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Recently we published an article that provided information about a study revealing that during organ removal after cardiac arrest donors are often awake, conscious and feel everything.
The article sparked a fairly lively discussion on Facebook. Many questions arose from it, which we would like to follow up on in this loose continuation.
Some commenters, including doctors, noted that we are talking about organ removal after cardiac arrest, while most transplants here are performed after brain death.
In this article, in addition to the actual course of organ removal, we will give a few important pieces of information about the types of organ removal and what a “brain-dead” person actually is, including moral questions.
The course of organ removal can be found described in 18 points at the end of this article, but be sure to read the other sections as well.
Two types of organ removal
- For organ removal to be possible, the person must still be alive. Their lungs and heart must be working. Blood must flow through their veins and oxygenate the whole body.
- Organs cannot be taken from someone who has been dead for some time. Therefore the potential donor must be kept on artificial lung ventilation and have a working heart. Various supportive means are used for this.
- We distinguish two types of situations in which organs are removed:
- Organ removal after cardiac failure
- Organ removal after brain death
1. Organ removal after heart failure
With cardiac failure, the organs must be removed quickly, because the body will soon die. This, however, allows removal of only one or at most a few organs, not all that could be utilized.
An alternative is connecting the patient to an artificial blood circulation. However, connection to an artificial blood circulation is permitted only in some countries, not yet in Slovakia.
And because the brain still functions during cardiac failure, there are cases where the person is conscious and feels everything. They cannot scream because, before removing the organs, they are given only a paralytic drug but no anesthetic.
Malicious voices claim that they withhold the anesthetic for the reason that if they gave it, the doctors would effectively admit that the person is still alive and feels. And that could jeopardize the credibility of the whole organ donation process.
In the discussion, arguments were made that when organs are removed from a person with “brain death”, which is the majority in Slovakia, nothing like that happens. In this article we will look more closely at cases of organ removal after brain death and explain why they are controversial.
2. Organ removal after brain death and its controversy
When is a person alive and when are they dead? Death is scientifically defined as the cessation of metabolic activity in tissue.
But brain death is a relatively new concept. Until recently a person was either alive or dead. For the transplant industry, however, this represented a serious problem.
From a medical point of view, organs can only be removed from a living body, otherwise they are already degraded. Yet from a moral point of view, removing organs from a living person is not acceptable.
This contradiction was resolved by introducing a purposive term “brain death” — a state in which the body, except for the brain, is otherwise fully alive.
Calling such a person “dead” therefore contradicts basic scientific definitions.
Moreover, “brain death” is not decided by a single unambiguous objective test or examination, but by a consultation of doctors who vote. And like any other vote, this is by nature subjective.
It often happens that a patient lies in hospital with a damaged brain. Then it is determined that they are a suitable organ donor and doctors suddenly declare them “brain-dead” just so they can remove the organs.
People have a mistaken idea about donation
But now let’s look at how people decide to become organ donors.
The majority have no problem with it — after all, organ donation saves lives. They tell themselves: “If I’m dead (brain-dead), they will switch off the machines and I won’t feel anything, then they can take my organs.”
But when they find out that the machines are switched off only after the organs are removed, they usually become alert. “I really didn’t know that,” they react in horror. Doctors almost never tell them this crucial fact. You can probably guess why.
They also don’t tell parents who are being pressured into organ donation for their dying child. Then, when they find out only after the procedure, they are often devastated for years by the fact that they let their child die abandoned, under the surgeons’ scalpel.
What actually are the “brain-dead”?
The term brain-dead raises many questions, such as whether such people are completely dead, half-dead, apparently dead, dying or actually alive?
Brain-dead people breathe, react to touch, during the surgeon’s first incision their blood pressure sometimes jumps, they begin to sweat, and drugs are administered to them during the organ removal procedure.
Transplant medicine thus essentially kills a living person for the purpose of obtaining his organs. And so as not to feel guilt about it, they call him “brain-dead”. Instead of “donation” it should rather be called by its true name, which is “removal” of organs.
A number of other questions suggest themselves:
- Can a person be dead and at the same time have vital organs?
- Is “brain death” merely a purposive definition to justify killing?
- Is it possible to reliably determine brain death or are those who claim that the failure of all brain functions is not measurable at all right?
- To declare a possibly dying person dead?
- Can we make a decision on behalf of a dying person who during life did not have time to make this decision? (94% of donors are such cases)
- What impact will it have on the dying person’s family?
- Is it acceptable to burden a desperate family with the question of “donating organs”?
- Are believers obliged in the name of “science” to give up their religion that teaches the unity of body, soul and spirit?
- Can we, for the sake of their “usefulness” to society, deprive a dying person who cannot defend themselves of their dignity?
- What if the dying person perceives much more than we think?
- Aren’t heartbeat, body warmth, breathing, fever, skin rashes, sweat, stool, urine, increased blood pressure, accelerated pulse or limb movement signs of life?
- How is the independence and impartiality of the doctors deciding on “brain death” guaranteed? The fact that transplant doctors are not part of the panels is not a guarantee. Other doctors do not live in a vacuum and could have been influenced (not to mention bribed).
- After accepting organ removal, will we move to accepting medical experiments on “brain-dead” people?
Won’t the time of death be increasingly accelerated by the salami-slicing method?
What are “brain-dead” people actually like?
- People also do not know that brain-dead people must be fed, cared for and carefully monitored right up to organ removal. This can last weeks or even months.
- In the meantime they are given drugs to strengthen the heart and other stimulants to keep them alive. Their metabolism, digestion and cellular respiration function. They can also fall ill and develop a fever.
- Their blood pressure is usually constant, but it rises sharply at the first incision with a scalpel.
- The body continues to produce blood, tissues and heal wounds. The kidneys function and produce urine. Even hormones whose production the brain is responsible for are created. Men still have 17 reflexes, women 14. They react to external stimuli.
- There is even a case of a pregnant woman who, after 107 days of “brain death”, gave birth to a healthy child by cesarean section. Can a dead person bring a new life into the world?
- These are all very serious questions and facts that no doctor has explained to people. So we had to do it ourselves.
Another thing that conscious donors during their lifetime, and the relatives of accidental donors, are never told is the actual course of organ removal.
So let’s look at how the whole thing proceeds:
1. Organ removal usually takes place at night when the donor is transferred from the intensive care unit to the operating theatre.
2. The donor is moved onto the operating table. This sometimes causes their movements and confuses the staff. If the heart fails during removal, they are normally resuscitated like a living person.
3. Sheets are spread on the floor so the surgeon does not stand in a mixture of water and blood that sprays everywhere during organ removal.
4. Donors’ hands are tied to prevent movement.
5. They are disinfected and covered with drapes.
6. Muscle relaxants and analgesic anesthetics are administered. However, many anesthesiologists today, following the recommendation of medical chambers, refrain from painkillers. Otherwise they would indirectly admit that the “donor” feels pain and therefore is probably not dead. They would rather risk that patients suffer during organ removal.
7. When removing multiple organs the whole procedure can last several hours; several transplant teams, even 20 different doctors, may take turns working on the donor.
8. During the entire time the donors are connected to respiratory and monitoring devices. Anesthesiologists must monitor vital functions continuously until the last organ is removed.
9. As needed, drugs, fluids and sometimes even blood or fresh plasma are administered to the patient during the procedure to ensure a balanced metabolic state.
10. When the neck is cut down to the pubic symphysis there is an increase in blood pressure, a speeding up of the heart rate and a rise in adrenaline in the blood. Sometimes redness and facial twitching or sweating occur. In a normal operation these symptoms are considered as the patient’s experienced pain. Not so with the “brain-dead”. Is this normal? Medicine here explicitly contradicts itself and interprets two identical situations differently.
11. A surgical saw is used to open the thoracic cavity and open the chest.
12. Organs are freed with a beating heart and immediately prepared and preserved for removal using a solution at 4 degrees Celsius.
13. If this cold preparatory fluid enters the living body, blood pressure and heart rate increase, and twitching may appear on the face.
14. The surgeon raises skin flaps so that kettles of ice water can be poured into the body to cool the organs and then it is suctioned away along with the blood.
15. Groups of doctors gradually remove all organs that can be transplanted — heart, lungs, kidneys, liver, pancreas, intestines, cornea and middle ear. The organs are checked on the operating tables and then leave the operating room in cooling boxes.
16. With the removal of all organs the “donor” has died.
17. In the end it is usually left to the caregivers to stuff the cavities and sew up the huge wounds. We apologize for the expression, but what remains of the “donor” is only an empty gutted body.
18. A peaceful and protected dying in the presence of family members or friends is not possible. The dying person’s last journey is accompanied by transplant doctors.
Conclusion
So, have these facts changed your view of “organ donation”?
We do not claim that every organ donation is necessarily wrong; in many cases it can save lives. However, we felt it necessary to present to you this other side of it, which doctors will probably never tell you.
The problem in Slovakia is that a law was passed that makes every citizen of the Czech Republic an automatic donor even without their explicit consent. If something like that happens to you or your loved ones, know that they can remove your organs even without the consent of the next of kin.
They may take the relatives’ will into account, but they do not have to. Thus in the case of “brain death” organ removal can even occur forcibly against the family’s wishes.
The only way to prevent this is to draw up a declaration refusing organ donation while still alive, have it signed by a notary and send it to the National Transplant Organization.
