“We had a long, heated battle at the meeting,” Veatch said. “It was a remarkably heated battle.”
Others, however, support the name change.
A different definition of death
“It was always kind of confusing to say, ‘You have donation after cardiac death,’ because a dead heart can’t be transplanted,” said Arthur L. Caplan, a University of Pennsylvania bioethicist. “It gave the impression that maybe in an odd way the rest of you was alive. I found it almost Edgar Allan Poe-like.”
But Caplan and others are disturbed by the discarding of language that says “the hospital’s primary health care team and the legal next of kin must have decided to withdraw ventilated support or other life-sustaining treatment” before anyone is evaluated as a possible donor.
“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.
UNOS’s Alexander argues that early evaluation lifts the burden of another decision for families whose loved ones turn out to be ineligible for donation and eases the withdrawal of life support for those who can donate.
“We really want to avoid undue delay for families that have gone through a very difficult hospitalization and come to a difficult decision that ongoing treatment is not something the patient would want,” Alexander said. “This is a service to the grieving family.”
But spiking a specific wait-time is fueling alarm that the changes may erode crucial public trust, critics say.
“By this document, every hospital in America can now develop its own definition of ‘dead,’ ” University of Washington bioethicist Gail Van Norman wrote in an e-mail. “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.”
But Alexander said that individual hospitals and specialists in emergency medicine are best equipped to determine the right interval.
“The existing recommendations were essentially arbitrary and not based on data,” Alexander said. “What we’ve come to realize is the hospital and the care team in charge of that patient is really the most qualified to make the determination of death.”
Another change would specify certain patients, such as perhaps those with spinal cord injuries, muscular dystrophy and Lou Gehrig’s disease, as potential donors. Some worry that might subtly pressure patients to forgo care. Others say the step was aimed only at making sure those who want to donate and could be candidates are not overlooked.
Said Jim Bowman of the federal government’s Health Resources and Services Administration, which oversees UNOS: “I don’t think this is targeting individuals.”
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