In the most recent Human Life Review a piece is reprinted from the HLR blog called "Coming to Peace with Brain Death." The title notwithstanding, the post actually indicates that the author, journalist Nona Aguilar, is far from being at peace with brain death.
She tells the story of her friend Richard, for whom she had medical power of attorney. Aguilar says that ten years ago her friend had a stroke. She was then strongly pressured by the hospital to agree to having his heart taken for transplant. The hospital told her that he was brain dead.
We find a crucial detail in Aguilar's account, which I emphasize below:
When I ran through the hospital’s swinging doors, signed health care proxy in hand, I learned that Richard was completely non-responsive. Further tests the following day indicated his condition remained unchanged.
In other words, he was brain dead.
A young nurse from the hospital’s organ transplant team came into Richard’s room to talk to me. Richard’s close friend Barbara was also there, so the nurse spoke to both of us. The question: Would I authorize an organ donation? Specifically: Would I authorize removal and donation of Richard’s heart?
For a heart transplant to be successful, the donor heart must be alive, throbbing and beating at the time of removal. The problem: The medical people considered Richard to be dead. I didn’t.
Despite the nurse’s wonderful, calm manner, I became stressed, upset. Could I think about it? Of course, but an answer as soon as possible was important.
I launched a frantic effort to learn about “brain death.” Richard’s medical reports, which were explained to me in excruciating detail, belied what I saw: a man who appeared to be peacefully asleep, breathing on his own.
First of all, it is simply untrue that "completely non-responsive" without likelihood of becoming responsive is "in other words...brain dead." That is not what "brain dead" allegedly means in the medico-legal literature. It allegedly means that the physical brain, including the brain stem, has completely ceased to function. I have raised questions as to whether there is such a condition, without concomittent cardiac arrest, that is reliably diagnosable, but let's keep it clear: Being unresponsive or being in a so-called "persistent vegetative state" or anything of that kind, whatever the prognosis, isn't even what brain death is alleged to be.
The most striking point here is this: No one is ever supposed to be diagnosed as brain dead while breathing on his own. Ever, ever, ever. Independent breathing indicates brain stem function. See here, for example.
What Aguilar reports should be a bombshell. Any hospital that made a diagnosis of brain death and tried to take organs from a person who was breathing independently was attempting to commit murder by every possible criterion. Even if one believes firmly that there is such a thing as total brain death, that it can be reliably diagnosed, and that a person diagnosed as brain dead is biologically dead, this one shouldn't even have been close. It should have been a cut and dried case: This patient is unambiguously, undeniably biologically alive.
So striking was this portion of Aguilar's report that I thought of trying to get her contact information and writing to her to ask her to confirm that her friend Richard was not on a ventilator. But I see that a commentator in the comments thread, John Janaro, has done that already. (For some reason I cannot seem to link individual comments. His comment was posted in the thread under the entry at 3:47 p.m. on July 14.)
Aguilar immediately responds and is adamant: Richard was definitely breathing on his own without a ventilator.
Understandably enough (I imagine any lawyer would advise this), she does not name the hospital. But this should be a scandal for that hospital. No hospital should ever under any circumstances say that a patient is brain dead and wheel him to an operating room to take his heart out if he is breathing on his own.
Not to keep you on tenterhooks, I will tell the end of the story: Richard went into cardiac arrest as he was being wheeled away to have his heart removed in the operating room. So he died of natural causes before they could kill him.
I am not claiming that this sort of thing happens often. At this point, I simply don't know. My own research on this indicates that most of the time hospitals at least try to cross the pons asinorum of diagnosing brain death: Is the patient breathing independently? In fact, I have never before heard of a case of this kind.
The most grisly cases I know of involve a) patients connected to ventilators who manifest physiological pain responses while undergoing organ harvesting or b) patients who are diagnosed as dead by the Pittsburgh Protocol, also known, misleadingly, as non-heart-beating donation, rather than by brain death criteria. In the case of NHBD there is genuine reason to fear that the patient could actually revive during harvesting, because the patient's heart has stopped only for a very short time before circulation is restarted. (See the second part of the post here.)
But a hospital that diagnoses a patient with both a beating heart and independent breathing as brain dead and wheels him toward the operating room to take out said beating heart--that's a new one on me.
So I have to recalibrate. How often is this happening? Was this an aberration for that hospital? Has that hospital gone on doing it? Do other hospitals do it? Why didn't the other people whom Aguilar desperately consulted tell her that something was seriously wrong with the hospital's diagnosis?
The story Aguilar tells should be more widely known, especially by people considering agreeing to vital organ donation for themselves or for loved ones.