Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium

Nicholas Gilbo, Ina Jochmans, Daniel Jacobs-Tulleneers-Thevissen, Albert Wolthuis, Mauricio Sainz-Barriga, Jacques Pirenne, Diethard Monbaliu

Abstract

Journal of the American Medical AssociationTransplantation of organs donated after euthanasia may help alleviate the critical organ shortage.1 However, aside from preliminary data on lung transplantation,2 data on graft and patient survival following transplantation of organs donated after euthanasia are unavailable. Because donation after euthanasia entails a period of detrimental warm ischemia that hampers graft survival, similar to donation after circulatory death,3 results after transplantation of this type of graft need to be carefully evaluated.


Gilbo N, Jochmans I, Jacobs-Tulleneers-Thevissen D, Wolthuis A, Sainz-Barriga M, Pirenne  J, Monbaliu D.  Survival of Patients With Liver Transplants Donated After Euthanasia, Circulatory Death, or Brain Death at a Single Center in Belgium. JAMA. 2019;322(1):78-80. doi:10.1001/jama.2019.6553

Short Form Conclusion of the China Tribunal’s Judgment

China Tribunal

In December 2018 The Tribunal issued an interim judgement:

“The Tribunal’s members are certain – unanimously, and sure beyond reasonable doubt – that in China forced organ harvesting from prisoners of conscience has been practiced for a substantial period of time involving a very substantial number of victims.”

. . .The Tribunal has considered evidence, in its many forms, and dealt with individual issues according to the evidence relating to each issue and nothing else and thereby reached a series of conclusions that are free of any influence caused by the PRC’s reputation or other potential causes of prejudice. . .

These individual conclusions, when combined, led to the unavoidable final conclusion that;

Forced organ harvesting has been committed for years throughout China on a significant scale and that Falun Gong practitioners have been one – and probably the main – source of organ supply. The concerted persecution and medical testing of the Uyghurs is more recent and it may be that evidence of forced organ harvesting of this group may emerge in due course. The Tribunal has had no evidence that the significant infrastructure associated with China’s transplantation industry has been dismantled and absent a satisfactory explanation as to the source of readily available organs concludes that forced organ harvesting continues till today.

. . . Governments and any who interact in any substantial way with the PRC including:

  • Doctors and medical institutions;
  • Industry, and businesses, most specifically airlines, travel companies, financial services businesses, law firms and pharmaceutical and insurance companies together with individual tourists,
  • Educational establishments;
  • Arts establishments

should now recognise that they are, to the extent revealed above, interacting with a criminal state.

China Tribunal Summary Report VIEW/DOWNLOAD HERE

Canadian Blood Services releases first set of national guidelines for organ donation after medical assistance in dying

The Globe and Mail

Kelly Grant

In the last moments before Bob Blackwood died, the doctor paused and, in front of a hushed crowd of operating-room staff, thanked Mr. Blackwood for the gift he was about to give.

It was the summer of 2017 and Mr. Blackwood, a 63-year-old former lawyer with a rare and excruciating neurological disorder, was about to become the first patient in Quebec’s eastern townships to donate his organs after receiving a medically assisted death.

“[The doctor] said he hoped that this was something they’ll be able to do more in the future to help save lives,” said Heather Ross, Mr. Blackwood’s widow. “It was just lovely how he put it.” . . . [Full text]

Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy

James Downar, Sam D. Shemie, Clay Gillrie, Marie-Chantal Fortin, Amber Appleby, Daniel Z. Buchman, Christen Shoesmith, Aviva Goldberg, Vanessa Gruben, Jehan Lalani, Dirk Ysebaert, Lindsay Wilson and Michael D. Sharpe

KEY POINTS

  • First-person consent for organ donation after medical assistance in dying (MAiD) or withdrawal of life-sustaining measures (WLSM) should be an option in jurisdictions that allow MAiD or WLSM and donation after circulatory determination of death.
  • The most important ethical concern — that the decision for MAiD or WLSM is being driven by a desire to donate organs — should be managed by ensuring that any discussion about organ donation takes place only after the decision for MAiD or WLSM is made.
  • If indications for MAiD change, this guidance for policies and the practice of organ donation after MAiD should be reviewed to ensure that the changes have not created new ethical or practical concerns. . .
  • [Full text]

Downar J, Shemie SD, Gillrie C, Fortin M-C, Amber Appleby A, Buchman DZ, Shoesmith C, Goldberg A, Gruben V, Lalani J, Ysebaert D, Wilson L, Sharpe MD.  Deceased organ and tissue donation after medical assistance in dying and other conscious and competent donors: guidance for policy. CMAJ. 2019 Jun 3;191(22):E604-E613. doi: 10.1503/cmaj.181648.

Are organ donors really dead?

BioEdge

Xavier Symons

What does it mean for a human being to “die”? This question is more complex than one might think. In the domain of vital organ procurement, there is significant disagreement about the criteria that we should employ to assess when someone has died.

The standard criterion for several decades has been the “brain death” criterion, according to which a patient can be pronounced dead once “whole brain death” has occurred. Whole brain death refers to the comprehensive and irreversible cessation of brain function, typically caused by trauma, anoxia or tumor.

Yet transplant surgeons have in recent years employed a different, more ethically contentious definition of death, the so-called “circulatory criterion for death”. “Circulatory death” refers to the permanent cessation of cardiopulmonary function, after which point brain tissue quickly begins to deteriorate (if it hasn’t already).

According to proponents of the circulatory criterion, a patient’s heart will never spontaneously restart after 2 or so minutes of pulselessness. As such, it is seen as ethically permissible to begin organ procurement once this short time period has elapsed. There are in practice different time periods specified by healthcare regulators for when organ procurement can begin (typically between 75 seconds and 5 minutes).

Yet several scholars have criticised the cardiopulmonary definition of death, arguing that the impossibility of autoresuscitation does not necessarily indicate that death has occurred. Critics point out that CPR could still restart a person’s heart even when autoresuscitation has become an impossibility.

The most recent criticism came from Kennedy Institute for Ethics bioethicist Robert Veatch, who wrote an extended blog post on the topic this week. Veatch states:

If one opts for requiring physiological irreversibility, death should be pronounced whenever it is physiologically impossible to restore brain function. Autoresuscitation is completely irrelevant. If autoresuscitation can be ruled out before physiological irreversibility, one must still wait until that point is reached. On the other hand, if it becomes physiologically impossible to restore function before autoresuscitation can be ruled out, death can be pronounced at the earlier point. Either way autoresuscitation is irrelevant.


This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

Is Costa Rica at the Epicenter of a Global Black Market in Human Organs?

If the events are in fact true, there were many people turning a blind eye and/or being paid off to not say anything about what was happening in these medical centers for years.

The Costa Rica Star

Wendy Anders

With criminal proceedings underway on a human organ trafficking case involving the trial of four Costa Rican doctors and their alleged accomplices, many interesting details are coming to light.

Intersecting forces of greed, corruption and international black markets are being identified and dissected as evidence is presented in this first of a kind trial in Costa Rica. More details will be forthcoming as prosecutors weigh testimony by numerous individuals over the next two months. . .[Full text]

 

Canadian surgeons harvesting organs from euthanised patients

BioEdge

Michael Cook

March 29, 2017 (BioEdge) — Taking advantage of the country’s new law, Canadian transplant surgeons have harvested organs from dozens of euthanasia patients. According to the National Post, 26 people in Ontario who died by lethal injection have donated tissue or organs. This involved mostly corneas, skin, heart valves, bones and tendons.

The National Post’s report only covered Ontario. Bioethicists, Transplant Quebec and an ethics committee of the Quebec government in Quebec argued last year that euthanasia could be a good source of organs, so it is quite possible that similar procedures have been carried out in that province as well.

“If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, this should be acceptable,” Dr James Downar, of Dying with Dignity Canada, told the Post, to allay fears that patients could be pressured into donating organs.

Oddly enough, this is a topic which did not emerge in discussions about euthanasia before the Supreme Court legalised it in 2015. An influential report by a Royal Society of Canada Expert Panel did not even mention it, for instance, nor the Supreme Court’s decision in Carter vs Canada.

Coordinating organ transplants with euthanised donors has been going on for several years in Belgium and the Netherlands. About 40 cases in the two countries have been reported. Last year Dutch physicians at the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam published a multidisciplinary manual for the complex procedure.

A recent article in the Impact Ethics blog by Professor Jennifer A. Chandler, of the University of Ottawa, pointed out that combining organ donation with euthanasia could lead to some tricky issues in ethics, law and conscientious objection:

• What if a patient seeks euthanasia to direct his donation to a family member? The potential for abuse is obvious.

• What if a next-of-kin is asked to approve organ donation after a person has been euthanised but has left no instructions?

• What if the transplant surgeon has a conscientious objection to the procedure? Should he be forced to do it?

• What if a recipient objects to receiving an organ from a euthanised patient?


This article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

 

Doctors harvesting organs from Canadian patients who underwent medically assisted death

What if people agree to donate, but then change their mind about euthanasia? Would they feel compelled to follow through, knowing someone is waiting for their organs?

National Post

Sharon Kirkey

Doctors have already harvested organs from dozens of Canadians who underwent medically assisted death, a practice supporters say expands the pool of desperately needed organs, but ethicists worry could make it harder for euthanasia patients to voice a last-minute change of heart.

In Ontario, 26 people who died by lethal injection have donated tissue or organs since the federal law decriminalizing medical assistance in dying, or MAID, came into effect last June, according to information obtained by the Post. A total of 338 have died by medical assistance in the province. . . [Full text]

 

 

Medical journal to retract paper after concerns organs came from executed prisoners

Study published in Liver International examined the outcomes of 564 transplantations at Zhejiang University’s First Affiliated hospital in China

The Guardian

A prestigious medical journal will retract a scientific paper from Chinese surgeons about liver transplantation after serious concerns were raised that the organs used in the study had come from executed prisoners of conscience.

The study was published last year in Liver International. It examined the outcomes of 564 liver transplantations performed consecutively at Zhejiang University’s First Affiliated hospital between April 2010 and October 2014.

According to the study authors, “all organs were procured from donors after cardiac death and no allografts [organs and tissue] obtained from executed prisoners were used”. . . .[Full text]