Are We Dead Yet?
How ethical justification of organ transplantation depends on the definition of death
Just as determining the start of life has been a hazy situation, so too is it when considering the end of life. In the latter case, the answer to what used to seem a trivial question – is the person dead or alive – is now complicated by modern medicine’s blurring of the line between life and death. As humans, we are akin to the notion of a human soul, the center of being which makes a person who he is. To be dead is to be without that spirit. But the soul is a metaphysical abstraction, which does not lend itself to direct observation in the context of an operating room. And yet, for proper organ transplantation to occur, definitive death of the donor (living donors are excluded in this discussion) must be established. Therefore, doctors rely on a biological and legal – a medicolegal – definition of death. In the US, brain death is the legally recognized definition of death. However, with the chronic shortage of organs for a growing number of people on the transplant waiting list, hospitals are looking to non-heart beating cadavers (NHBC) as an addition to the pool of potential donors. The controversy surrounding the ethics of organ procurement from such patients lies not just in the declaration of death under the cardiac criteria, but also in the treatment of the dying patient. These concerns are safeguarded against, though, when proper protocol is enacted, such as that delineated in the Pittsburgh Protocol.