What is a donor? What is the meaning of any word?
Is it all in the definitions? We have been there before, in the discussion of obesity in America. Some have suggested that the solution to the escalating volume of obese Americans would be to simply change the definitions. See Zen and the Art of Trial (November 2023) and What's in a Name (August 2020).
Now there may be some arguments for rethinking who is "obese." The National Institute of Health points out that there may be valid considerations of Eurocentrism regarding the body mass index (BMI) and our preconceptions regarding body habitus. That said, changing such a definition should come through introspection and science.
These thoughts returned to me with the recent New York Times publication of a guest essay, "Donor Organs Are Too Rare. We Need a New Definition of Death." That piece, written by three physicians, is behind a pay wall.
Other publications have picked up the piece, affording access to the rest of us. The essential point is that there are two definitions of death recognized by medicine:
- "Either the heart has stopped, or"
- "The brain has ceased to function, even if the heart is still beating."
The author notes that "most donor organs today are obtained after brain death." This is complete cessation of function, "devastation of the whole brain." The complaint is that "brain death is rare," and there is a high demand for donor organs. The problem, from the author's perspective, is that too few are dying in a donation-friendly manner.
The prevalence of "circulatory death" is said to be much higher, but with the cessation of circulation, "organs from people who die this way are often damaged and unsuited for transplantation." The authors therefore advocate that we "broaden the definition of death" to allow earlier harvest of donor organs.
BioEthics.com poses some intriguing questions about the use of tools to prolong circulation in an effort to preserve organs. The idea of restoring circulation to preserve organs is broadly interesting. It might also have some implications for advance directives and do-not-resuscitate (DNR) documents that are signed by many.
Others contend that the proposal published in the N.Y. Times is advocating change "to allow patients to be killed for their organs." It is fair to say that there are some vehemently opposed to changing the definition of "dead." Who should make such a decision? Would it be subject to various state laws, and thus depend on where the patient is when a decision on death is to be made?
The questions here are difficult. There is some potential for expanding the availability of donor organs. But, there is also some potential for donors to be less-than-enamored with the effort to change the definition of "dead." Would the state law where the donor made the donor agreement matter more than the law in the state where the donor is at the time of deciding whether they are dead?
Might such a change result in fewer donor volunteers? If the definition were changed, would all those previously executed donor agreements remain effective? Are these contracts in the truest sense of the word? Likely not, as there is no quid pro quo, no "consideration" received by the "donor," a word that itself means:
one that gives, donates, or presents somethingThe donor agreement is far more likely a gift than a contract, and as such, one that could be validly revoked.
