Thursday, October 23, 2008

OPOs, stop and think!

Tarris Rosell, PhD, DMin
Program Associate
October 23, 2008

How dead does a “cadaveric” organ donor need to be before the heart is removed for transplantation? Or ought death be the necessary precondition for doing so?

Even asking these questions may seem crass and insensitive to those families who have given the “gift of life.” It also is ringing alarms for some Roman Catholic pro-life moralists, according to a recent article in The Economist (

These are matters more commonly discussed in medical and bioethics journals. Yet organ procurement policies do indeed have something to do with economics, despite U.S. laws forbidding commerce in transplantable organs.

Donors or their families receive no compensation, or ought not, we say; but organ procurement organizations (OPOs) pay decent executive salaries and transplant clinicians may receive even better ones. Transplantation is expensive medicine, with much money legitimately trading hands.

Another interest to economists is the law of supply and demand, which is a perpetual problem for transplanters. Organ supply is woefully short of patients’ demand.

What to do? In a recent New England Journal of Medicine article (, Dr. Robert Truog has suggested that we increase organ supply by dispensing with the “dead donor rule.”

(See Center blog for 8/20/08:

He argues that we should procure vital organs like the heart and lungs before either cardiac or brainstem death so as to minimize cell death in transplantable organs and thereby maximize transplant success.

Criteria for doing so, says Truog, would be prior signed consent of the donor and a subsequent situation of irreversible severe brain damage with do-not-resuscitate orders.

This worries many of us, notes The Economist, and particularly so some Catholic scholars who will gather at the Vatican in November for a conference on organ donation. “O death, when is thy sting?” quips the journalist. “OPOs, stop and think!” may be the more somber religious pro-life response to Truog and his proposal.

I too think this is a matter not to be ignored in an era of short supply and high demand for human body parts. Clearly, moral boundaries and clinical guidelines are shifting. Perhaps that is not a bad thing. But more thoughtful dialogue is needed, both by economists and ethicists, religious scholars and organ procurers, those who transplant body parts and those who would receive them.

Demand alone is insufficient moral justification for increasing supply by any means imaginable. On this we all agree. Could we have imagined, even a short time ago, that a serious proposal would be offered for recovering vital organs before declaration of donor death?

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