As America’s organ transplant system faces scrutiny from the Department of Health and Human Services for a “systemic disregard for sanctity of life,” three doctors from New York’s largest healthcare provider published an op-ed with the New York Times arguing that “we need to broaden the definition of death” in order to harvest more organs. Chillingly, the op-ed was titled “Donor Organs Are Too Rare. We Need a New Definition of Death.”

The authors, doctors at Northwell Health in New York, maintain that “we need to figure out how to obtain more healthy organs from donors while maintaining strict ethical standards. … The best solution, we believe, is legal: We need to broaden the definition of death.”

Although the authors point to the need for “ethical standards,” in their view, definitions must be changed so that what is currently considered to be unethical will be accepted.

The op-ed comes in the wake of reports from the HHS and the New York Times itself that found a systemic problem of “rushed or premature attempts to remove [people’s] organs.” Many patients who were greenlit for organ harvesting “were gasping, crying or showing other signs of life,” according to the New York Times.

If the organ transplant system’s current practices have produced appalling results, expanding the definition of death promises results even more ghastly.

Currently, patients can be declared dead either by circulatory death (when the heart stops beating irreversibly) or by brain death (when the entire brain ceases to function, irreversibly, even if the heart is still beating and the rest of the body is functioning). Although brain death has been the standard for organ donation — it’s easier to harvest more and healthier organs per donor because the rest of the body’s vital organs are kept alive by the heart — organ donation after circulatory death has become increasingly common because of “organ scarceness.”

In particular, the op-ed writers want to expand the definition of brain death to include “irreversibly comatose patients on life support.” This redefinition would mean that organs could be harvested from those who aren’t fully brain dead (under the current definition), and who still have a heartbeat, but have lost “higher brain functions.”

Effectively, this new definition could negate the need for many donations after circulatory death, because doctors wouldn’t have to wait for those patients’ hearts to stop beating before taking out their organs.

However, the authors also support this new definition because it would resolve the fact that our current practices are arguably already violating the current definitions of death.

In cases of donation after circulatory death, doctors have increasingly used a new technology called normothermic regional perfusion. The technology keeps vital organs alive by circulating oxygen-rich blood through the body, allowing doctors to transplant more and healthier organs.

But, as the authors write, “By artificially circulating blood and oxygen, the procedure can reanimate a lifeless heart. Some doctors and ethicists find the procedure objectionable because, in reversing the stoppage of the heart, it seems to nullify the reason the donor was declared dead in the first place.”

In response, the op-ed authors present their expanded definition of death as a way to avoid these tricky questions altogether. Under this expanded definition, the patient would already be considered dead before their heart even stopped beating in the first place, even though the patient was not fully brain dead (only mostly dead). Claiming victory, the authors argue that “the ethical debate about normothermic regional perfusion would be moot. And we would have more organs available for transplantation.” Win win.

Naturally, however, redefining death creates its own set of difficult ethical questions.

The Redefinition Treadmill

While shifting the goalposts of what it means to be dead in order to increase the organ supply may be unsavory, this move is hardly new among organ donation. It’s how the industry has always operated.

The first redefinition of death, the concept of brain death, was originally developed in 1968 to retrospectively legitimate the new practice of organ harvesting from people who had continued breathing and a heartbeat (a practice that doctors had already been doing for five years without conceptual justification).

As previously reported, medical scholars concur that “the impetus for brain death understood as both a medical and legal definition of death was the substantial need for organs.”

Further, as the authors of the op-ed pointed out, the 1968 report that invented the concept of brain death initially stated this fact explicitly. The initial report provided the utilitarian justification that “there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.”

This frank and utilitarian statement was ultimately removed from the final report because a reviewer objected to it for being too on the nose, but the op-ed writers are not alone in believing that this paradigm “should guide death and organ policy today.”

That 1968 definition ultimately became the basis for brain death laws in all 50 states, which mostly follow the model of the 1980 Uniform Determination of Death Act.

Likewise, organ scarceness also led to development of the current guidelines and practices for donations after circulatory death — the method which has been at the center of the scandals found by the HHS.

Although circulatory death donation used to be largely avoided, the practice has been becoming more frequent, particularly in light of revised 2020 HHS guidelines that grade organ procurement organizations on the “number of organs” they procure “from eligible donors in its donation service area.”

Now, donations after circulatory death make up 43 percent of all deceased donors.

Troublesome “Philosophical” Reasoning

Beyond the pure utilitarian calculation of being able to harvest more organs, the op-ed authors also provided another line of argumentation. They argue:

“Apart from increased organ availability, there is also a philosophical reason for wanting to broaden the definition of brain death. The brain functions that matter most to life are those such as consciousness, memory, intention and desire. Once those higher brain functions are irreversibly gone, is it not fair to say that a person (as opposed to a body) has ceased to exist?”

The claim that living humans are only those with “consciousness, memory, intention and desire” will be immediately recognizable to anyone acquainted with debates about abortion, as the argument is frequently used to claim that unborn babies are not alive. Because the unborn do not yet possess consciousness and choice, the argument goes, they can be terminated without remorse. While the pro-life movement has sufficiently debunked this argument, it’s safe to say that accepting the authors’ claim would be a defeater for the pro-life position.

The authors’ “philosophical” line of reasoning is far from compelling, and that shouldn’t be surprising. One of the authors, Dr. Sandeep Jauhar, has previously stated that he believes defining life and death is simply an arbitrary preference or choice. Philosophic soundness may not really be his primary concern.

He wrote, “[O]ur definition of death is man-made. In the spectrum between alive and dead, we set the threshold, and we can do so in response to biological, ethical and even practical considerations. Death is not a binary state or a simple biological fact but a complex social choice.”

Because Jauhar believes any definition is automatically arbitrary, why shouldn’t society just change definitions to the one that is the most pragmatically useful? “To increase the number of donor organs, we should expand the definition of death,” he wrote in a post promoting last week’s article.

In reality, these op-ed writers are hardly the only doctors involved in organ transplantation who are making ethically suspect arguments. Per previous reporting, an astonishing number of medical scholars are pushing to simply get rid of the dead-donor rule — the principle that people actually have to be dead before doctors can start harvesting their organs. They want to just dispel “the fiction” that most people are actually dead at the time their organs are taken so that more organs may be harvested.

The process of organ donation requires an immense amount of trust in America’s doctors. But the fact that so many in the medical profession are championing such disreputable positions naturally raises questions as to whether doctors have earned the credibility necessary for citizens to continue to “trust the experts.”

Is it at all surprising that a medical profession that has supported abortion, medical castration, and euthanasia might haphazardly neglect the sanctity of human life in another context — particularly one so ethically complex as organ donation?

READ MORE by Jonah Apel:

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