Brain Death and Organ Transplants

Types of Organ Transplants

Transplanted organs ONLY come from brain death patients. This happens in two ways:

• Cardiac Non-Heart Beating Death – which means the doctors declare death after the heart stops and then organs are removed from the body.
• Beating-Heart Brain Death – which means a person who is declared brain dead is removed from life support and their organs are donated according to the Organ Procurement and Transplantation Network (OPTN).

The OPTN is operated by the U.S. Department of Health and Human Services and maintains the official list of patients who are waiting for transplants.  The OPTN’s 2011 annual report has this to say about beating-heart brain death donations.

“Organs are best preserved when left inside of a living body or beating heart (donor)… In many cases medical professionals try to keep a person “alive” for the sole purpose of preserving these organs… (Note: Anesthesia is given to a brain dead person to keep their heart and lungs functioning so that the organs of the donating patient are well-perfused and oxygenated.) However, this is seen in many ways as violating the rights of the organ donor… If a patient is unable to give permission for medical treatment… (they are only) … allowed to receive treatment if it is found that the treatment would be in [the patient’s] best interest.  This raises the question of whether keeping a person alive to remove their organs is ethically correct.” For more information read about legal death-organ transplants.

When someone donates their body to medical science it can only be used for research. No organ or tissue donations, except corneas, can be made. Every state and jurisdiction has its own laws, and all organ donations can only occur after the death declaration has been made in those states and jurisdictions.

Facts from the Organ Procurement and Transplantation Network

The OPTN defines “eligible deaths” as the death of a patient aged 70 years or younger who is legally declared brain dead by at least two doctors in the U.S.

Take a look at some of the facts about organ transplants from the OPTN.

• For every 100 eligible brain dead people, 72.9 percent—or approximately 16,174.32 people—had their organs converted to donations.
• The above statistic means that about 5,868 transplant patients were left to live their lives with the psychological, physiological and financial complications of that decision. This includes follow-up care in addition to procurement costs from hospital/transplant center, which can cost as much as $500.000 – the price of a liver transplant surgery.
• Out of the 84,000 people waiting for a transplant, one third—or 25,666 of all national waiting list transplant recipients—will never be eligible, even if an organ is available and they are considered “inactive.”
• In 2010, 18 percent of living organ donors were uninsured at the time of donation, and most organ transplants only go to recipients who have medical insurance.
• Sixty-six percent of all organ donor recipients in America are Caucasian.

The 2012 National Survey of Organ Donation Attitudes and Behavior surveyed more than 3,200 adults. This survey includes measures of attitudes and behaviors related to donation of organs for transplantation, discussing donation wishes with family, permission to donate, beliefs about the process and opinions on polices related to donation. The numbers in this report were derived from public sources and are accurate approximations.

Another study published by the Canadian Medical Association Journal found that there has been a decline in organ donation by families of brain dead patients because of better injury protection and improved care.

In 2014, the projected U.S. population, according to the United State Census Bureau, is expected to be 317,297,938. With a death rate average of 2.5 million people annually, approximately 1.2 percent are declared brain dead.

These numbers mean that .069925 percent of the 2014 projected U.S. population will have a chance of receiving an organ donation from a brain dead person.  The 22,187 donor transplants that occur from the annual 2.5 million deaths each year average to a total of .8875 percent of the population receiving an organ transplant.

What is the “True Cost” of Dying and Organ Donation?

Non-heart beating donors are people whose organs are donated after cardiac death, yet who have been on a ventilator and are not declared dead in the operating room when their heart stops, and their organs (mostly kidneys and livers) are immediately removed.

Organtransplants.org states that when someone’s heart stops beating from cardiac death “the vital organs quickly become unusable (ischemic) for transplantation.”

Donations of corneas, skin, and bone, as well as heart valves, can be used if donated within the first 24 hours after death.

Organs can also be donated by a healthy living person. For example, someone who donates a kidney to a family member and then continues their life as normal is a healthy organ donor. The brain dead patient’s organs, on the other hand, are removed after being declared dead, yet their heart can still be beating from some brain stem function.  This practice allows for a declaration of death for a ventilator-dependent individual before cessation of heartbeat and respiration if they are coma dépassé brain dead, a condition of maximum incapacitation of the brain.

The question then becomes, is the patient brain dead if certain functions are still being regulated by the brain stem such as the kidneys?  According to the notion of intent and interpretation, as described by the Uniform Determination of Death Act (UDDA). Under the letter of the law the patient would still be considered alive if they still have brain stem function.

The body is still alive, it is just experiencing a condition of maximal incapacitation and deep coma while on a ventilator.

This interpretation of brain death, in which the patient is in a state of deep irreversible coma where he or she is “near death but not yet dead,” is not in compliance with the UDDA law.