The conundrum of death, dying and organ donation

Leading ethicists have called for “irreversible loss of circulation” to be reinstated as the major defining characteristic of death, in a bid to halt the decline in organ donation. Despite widespread public support, research shows that the reluctance to give consent hinges on lingering confusion on what it means to be brain dead. There is some justification for this equivocal stance.

Advances in medical treatment and technology, coupled with some evidence of continuing regulation of bodily functions, cortical activity, or pain stimuli responses in patients who meet the criteria for brainstem death, undermine the biological plausibility. Medical staff and relatives understand the need to use brainstem criteria for brain death for the purposes of organ transplantation, but many act as if they do not really believe that brain death equates to “actual” death.

The authors conclude that the term “death” be reserved for those in whom there is an irreversible loss of blood circulation, while “brain death” should be regarded as a clinical diagnosis of the tissue itself rather than the organism as a whole. Brainstem death should be a surrogate marker for brain death which implies imminent death without ventilatory and intensive care support. Patients who meet these criteria may have treatment withdrawn on the basis that there is no hope of recovery and they may also be considered for potential organ transplantation.

Alternatively, rather than redefining the concept of death and changing legislation, the authors suggest the transplant programme may be better served by abandoning the “dead donor” rule and acknowledging that the removal of organs will kill the patient.