The ethics of Organ donation in Brain death

Dr Anushka Reddy Marri

Editor In Chief

Lexicon India

                         

Brain Death:

Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is legally and clinically dead.

Organ Donation (Human Organ Transplantation):

Organ donation is the process of surgically removing an organ or tissue from one person (the organ donor) and placing it into another person (the recipient). It is considered in cases where the recipient has suffered from an organ failure or has organ damage due to disease or injury. 

The Importance of Organ Donation from Brain Dead patients in India:

The number of organ donations in India have always been on the lower end of the spectrum. According to WHO, only around 0.01 percent of Indians donate organs after death. This may be due to lack of awareness, religious beliefs or superstitions. Another contributing factor is the lack of expertise on declaration of brain stem death in majority of the hospitals.

Harshit, a 21-year-old boy who was declared brain dead was simply taken off ventilation because keeping him on a ventilator was not affordable for the family. Neither his parents were aware about the concept of organ donation nor did the doctors tell them about the importance of organ transplantation.

The donation rate in India in 2019 was only 0.65 per million population in spite of being the country that conducted the second largest number of transplants in the world in that year.

Around 4 lakh people die every year in India due to unavailability of organs. For about 160,000 patients in need of organs, only 12,000 donors are available.

Dead organ donors may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine. After brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs.

From the above statistics, it is clear how vital it is to emphasize on the importance of organ donation from brain dead patients. 

Brain stem death was legalized in our country in 1994 with the passing of The Transplant of Human Organs (THO) Act. The diagnosis is clinical. The process of donation takes place only after a physician declares a person brain dead, using strict neurological criteria.

Do brain dead patients have an ethical responsibility to donate organs?

When it comes to organ donations from patients declared to be brain dead, the major hurdle comes from the family of the said patient facing a hard decision. If the concept of IRREVERSABILITY isn’t clearly explained to the immediate caretakers, they may assume that they would be giving up too soon or not giving enough time for the patient to recover. 

The question of ethical responsibility in this case is practically misdirected. Being brain dead, the person is obviously not in a position to make that decision for themselves. So, the actual question should be, ‘Is deciding to sign up to donate your organs in case of such an unforeseen tragedy happening to you, an ethical responsibility?’

The desire to offer one’s organs after death to prolong the recipient’s life is noble and should be honored. An ethical standard called the Dead Donor Rule (DDR) states that vital organs should be removed only from a dead body and not from a living person. Here, a question of if brain death should ethically be considered as legal death arises.

In optimal circumstances, the ethical path is clear. When a patient who has been clearly determined to have no brain-activity has been put on artificial life support as spontaneous breathing has ceased to occur and recovery not possible, the decision to donate the organs can provide another fatally ill person a chance at life. Given that the donor has zero chances at survival irrespective of the provision of artificial support, this is a reasonable alternative.

Even though cadaveric donors are readily accepted, the extraction and preservation of organs for transplant becomes more plausible when done from those declared to be brain dead. Because, everything in this process is time-critical down to the minute. Hearts and lungs can survive outside the body for only four to six hours, livers up to twelve hours, intestines sixteen, pancreases eighteen, and kidneys thirty-six. It is not hard to see the ethical conflict between certainty of death and desire to harvest transplantable organs.

It cannot be emphasized enough on how vital it is to reach a prompt diagnosis of brain death and to spread awareness about the possibility of providing a survival opportunity to multiple others who can actually be saved.

If we open our minds to it, it will be clear that ethically, we could prevent a meaningless and sudden end to someone’s life by ensuring that a part of them lives on. They will always be remembered for having given someone a gift to keep living when they themselves could not. 

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772257/

2. https://sites.ndtv.com/moretogive/lack-organ-donation-india-half-million-people-die-annually-india-due-unavailability-organs-2107/

3. https://pib.gov.in/Pressreleaseshare.aspx?PRID=1594355

4. https://www.firstpost.com/india/world-kidney-day-with-just-0-01-indians-donating-organs-an-opt-out-model-is-nations-only-hope-of-saving-lives-4381187.html

5. https://www.catholic.com/magazine/online-edition/when-is-organ-donation-moral#:~:text=The%20ethics%20of%20organ%20donation%20depends%20on%20two,in%20fact%20deceased%20when%20vital%20organs%20are%20removed.

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