Support Innovation: Orange County, CA has become the hub for next generation medical technologies. Chronic diseases like Diabetes, Occular disease, obesity, orthopedics/spine, cardiovascular technologies.
Severe shortage of viable organs for transplantation in the U.S. has led a transplant surgeon to propose harvesting kidneys from people who are not dead yet
Dr. Paul Morrissey, an associate professor of surgery at Brown University's Alpert Medical School, wrote in The American Journal of Bioethics that the protocol known as donation after cardiac death
-- meaning death as a result of irreversible damage to the
cardiovascular system -- has increased the number of organs available
for transplant, but has a number of limitations, including the need to
wait until the heart stops.Because of the waiting time, Morrissey said that about one-third of
potential donors end up not being able to donate, and many organs turn
out to not be viable as a result.
Instead, he argues in favor of procuring kidneys from patients with
severe irreversible brain injury whose families consent to kidney
removal before their cardiac and respiratory systems stop functioning.
"These individuals, maintained on
mechanical ventilation, do not meet the criteria for brain death," he wrote. In these cases, the patient would be removed from life support and
kidneys
would be harvested while ensuring that the patient receives anesthesia
and pain relief during the operation. After that, the patients would be
kept comfortable until they have not had a pulse for five minutes, a
threshold at which they are declared dead.
"Under this protocol, the donor is alive at the time of kidney recovery,
but a determination has been made and confirmed by medical experts that
death is imminent," he wrote.
Kidney removal, he stressed, would not cause the death of the donor,
which is "instead caused foremost by the original catastrophic injury
and secondarily by terminating mechanical ventilation."
In addition to providing more organs usable for transplant, Morrissey
said this revised protocol would allow families to grieve in peace,
since surgeons wouldn't need to rush the body into the operating room to
remove organs. He said they could also take comfort in the knowledge
that their loved one's death saved other lives.
A number of experts responded to Morrissey's proposal in commentaries
published in the same journal. Some supported his arguments, while
others expressed concern that it wouldn't be in the donor's best
interests and could potentially violate medical ethics and the law.
Donald Marquis, a professor at the University of Kansas, wrote that Morrissey's argument has some validity.
Removing both kidneys, he said, "will not make the donor worse off than
the donor would have been in the absence of the nephrectomy."
"Though not dead yet, they are 'as good as dead' from an ethical
perspective," wrote Franklin Miller, a bioethicist at the National
Institutes of Health, along with Dr. Robert Truog, a professor of
medical ethics, anesthesiology and pediatrics at Harvard Medical School.
"No harm or wrong is committed by procuring vital organs prior to
stopping life support, provided that valid consent is obtained for
donation."
But removing both kidneys from a living donor would not always be in a patient's best interests.
"There is no reason to believe that registering as an organ donor
involves the willingness to undergo premortem double nephrectomy,"
argued bioethicists Maxwell Smith of the University of Toronto, David
Rodriguez-Arias of the Spanish National Research Council and Ivan Ortega
of Alcala de Henares University.
And Norman Cantor, a distinguished professor of law at Rutgers School of
Law, wrote that removing both kidneys before death could be legally
risky.
"An organ retrieval intervention poses some hazard of accelerating
death, as by hemorrhage or cardiac arrest," he said. "Any medical
action potentially accelerating death, even by a few minutes and even
for a gravely debilitated patient, demands a legally recognized
justification."
Removing one kidney, he said, could be legally defensible, but removing
both "would almost certainly be deemed unlawful under the current legal
framework."
In Orange County, Ca there has been a continued effort to nurture innovation in medical technologies that can treat chronic disease. It has become a hub for ophthalmology, obesity-weight loss, diabetes, orthopedic and spine, cardiovascular and heart valve disease. These innovative companies need investment support, so US does not have to depend on outside US innovation. The fear is, these companies might move their innovations to countries where funding for such innovation is available, resulting in higher cost of health care in the US.
For more information contact: Dr. Raj Nihalani, at: accessclinicaltrials@yahoo.com
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