Sunday 9 February 2014

Ben gets it wrong again

One of the more difficult things in life is to admit to having been wrong.

Not just a little bit wrong, but stridently so.

I had the privilege of having dinner yesterday with a distinguished doctor; a Catholic of unimpeachable ethics, and a good chap to boot.

We discussed heart transplants, and he told me that I was wrong.

Given that I have blogged (and as I say, stridently) on this, on more than one occasion, it is important that I correct this error.

He is very clear that brain stem death is an acceptable and reliable indication of death; that the heart may continue to beat beyond death if a patient is on a ventilator, and that the removal of that beating heart is ethically quite acceptable. Indeed, if it is done to save another life, it is clearly a moral good.

Once the brain stem is dead (which is verifiable) there is no prospect of any recovery. The brain is irreversibly damaged, and consciousness is forever gone. This is most common in people with severe trauma to the head (eg as a result of road traffic accidents) and whilst their heart may be kept going by extraordinary technical means, they really are dead.

I raised the query about the need to anaesthetise before removing the beating heart (which I have to confess is the bit that really brings me up short) and he said that is done as there may still be nerve activity from (eg) the spinal cord that might cause movements, which could impede the operation (as well as needlessly distress the medical staff).

The other instances that have caused concern have been where doctors have failed in their duty of diagnosis etc.  Clearly that is very wrong, but it does not call into question the practice of heart (or liver etc) transplants per se.

I am now going back over my old posts about this, adding an update, directing people to this post, to minimise any further risk of misleading people.


I should make it clear that we were discussing the situation in the UK. I understand that different and more dangerous ideas and practices may be prevalent elsewhere, including the US.


umblepie said...

Before you change anything that you have previously written, I would suggest that you visit the 'Renew America' website and read the articles by Dr Paul Byrne on 'major organ' transplants. He makes it quite clear that so-called 'brain death' is not death at all, but is a contrived medical condition which allows major organ transplants to be carried out within a legalised framework. Dr Byrne is an experienced and highly qualified Catholic doctor, who is only concerned with the truth.

Ben Trovato said...


Thanks for your comments. I should have made it clear (and will amend this post to do that) that the good doctor and I were talking specifically of the situation in the UK. He is confident that a proper medical diagnosis of brain stem death (not the more nebulous notions of 'brain death' referred to elsewhere) is sound.

We talked in passing (though not in depth) about ideas and practice in the US, which are different and worse.

So I will look atPaul Byrne's material with interest, but we need to be careful not to read across too directly from the US to the UK if we are actually talking about different ideas and practices.

umblepie said...

Thank you for your reply, but the reality seems somewhat different, with the medical definition of death in the UK, strongly criticised by the US President's Council on Bioethics, as 'conceptually suspect and clinically dangerous'. For more information on this please see the post on 'whitesmokeahoy' dated 25.11.10. As you say this is such an important moral issue, it is vital that the truth is acknowledged. The post is headed 'Vital-Organ Transplants' - 'Brain Stem Death' conceptually suspect and clinically dangerous', and
includes a copy of a somewhat ambivalent letter from the UK Guild of Catholic Doctors on the subject of major organ transplants.

The following is a short extract from the post of 25.11.10 on 'whitesmokeahoy':-
'In the UK the Royal College of Physicians reported in 1976 and 1977, rejecting the whole ‘brain death’ criterion as scientifically worthless, and adopting the notion of 'irreversible brain stem dysfunction' as an indicator of death.
‘The UK ‘brain stem death’ standard for the diagnosis of death on neurological grounds ignores evidence of persisting life and function in other parts of the brain, and has never been accepted in the USA – where the irreversible cessation of function of the entire brain, specifically including the brain stem (‘whole brain death’), is required'. The US President’s Council on Bioethics has recently described the UK standard as “conceptually suspect” and “clinically dangerous”.(Wikipedia)
Please Ben, do not rush into any hasty decisions. This area of medical practice seems to be an ethical/moral minefield.