GESTIÓN EN SALUD PÚBLICA: Are organ donors really dead?

domingo, 6 de mayo de 2018

Are organ donors really dead?

Are organ donors really dead?

by Xavier Symons | 5 May 2018 |

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.

Sunday, May 6, 2018

Personally, I'm not a big fan of super-hero films. I get a bit tired of the wisecracks and the fake explosions and crumbling buildings. But that's me, I'm afraid. Age. Generational change. Fuddy-duddy etc.

However, they are interesting thermometers of the culture. Black Panther certainly taps into a revolt against racism. Guardians of the Galaxy revolves around lost fatherhood. And the really, really bad guy in the latest epic, Avengers: Infinity War, is obsessed with population control. He has a plan for eliminating half the population of the earth. It's a reprise of Paul Ehrlich's 1968 damp squib, The Population Bomb, which predicted social collapse and environmental disaster unless the brakes were put on world population. It was a very scary script and it never happened, like most disaster movies.

What I wonder is this: does this mean that over-population still scares people or that it no longer does? Thanos, after all, is a villain, and the Avengers are out to defend the world, not support his extreme environmentalist creed. My feeling is that very few people are fretting about over-population as such, although the real problem, a shrinking and greying population, isn't attracting much interest either. Any thoughts?