Organ Donation and Death's Timing.

Dr. Michael Kirsch posted a comment on this site this morning that is reiterated in his column at MDwhistleblower. That column in part reads:

I think we should provide more incentives to donate, although I do not advocate buying and selling organs on the free market. This would lead directly to economic and physician exploitation of our most vulnerable people. I also vigorously oppose bending the definition of death for the purpose of saving others. One life is not worth more than another. Of course, it’s easier to make principled and categorical statements as a blogger. But, don’t ask me for my high and mighty opinion if my child is on the transplant list. I’d pay the ransom.

If it were up to me, health care - period - would not be monetized or profit-driven. So of course I agree that buying and selling organs should be out of the question. Forever. Always.

I don't think anyone posits that one life is worth more than another's - to justify any type of organ donation. Such a statement is insensitive to the difficult decisions that face both families of the dying and families of those in need of organs. Demonization of any faction of society is so unnecessary - and plays into the overblown fears of a "culture of death" that in actuality doesn't exist. So let's just leave that strawman to those who want to have irrelevant, emotional conversation.

The challenge to organ donation in the US is that fewer people donate than organs are needed. And as Sanghavi noted in his NYT article, when organs are harvested is vital. That schedule is contingent on a medical and legal question that does not have a clear answer: when does death start?

The very best answer is to do what we already do: leave decisions regarding organ donation up to patients and/or their medical proxies. Technology constantly evolves and allows us greater understanding of the dying process. So until someone can tell us definitively what death's schedule is, I think we'll be left to discuss this issue for a while.

Another thing we can do - as Dr. Kirsch suggests - is promote organ donation. I add that this should be done with a sensitivity to the fears that minorities and the disabled have historically had about donation.

I'm thinking I'll change my living will to say something like, "In lieu of flowers, mourners are asked to ensure that they have marked their driver's licenses for organ donation."