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a decision to donate used to be a highly personal matter. but dying in the modern medical system is anything but.
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what’s the emotion that comes with the moment of giving consent to be an organ donor? it might be a mix of deep generosity and dreadful fear. you check the box and hope for the best. if the time comes, your organs may give someone else a second chance at life. but organ donation is a very complicated business, and as recent headlines show, many of us have no idea that there is a lot more involved than simply checking a box.
doctors have become adept at keeping the human body functioning when a person is near death. at the same time, transplant specialists have become adept at putting functioning organs into somebody else’s body. this has resulted in challenging questions at the heart of organ donation. when is a person considered “dead”? who decides? and what safeguards are in place to ensure organs are not being taken too soon?
a recent report in the bmj shared a disturbing case. in kentucky, anthony “tj” hoover ii had been declared dead after a drug overdose and was being prepared for organ donation in 2021. staff noticed that he was moving, “thrashing and crying.” the organ retrieval did not proceed and hoover survived. the organ procurement organization involved has disputed allegations that it pressured staff to continue.
another case, in new mexico, involved 38-year-old danella gallegos, who had been in a coma. her family agreed to organ donation after being told she was unlikely to recover. as preparations were made for the procedure, her family noticed tears and movement. a doctor asked her to blink. she did. the operation was stopped, and gallegos eventually made a full recovery. the organ-donation organization has disputed allegations that its coordinators interfered with medical decisions.
these are horrifying cases. they are also rare, and they should not be used to undermine one of modern medicine’s greatest achievements. by my estimate, roughly one million north americans are living today because somebody donated an organ. but instances of grave mistakes should give rise to questions.
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we tend to think of organ donation as a personal decision. “i decide what happens to my body after death.” but that decision now enters systems involving doctors, hospitals, organ-donation organizations, transplant teams, lawyers, governments and, often, our families.
determining death has become more complex. a person may be declared dead because there is irreversible loss of brain function. or life-sustaining treatment may be withdrawn after a decision that further treatment is no longer appropriate, followed by determination of death when circulation stops.
the details differ between jurisdictions. the laws differ. the safeguards differ. and this is where the organizations involved owe people more information than they usually have in hand when making decisions.
let’s suppose you sign an organ donor card. don’t think this is the only important decision. there are a lot of factors to consider depending on where you live, the guidance you have given in your will or advance care directive, how your medical team functions, and the practices of your local organ donor organization.
what’s one of the biggest obstacles to donation among willing donors? it’s their own family members. when your wishes collide with your family’s wishes, and you cannot argue your case, guess who wins?
a decision to donate used to be a highly personal matter. but dying in the modern medical system is anything but. if you want your wishes honoured, do your homework about the laws and organizations involved. then make your wishes known – and do it while you are healthy and able.
this column offers opinions on health and wellness, not personal medical advice. visit www.docgiff.com to learn more. for comments, diana@docgiff.com.
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