Controversial Organ Donation Now Available in Canada
By Camilla Gunnarson

In June of this year, Canadian doctors preformed the first-ever non-heart beating organ donation (NHBD) procedure in Canada. 
           
The procedure, also known as donation after cardiac death (DCD), typically involves patients in intensive care units who may be in a coma or have suffered a stroke or trauma and requires the use of a ventilator.  Although the patient has measurable brain function, he/she is determined to have “no hope of recovery.”  The doctors then remove the ventilator and wait for the heart to stop beating.  If the heart stops for a period of five minutes, death is pronounced and a new surgical team proceeds rapidly to remove the kidney, liver and/or lungs. 
           
Although doctors have been performing organ transplants for thirty years, the typical procedure was based on the “brain death” criteria. This procedure is not without controversy as medical experts cannot agree on the definition of “brain death” (see LifeCanada News, April/May Issue 2, Vol. 5, Defining Death, Taking a second look at organ donation). 
           
But DCD is even more controversial since there is very little time for ethical considerations because of rapid deterioration of soft tissue due to lack of blood flow. One of the major ethical concerns with the procedure is that the stoppage of the heart is NOT caused by the patient’s medical condition, but by the removal of the ventilator.  Another is that there have been cases where the heart has restarted and circulation resumed after a period of five minutes.
           
In an interview with LifeSiteNews.com, Dr. Moira McQueen, President of the Canadian Catholic Bioethics Centre, said that waiting only five minutes after cessation of cardiovascular circulation was "frankly . . . not nearly enough."  The report stated that McQueennoted there have been cases of auto-resuscitation after more than five minutes without a heart beat.  Even though organs may be harmed by waiting for a sure determination of death, the principal concern is an accurate determination of death, since otherwise the patient is being killed by organ extraction.  "The important thing for us is that the person donating has to be dead," explained Dr. McQueen. "The organs are a secondary consideration…”
           
A Calgary critical care doctor, Dr. Christopher Doig, is concerned that a change in the rules in defining death for purposes of organ donations could place patients in danger and ICU doctors in a conflict of interest. 
           
Dr. Doig was co-chair of a national forum that began studying in February 2005, how DCD might proceed in Canada. Doig has since resigned from the committee and has not endorsed the newly released report.
           
In an editorial in the Canadian Medical Association Journal, Doig writes, “DCD may represent an additional source of organs; however, DCD is a major change in end-of-life practice and poses significant ethical problems for end-of-life decision-making.”
           
Doig points out that there is inconsistency in determining “from whom and how to withdraw life-sustaining treatments in the ICU.” He refers to a study of 1,600 Canadian ICU health care providers who were asked to ascertain treatment recommendations in 12 "usual" ICU scenarios. The treatment recommendations included five potential options, ranging from continuing full treatment to withdrawing all active treatment. The results revealed that “in only one of the 12 scenarios was the same option chosen by more than fifty percent of the doctors.”
           
In another study, involving166 ICU patients where death was anticipated after being taken off ventilators, "six were ultimately discharged home,"
           
“When there is such variability in end-of-life ICU practice, the possibility of conflicted decision-making in a controlled DCD program is more than a theoretical possibility,” Doig warns.
Doig feels it is premature to proceed with DCD based solely on the results of this one forum. Its practice could “rightly cast doubt on the intentions and practices of health care professionals particularly in the ICU and on organ donation practices as a whole.”
           
The Canadian public needs to be consulted before DCD is widely offered but it’s highly unlikely that honest debate will take place. Despite several ethicist’s warnings, organ donation campaigns continue to intensify.
           
One such example is the celebrity poster campaign launched by the Trillium Gift of Life Agency in Ontario. The campaign is intended to persuade the public to sign an organ donation card. Well-known Canadian celebrities such as Keiffer Sutherland, Tom Cavanagh, Don Cherry, Tom Cochrane, Carla Collins, David Cronenberg, and Colin Mochrie  are just some of the celebrities who are lending their names and faces to the campaign. The campaign encourages family members to speak to one another about organ donation, and to sign their organ donor card. The posters will appear in hospitals and doctor’s offices, newspaper supplements and driver license renewal offices.
           
Organ donation has become so commonplace that fewer and fewer people question the morality of the procedure.  With all of the publicity it's easy to ignore the specifics, namely, how are the organs obtained? How is death declared for those who are potential organ donors? And will the medical community’s eagerness to seek organs over-look therapeutic treatment?

Camilla is the part-time editor of LifeCanada News.