Human Exceptionalism

When is Dead Really Dead? Organ Donation Just Got More Complicated

A Frenchman who suffered a severe heart attack has apparently spontaneously awakened after 1 1/2 hours without a normal heartbeat (but mechanical heart message). From the story:

A man whose heart had stopped beating woke up just as surgeons were about to remove his organs for donation, it was disclosed yesterday.

Doctors in Paris earlier this year called in transplant surgeons after failing to resuscitate a 45-year old man believed to have suffered a massive heart attack in the French capital. According to a report by the Paris university hospital’s ethics committee–seen by Le Monde newspaper–doctors continued providing a heart massage for an hour and a half while they waited for the surgeons to arrive.

When the surgeons began operating on the man to remove his organs, he began to breathe, his pupils became responsive and he reacted to a pain test.

As soon as I read that I thought this could materially impact the ethics of non heart beating cadaver donor protocols that start procuring organs five minutes after cardiac arrest. I am not alone:

In particular, the case is likely to ignite public debate over so-called controlled non-heart-beating organ donation (NHBOD)–retrieving organs when the heart stops, which has only been legal in France since last year. Before then a patient had to be declared brain dead before transplant could occur. NHBOD is legal in the UK.

“All specialised medical literature on the subjects allows one to conclude that a person who has suffered cardiac arrest and has had proper heart massage for over 30 minutes is, for all purposes, brain dead,” said Professor Alain Tenaillon, in charge of organ transplants at France’s biomedical agency. “But one must acknowledge that exceptions do exist…there are no hard and fast rules on best practice,” he told Le Monde.

I am not sure what the answer is. But it seems to me that the public’s confidence in organ donation requires that this matter be looked at closely, as well as trying to determine if there are other such cases.