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Edited: April 13, 2020, v. 2.1

My apologies, I corrected my use of the terms opt-in and opt-out in this series. See https://www.medicalnewstoday.com/articles/282905

Part 1

This post will try to get at the facts about the state of the “deceased” donor’s body during the donation process. I’m trying to focus on Ontario and Canada as much as possible.

Other questions for future include the question of how many donors are there, what are the percentages for research donations vs. transplant donations, what are the percentages for each type of organ donated, and what institutions are receiving the research donations. Also, how do the financial incentives work? What is the process for qualifying for an organ transplant?

1.1

https://beadonor.ca/about-donation

This claim is made:

All major religions support organ and tissue donation, or respect an individual’s choice.

Is that true? And are these religions right to be so supportive of organ and tissue donation?

https://beadonor.ca/about-donation/faqs

If your religion restricts the use of a body after death, consult your religious leader: these restrictions may not include organ and tissue donation

So, this indicates that some (or many) religions believe that the body needs to be treated with a special dignity after death.

So might there be spiritual and religious issues with organ donation that are not explicitly discussed here?

Continued: 1.2 (update: April 3, 2020)

In the context of events, including COVID-19 lock-down policies (Italians are suffering deprivation due to those policies) and the recent effort to expand relatively new Canadian euthanasia legislation even further (after a court decision) to allow even more reasons for medically assisted dying (which is mad so they call it maid), certain media stories are promoting exactly the value system that I have been talking about, which includes life-boat or situational ethics–as in this article: https://ca.news.yahoo.com/doctors-canada-decide-lives-dies-080004210.html: Canadian Press: April 3, 2020: How doctors in Canada will decide who lives and dies if pandemic worsens.

This plague has created a situation where humans are presented as a liability where they are supposed to space themselves out and isolate themselves from each other and not hang out in public, etc. So two is a crowd in this COVID-19 regime. Person A fears person B in many cases and doesn’t even want them standing around them. I believe this is designed that way in order for us to demonize the presence of human beings. In Huxley’s Brave New World, population control is part of the system, euthanasia at age 60 is part of the system (this is being discussed a lot during COVID-19) and using dead bodies for energy is described in the novel also.

So it makes sense that death can be associated with the ultimate good supposedly–a good intention for sure at the level of the donor–with the idea of the ultimate gift of giving one’s organs–and also linked to the practice of euthanasia as the ideal form of death for organ donation. And so here we are:

Organ donation changes dying for those getting medically assisted death
(by Karen Pauls, CBC News, January 4, 2018)
https://www.cbc.ca/news/canada/manitoba/dying-organ-donation-benefits-1.4405020:

People who have chosen to die with medical assistance are often the best candidates for donation

Continued: 1.3 (Updated April 4, 2020)

From the FAQ at beadonor.ca, an Ontario website:

https://beadonor.ca/about-donation/faqs

What organs and tissue can be donated?

Organs and tissue that can be donated include the heart, kidneys, liver, lungs, pancreas, small intestines, eyes, bone, skin, and heart valves

In addition to the earlier questions, it would be good to know how many of these require a deceased (not living) donor (most of them it appears) and how many organs are typically removed from a particular deceased donor.

Why should I register as an organ and tissue donor?

By registering consent for organ and tissue donation, you give hope to the thousands of Ontarians waiting for a transplant. Individuals on the transplant wait list are suffering from organ failure and without the generous gift of life from an organ donor, they will die. Tissue donors can also enhance the lives of recovering burn victims, help restore sight, and allow people to walk again. Transplants not only save lives, they return recipients to productive lives.

Those are the claims made about the effectiveness of organ donation and they sound plausible, but everything should be looked into. According to the above, there are “thousands” of Ontarians waiting for a transplant, and that number does seem very high, and it makes me concerned that it generates a lot of pressure to produce organ donors, who would mostly have to be deceased donors.

Returning to religion

The answer about religion points to this page at the Trillium Gift of Life Network’s main website: https://www.giftoflife.on.ca/en/community.htm#brochureslice; scroll down to “The Importance of Culture and Religion”.

Most of the religions have a naive point of view if this information is accurate (e.g., “matter of individual choice”).

People need to straighten out their religions in my opinion on this subject (go to the end of this series of posts to understand why).

Scroll to the right to see “Catholicism”. At least the Roman Catholic position seems to include some reservations and thought:

• Encourages donation as an act of charity and as an individual decision
• Ethical considerations include no commercialization; organs can be removed when natural death is ascertained

There is the concern about commercialization and there is concern that natural death is reached before the organs are removed.

But why the concern about natural death? Is it really the case that “natural death” is reached first?

We wouldn’t want the person to be hurt or killed or just deliberately allowed to die in order to take their organs and we wouldn’t want them to be still alive (or even conscious) when their organs are being removed (which would kill them in most cases). That’s how I would express it anyway, and it turns out that we need to stop assuming that those conditions we might assume are satisfied in reality.

I think people would want to reassure themselves about such things. I think members of the public should be properly informed of the relevant details of the organ donation process, and all religions should properly inform themselves also.

That description links to a Catholic brochure: https://www.giftoflife.on.ca/resources/pdf/Catholic_Brochure.pdf. The guidelines are at the top:

Organ donation is reserved for those with serious illnesses who may, otherwise, die if a transplant does not occur. Organ donors can be alive or deceased.

For living donors, the following must be considered:·The recipient’s need must be serious with no other treatment options.·The benefit to the recipient must be proportionate to the risk taken by the donor. There must be free, informed consent from the donor, without coercion.

For deceased donors, the following must be considered:·Vital organs that occur singly in the body may only be removed after death.·The donor’s consent must be given well in advance, freely and in writing or in discussion with loved ones. ·There must be moral certainty that the donor is dead

Note the religious concern: There must be moral certainty that the donor is dead.

Why might there be uncertainty?

Continued: 1.4 (Updated April 4, 2020 – 8:52pm)

There is a lot in this Catholic brochure. Obviously it was a big deal for those who wrote this to defend and justify organ donation and they work hard in the brochure to do this.

What are the doubts about? Why is there so much effort put into selling this to people?

Everyone has the right to be aware of what the concerns are.

Quote:

The Compendium of the Catechism of the Catholic Church tells us: “The transplant of organs is morally acceptable with the consent of the donor and without excessive risks to him or her. Before allowing the noble act of organ donation after death, one must verify that the donor is truly dead.” (Compendium of the Catechism of the Catholic Church Sec. 2296, Compendium Sec. 476

Key concern. I think it means that people shouldn’t assume that they know the donor is really dead.

There is a quote by John Paul II endorsing organ donation and another one by Pope Benedict XVI.

The brochure makes the following assertion (and this edition is specific to Ontario):

First and foremost, doctors’ primary concern is for the patient in their care. . . . it should be noted that the medical team working to save the life of an individual is completely separate from the transplant team that performs organ transplants.

So people would want to hope that assertion is true.

Already, it seems to me that this system has multiple moving parts in a sense, like a machine. So, in a complex system, what keeps that assertion true, what keeps mistakes from happening, and what keeps the ethical concerns in place at each step in the process when there are possibly pressures with finances, time, resources (lack of surgeons ever?) and even corruption?

And how does the incentive process work within Ontario to pay for the transplantation process–is it government tax money also or is it also donations of some kind?

More broadly, I wonder about how medical procedures are prioritized–how organ transplantation compares with other treatments in terms of what priority it is given–because my general impression as as an Ontarian is that there are long wait times in the Ontario health care system.

Continuing with this brochure, Organ Donation: A Catholic Perspective, which was created by the Canadian Catholic Bioethics Institute (original: http://www.ccbi-utoronto.ca).

It states the following:

Catholic ethicists and clinicians generally agree that persons in whom there are signs only of the loss of higher (cortical) brain function, such as those in a “post-coma unresponsive state” or “persistent vegetative state”, are not dead. Catholics should oppose proposals to increase the number of possible organ donors by introducing the concept of partial or higher brain death as the definition of death.

This implies that there is pressure coming from somewhere to change this system of values to allow for this.

I appreciate this particular statement on the main anti-eugenics point, but I will keep examining the concept of brain death, which is also discussed in this brochure–and which seems to go hand in hand with organ donation.

If the doctors who are preparing the deceased person for organ removal are keeping the blood and oxygen circulating for the sake of the organs, then that might be seen as life by the old definition. You would think that doing that would normally be associated with an effort to revive someone but it’s not in this case. So that’s one issue in itself. And what if their theories about the brain and brain death are wrong and there is a non-physical element (as the Church believes) that determines life–or what if there is some other error in their theories or methods, and what if there is a chance of the person reviving while their body is trapped waiting to have its organs removed? Another issue. I have heard stories of this happening–are they true–can we get some verified accounts? In any case, there is more detail to this “brain death” determination to learn about.

It turns out that there are a lot of surprising twists and turns to the subject of brain death (or the other determination of death) and maybe it is meant to be–just read to the end of this series.

I’m just wondering what would happen if the public started examining this procedure and started asking questions and being involved in how their lives are being managed. Organ donation has been pushed hard in recent decades and it is portrayed as purely benevolent–even by the Catholic Church with its provisos.

Everyone is prodded into participating through their driver’s license renewal forms in Ontario. In Ontario, we are not forced, thankfully, and we are not currently registered by default (which is called an “opt-out” system because to not participate in automatic registration, you have to “opt out”. Fortunately we still have an “opt-in” system). But we are being pushed and prodded into donation, so everybody should be entitled to know the details.

I found the the main websites in Ontario are not so upfront in their FAQs about what happens to “deceased” donors. I had to go to American websites.

Another topic is illegal organ donation and the abuses that happen with that. In that case, it’s clear that the poor can be exploited and suffer for it (as living donors for some organs). That’s a big topic (see other posts) but what happens with the illegal market is related to the fundamental question of values.

People shouldn’t just assume others “in charge” are making the right decisions–not at all.

What drives governments and some politicians and parties to push so strongly for increased organ donation? Why is it such a big deal as opposed to improving cancer treatment? It fits into a bigger picture and value system that sees human beings a certain way, and it is in conflict with the values expressed in the Canadian Charter of Rights and Freedoms for example, which state that human beings have freedom of conscience, etc.

When I was opposing opt-out (automatic default registration) organ donation for Ontarians years back (a post on this website), I was a naive libertarian who also thought the market could be applied so that donors could benefit (they do not receive funds in the current system), but this was a side issue and my main point at the time was to oppose coerced registration.

But I don’t believe that now–I think some things should be restrained by laws based on strong moral codes–to protect the vulnerable for example, which could be anybody in this case–and I think that would be a reasonable society, not an ideal society. In Ontario, supposedly we have a government-based health care system (but in reality government means public-private partnership in most countries I can think of, we’re talking about an even bigger kind of government)–but that does not protect us from all the moral pitfalls–and morality has to do with how we believe people should be treated.

And I believe it is clear that we have a conflict between two value systems–one that sees human life as sacred (with traditional religions) and the current Huxleyan value system that pretends to care, but which really sees humans as a resource or as a drain on society. And this is the value system dominating our institutions, media and our thinking apparently–as it has been sugar-coated with heavy doses of propaganda. More blatant expressions of this elitist value system were expressed by the early Fabian writers such as H. G. Wells and George Bernard Shaw–against those who are weaker and “unfit”. The values of the elites haven’t changed.

Continuing with the brochure, and discussing the determination of death:

Catholics understand death to be the separation of body and soul, which cannot be observed directly. Medical science determines that death has occurred based on signs that an individual’s ability to carry out the activities of life in an integrated way is irreversibly lost. Usually this is based on detecting a person’s permanent loss of a heartbeat and ability to breathe, but increasingly with the use of ventilators and other life-sustaining treatments, doctors rely on neurological signs.

In Canada, brain death, which has been defined as the irreversible loss of the capacity for consciousness combined with the irreversible loss of all brainstem functions including the capacity to breathe is generally accepted by the medical community and the public as equivalent to the traditional circulatory criterion of death. However there is no law relating to determining death in Canada and there are no uniform clinical guidelines for detecting brain death.

That last point seems critical to me.

Catholics who are considering organ donation should know that the Church has no official position on the particular medical criteria that should be used for determining when death has occurred. The Church relies on the expertise and judgment of scientists, clinicians, and ethicists for such questions . . . .

I think that highlights a weak point in the Church’s position. A religion’s value system–or maybe even a nation’s value system–should be held above the heads of “scientists, clinicians, and ethicists”. There could even be democratic accountability and modification to a value system to correct errors even, which might actually keep it from being pushed off course by minority agendas. A full system of direct democracy with a type of values-explicit constitution as its foundation could actually, contrary to what many conservatives assume, work to preserve values more effectively than anything. I don’t want to just use that as an ideal for a future that never comes. I’m saying that we should think about that as we work to survive in the midst of Brave New World chaos.

Continuing:

. . . Catholics should, however, be informed about the ways in which death is determined in Canada and the distinct ethical issues for organ transplantation that may arise with each method. When death is determined using the circulatory criterion, enough time should be allowed after a person’s heart has stopped beating to be morally certain that this loss is irreversible.

Regardless of the way death is determined, it states that there should be certainty, but how would a person know enough to be “morally certain” that the presumed death is irreversible? Even if there isn’t a soul, where does all the certainty come from with the current level of knowledge?

The motivation for certainty comes from the fact that they want to guarantee that the person is dead relatively soon–and they don’t want any doubts about it. However, blood and oxygen are going to be circulating (isn’t that uncertainty?!) before the organs are removed. So the tests they have sound very overly certain and absolute–and it turns out the set of brain death tests are very questionable for different reasons (jump to the last post if you like).

Because of the shift in perspectives, from looking at the same person as a patient and then as a donor, this process should be under scrutiny by everyone in our society–using their own sense of right and wrong–because everyone is encouraged to register as a donor.

Continued: Part 2