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Posted on February 8, 2019 at 3:21 PM
By Jon Holmlund

The ethical practice of human organ transplantation entails
consent from a donor to donate an organ while still living (e.g., one of the
donor’s two kidneys), or after dying (e.g., the heart).  In the latter case, it is still generally
accepted that the donor must be dead first, and that the harvesting of the
vital organ to be transplanted not be the cause of the donor’s death.  This is referred to as the “dead donor
rule,” the interpretation of which is open to some controversy (about
which more in a future post).  But it is
still generally followed.

Periodically, one reads of suggestions or practice that
violates this.  In 2006, the bioethics
observer Wesley Smith posted
about proposals in the medical ethics literature to the
effect that some had said that patients permanently comatose but not dead, in
what is known as a “permanent vegetative state” (PVS), could
ethically not only have their organs harvested for transplant, but be human
subjects for experimentation involving the transplant of animal organs into
them, to try to learn how to improve that practice, called
“xenotransplantation.”  Presumably,
these “donors” would have previously “consented” to have
their organs harvested—essentially, to be killed—if they became persistently
comatose.  The validity of such
“consent” is of course questionable, and the prospect of the practice
should be seen as abominable.  An
argument in favor seems to rely on the notion that it’s too risky to transplant
animal organs into humans who have full brain function and seem to be more
clearly alive than PVS patients (suggesting they be seen as dead), or that there
is some envisioned state where a PVS patient could potentially benefit from the
animal organ and give consent in advance. 
The former is disturbing, and the latter implausible.  A link to one proposal that appears to be in
favor is here, and to arguments
raising concerns, here and here.

(More to follow in a future post on comments about
xenotransplantation from the recent Hastings Center conference on the 50th
anniversary of the development of brain death criteria.)

More recently (again with the blogger’s “HT”
to Smith
), not only is organ harvesting after euthanasia apparently
performed, on occasion, in countries that permit euthanasia, but a
transplantation medical journal has carried an article arguing for “organ
donation euthanasia,”
wherein someone who had previously
requested euthanasia could also “request” organ donation while still
alive—essentially, authorizing the removal of the heart as the means of active euthanasia.  Now, what is first in view is harvesting a
kidney, which would not cause death, but if someone is in a state where
euthanasia is perceived as a preferred option, why would someone want to undergo
invasive surgery first? 

If euthanasia is accepted, then this troubling stance on
organ donation will be difficult to resist.

At least the above pay lip service to “advance,
informed consent.”  This week, an
article in the Wall Street Journal
calls attention to the covert but well-attested practice in China to
accommodate demand for organ transplantation without the encumbrance of a
waiting list, by harvesting organs from prisoners of conscience, such as
political dissidents, who are given a mortal but not immediately fatal wound,
then have their organs removed before they are dead—satisfying the
“need” for a donated organ while finishing the prisoner off.  Because of this practice, several countries
have prohibited their citizens to travel to China for “transplant
tourism,” just going there to get their transplant.  What the Chinese seem clearly to be doing
should not be supported, by anyone.

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