own definition of ‘dead,’ and that is profoundly disturbing. . . . We are, it seems, admitting that we are willing to take the chance of procuring organs from someone who is not dead yet.”
Those who support the changes in the transplant rules claim that they are simply catching up with the current state of medical knowledge and practice. They also argue that the new guidelines help to satisfy the wishes of those do who want to donate their organs after their deaths.
“The ultimate goal is to facilitate the dying wishes of patients who wish to be donors and save the lives of the 112,000-plus patients who are in need,” said Charles Alexander, the immediate past president of UNOS. “We are always very aware of our public trust.”
However, opinion within the medical community on the changes in transplant rules is divided. Robert Veatch, a Georgetown University bioethicist, who serves on the separate, 31-member UNOS ethics committee, says that at a recent committee meeting in Chicago, there was an emotional discussion over whether the medical state of DCD patients really should be considered “irreversible.” He called the debate, “a remarkably heated battle.”
Michael A. Grodin, a professor of health law, bioethics and human rights at Boston University suspects the motives of the transplant community saying, “The bottom line is that they want to do everything they can to increase organ donation.”
They new UNOS guidelines also identify certain types of patients, such as those with severe spinal cord injuries, and terminal diseases such as muscular dystrophy and ALS (Lou Gehrig’s disease), as potential organ donors before they reach the end stage. Critics worry that this will encourage doctors to subtly pressure these into voluntarily foregoing the most heroic medical measures in order to gain access to their organs for transplant that much sooner.
Critics of the new UNOS standards say that they increase the risk that potential organ donors will be treated more like living human tissue banks than critically sick patients who deserving every chance to live, or to have their wishes to die peacefully respected.
“This change in policy creates the appearance that the patient is always being evaluated as a possible donor, which I think would make the public uneasy, and rightfully so,” said Leslie Whetstine, a Walsh University associate professor of medical ethics.