Vital Distinctions in Transplantation – Brain Death

by Dr. Paul Byrne, M.D.

Organ and tissue donation can be divided into four general categories:

Category #1 – A living person might donate one of a paired vital organ or part of a vital organ
A living person might donate one of their two kidneys, a part of their liver, or one lobe of a lung to another person. “Might donate” is used to alert potential participants that so long as such donation does not cause death or disabling mutilation to the donor, it is acceptable.* However, when such donation will result in decreased function of a vital organ, this would be disabling mutilation. Informed consent for donor and recipient ought to include information about the possibility of decreased function in the donor’s remaining vital organ.
This first category encompasses organ and tissue donation that might constitute a charitable act and could be considered commendable to benefit someone else. However, for the donor, the reduction in kidney function associated with giving one away must always be considered. The same must be said regarding reduction in lung and liver function after a donation is made. Some people say that donation of part of a liver is morally acceptable, but it is risky. There is a risk of decreased liver function and even death for the donor. The mortality rate for a partial liver donor is 0.2-2.00%; this means two to twenty deaths per 1000 partial liver donors. How can this be considered acceptable?

Category #2 – A dead body – cold, blue, pale and stiff – what can be donated?
After true death the dead body does not have heartbeat, respiration or response to any stimulus. After circulation and respiration have stopped, within 4-5 minutes the heart and liver are corrupted to such a degree that they are not suitable for transplantation. For kidneys this time is about 30 minutes. After true death, tissues that can be taken for transplantation include corneas, veins, heart valves, bones, skin, ligaments and tendons. Note that these are tissues, not organs.

Category #3 – Heart Beating Cadaver Donors – unpaired vital organ transplantation imposing death
Vital organs, such as the heart, whole liver, lungs, pancreas, and intestine, are harvested from persons
declared “brain dead.” These are called “Heart Beating Cadaver Donors.” Calling such a donor a cadaver misleads physicians, clergy, lawmakers and the public. Can a cadaver have a beating heart and circulation? It is legal, but is it moral for the transplant surgeon to stop the beating heart just before he lifts the heart out of the donor’s chest?

Category #4 – Non-Heart Beating Donors (NHBD) – unpaired vital organ transplantation imposing death
Organs are taken from “Non-Heart-Beating Donors.” A non-heart-beating donor is a living person with normal vital signs and a brain that is clearly functioning. These persons are taken off all life support including the ventilator. When the pulse is no longer palpated, the organs are taken. After the organs are taken, the patient is truly dead. The public are continually misled. To stop a ventilator to harvest organs for another person is clearly an evil action.
Categories #3 and #4 constitute imposed death. While this is falsely labeled the “gift of life,” it is the immoral taking of the life of the “donor” through the excision of a vital organ or organs.
Note that organs are taken after a declaration of “brain death,” not after true death, which is the natural end of life. The person from whom a beating heart is taken could well have been a person not very different from you and me. Most likely, he or she was able to think, walk and talk, but then something happened—possibly, brain injury from an accident, a stroke, or decreased oxygen to the brain. Now he or she is in an intensive care unit (ICU); a ventilator is assisting breathing.

Ventilators
The ventilator—commonly mislabeled a “respirator”—is a machine that moves air into the lungs, not out. “Exhale” is the term that describes the air going out, which occurs only when the person is living. Exhaling can never occur, and is, in fact, impossible in a cadaver. The ventilator can be effective only when the vital activities of respiration and circulation add oxygen to the blood and carry the blood to and from the tissues of the body. The heart is beating; there is normal blood pressure. Intact internal organs and systems maintain the unity and oneness of the body.

Neurologic Exam to declare “Brain Death”
Neurological examination to declare “brain death” include the following clinical observations of the brainstem:
1) When a light is shined into the eye, the pupil response is not seen.
2) When ice water is put into the ear, there is no response.
3) When the head is turned, movement of the eye is not observed.
4) No cough or gag would be observed.
5) The life supporting ventilator is taken away for 10 minutes. Yes, the patient is suffocated for 10 minutes. If no breath is observed, that is the signal to cut out the heart and other organs.

A neurologist makes a declaration of “brain death” using one of many different sets of criteria. The neurologist or hospital can use any of these divergent sets. Thus, a person could be declared “brain dead” if one set is used, but not be declared “brain dead” if another set was employed.

Apnea Test
Every set of criteria for “brain death” includes the procedure called an apnea test. (“Apnea” means the absence of breathing.) This test has no benefit for the comatose patient and, in fact, aggravates the patient’s condition. The apnea test is commonly done without providing any information to the relatives. Without this knowledge there cannot be informed consent of family members. The “apnea test,” during which the ventilator is turned off for up to 10 minutes, causes carbon dioxide to increase in the blood. This can increase brain swelling. Sometimes blood pressure drops, and cardiac arrest occurs. The sole purpose of the procedure of the apnea test is to determine the patient’s inability to breathe on his/her own in order to be declared “brain dead.” Never allow an apnea test to be done on your family member.

Signs Present in Patients declared “Brain Dead” 
When patients declared “brain dead” are treated instead of having their beating hearts cut out, they can continue to live. Pregnant women have given birth months after having been declared “brain dead.” Thus, the editor of the Journal of the American Medical Association wrote,
“Now we are told a brain-dead patient can nurture a child in the womb, which permits live birth several weeks ‘post-mortem.’ Perhaps this is the straw that breaks the conceptual camel’s back. Death of the brain seems not to serve as a boundary; it is a tragic, ultimately fatal, loss but not death itself.”

In the case of transplantation, after “brain death” has been declared, the ventilator and other life support are continued until it is convenient to harvest the “donor’s” organs. Everyone present can witness the following:

1. The intact circulatory system via the beeping of the heart monitor and the visual display of the signals from the beating heart, as well as the recordable blood pressure.
2. The intact respiratory system is manifest through the normal color of the skin. The exchange of oxygen and carbon dioxide can be verified by determining blood gasses (pH, pCO2, and pO2).
3. The intact interdependence of circulatory and respiratory systems can be readily observed by applying pressure to the skin, resulting in blanching, which will be followed by return of normal color within a few seconds after removal of the pressure.
4. Through more sophisticated means, an intact endocrine system (pituitary, thyroid, and adrenal hormone production) can be demonstrated.
5. An intact functioning liver can be documented through laboratory tests.

Clearly there are many signs present in “brain dead” patients, including vital signs** that physicians and laymen are accustomed to associate with being alive. After the beating heart is excised, however, findings more commonly identified with true death, that is, no circulation or breathing, can be observed. Without organs needed to sustain life, the “donor” is cold, blue, pale, and stiff–truly dead.

Are we not being asked to accept two medically distinguishable situations as legally equivalent? To say that a patient with a beating heart, normal pulse, normal blood pressure, normal color, and normal temperature is “dead” is a lie. The force of law will not make it true. Great care must be taken not to declare a person dead even an instant before true death has occurred. Death should be declared only after, not before the fact. To declare death prematurely is to commit a fundamental injustice. A person is living before death and must be treated as such.

Heart Transplants – Impose Death
Every time a heart is taken for transplant, it is a beating heart that is stopped by the surgeon just prior to excision. It takes about an hour of surgery to remove the heart. During this time, it is common for the so-called “donor” to be given a paralyzing drug, sometimes along with an anesthetic, but not always. Commonly, when the incision is made to take the organs, there is an increase in heart rate and blood pressure. Could this occur if the person were truly dead? The answer is “no.” A doctor or other medical personnel must never impose death on a patient. Imposed death in Greek is epivalothanasia.

It is easy to move one’s emotions with images of organ recipients resuming “normal lives” after they have received a heart, but what about the life of the donor? Was the donor in fact dead? If there is any doubt about the fact of death, may one carry out an action that will impose death on another? Who sheds tears for the victims of utilitarian euthanasia?

Conclusion
It is wrong to impose death on an innocent human being and for anyone to participate in such an act. Likewise, the donors of one of a paired vital organ or part of a vital organ must be fully and explicitly informed about the possibility of decreased function in their remaining vital organ. Furthermore, everyone getting a driver’s license ought to be informed of the truth about “brain death” and organ transplantation before answering the question, “Do you want to be an organ donor?” Your life may well depend on your answer.

*Catechism of the Catholic Church, #2296
** Vital signs are measurements of the body’s most basic functions. The four main vital signs routinely monitored by medical professionals and health care providers include the following:
1. Body temperature
2. Pulse rate
3. Respiration rate (rate of breathing)
4. Blood pressure (Blood pressure is not considered a vital sign, but is often measured along with the vital signs. To have blood pressure there must be a beating heart and tone of blood vessels. Impossible in a cadaver.)

© Paul A. Byrne, M.D.
January 20, 2018
577 Bridgewater Drive
Oregon, Ohio 43616
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Dr. Paul A. Byrne is a Neonatologist, and Pediatrician. He was Director of Neonatology at Cardinal Glennon Children’s Hospital in St. Louis, Bergan Mercy Hospital in Omaha, Nebraska and St. Charles Mercy Hospital in Oregon, Ohio; a Medical Doctor for 60 years. He is Clinical Professor of Pediatrics University of Toledo College of Medicine, Board Certified in Pediatrics and Neonatal-Perinatal Medicine, and Member of Fellowship of Catholic Scholars. Dr. Byrne is past-President of the Catholic Medical Association (USA), formerly Clinical Professor of Pediatrics at Creighton University School of Medicine in Omaha, Nebraska, and at St. Louis University School of Medicine in St. Louis, Missouri; Professor and Chairman of Pediatrics at Oral Roberts School of Medicine. He is author and producer of the film, “Continuum of Life” and author of the books: Life, Life Support and Death, Beyond Brain Death, and Brain Death Is Not Death.

Dr. Byrne has presented testimony on “life issues” to eight state legislatures beginning in 1967. He opposed Dr. Kevorkian on the television program “Cross-Fire.” He has been interviewed on Good Morning America, public television in Japan and participated in the British Broadcasting Corporation Documentary “Are the Donors Really Dead?” Dr. Byrne has authored articles against euthanasia, abortion, and “brain death” in medical journals, law literature and lay press. He was married to Shirley for forty-eight years until she entered her eternal reward on Christmas 2005. They are the proud parents of twelve children, grandparents of thirty-five grandchildren and great-grandparents of five.