Some thoughts about organ and tissue donation when hastening death

Over 95% of Americans support organ and tissue donation, so it should not be surprising that many of us in the right-to-die movement also support such donations.  However, those who choose to hasten their deaths will usually end their lives in their home, rather than in a hospital.  Death at home prevents the donation of organs, but still leaves open the possibility of donating tissue. 

There are three sources for organ and tissue donation:

1.  Donation-after-brain-death (DBD), which began in the 1970s after the adoption of neurological criteria to determine death, refers to irreversible brain death, after which a breathing machine is used to keep oxygen going to the organs until they are recovered for transplant.

2.  Living body donation, which refers to a donation by a living person, is limited to a kidney; a lung or a portion of the lung, liver, pancreas, or intestine; and blood and bone marrow.  Living donors provide about 17% of organ donations each year.

3.  Non-heart beating cadaver donors (NHBCD), which refers to those who have no heartbeat or respiration, may be referred to as donation-after-circulatory-death (DCD) donors.

If a DBD or DCD death occurs in a hospital, almost all organs and tissue can be donated, though DCD death protocols generally require waiting for five minutes after cessation of the heart to assure that there is no possibility of auto-resuscitation.   Any waiting period may compromise the quality of the major organs because cell death begins immediately after the blood stops circulating, but waiting is necessary to prevent taking organs from someone who is not clinically dead.  As a result, some major organs deteriorate too much to remain useful for transplantation, or may not be in optimum condition for transplant, reducing the life-span of the transplant.  The five-minute protocol is not universally followed, and may be as little as two minutes in some hospitals.

People who die at home, rather than in a hospital, fall into the third category of sources for donation.  Their major organs (heart, lungs, kidneys, liver) will not be viable for transplantation, but several kinds of tissue still can be successfully donated if their bodies are discovered shortly after death and time of death can be reasonably determined.  Recoverable tissue may include corneas, sclera (the white of the eye), heart valves, skin, bone, tendons, and ligaments.

A bioethics article in America–The Jesuit Review explains, “[DCD] quickly leads to tissue deoxygenation and organic ischemia, which renders the organs nonviable. The continuously profused organs of living donors, or donors meeting the neurological standards for death, do not incur these problems.”  Ischemia is the decrease of blood supply to an organ or tissue with the concomitant loss of oxygen supplied by the blood, referred to as hypoxia.

Tissue donation is possible despite the presence of lethal drugs or gases in the body. States with voluntary assisted death (VAD) laws provide that lethal drugs may be prescribed for someone who qualifies for assistance under those laws.  Others who choose to hasten their death may use inert gas.  Neither barbiturates nor nitrogen, the commonly used substances in hastened deaths, will harm the transplantable tissue.  If the body is refrigerated soon after the death, there may be as long as 24 hours from the time of death to harvest the tissue.  The earlier the discovery of the death, the greater the likelihood that tissue donation is possible.

After a death of someone who wishes to be a donor, the tissue procurement organization, often a non-profit organization that may be part of a blood bank, will evaluate the tissue for suitability, usually at a facility that can hold the body in refrigeration, such as a coroner’s office, tissue bank, or funeral home.  The evaluators look for infectious disease and other medical conditions which might make tissue unusable for transplantation.  If the tissue is deemed usable, the organization will remove it and process it.

Another donation opportunity is what is commonly termed whole body donation.  This can be done through a state’s Willed Body Program (mainly used by medical schools and teaching institutions) or a forensic research program, usually associated with a university.

Whole body donations also can be made to a tissue and body parts procurement organization that provides tissue and body parts for research and teaching.  The unused parts of the body normally are cremated and can be returned to the family of the deceased.  Some such procurement groups are Medcure, Science Care, Life Legacy, and Genesis Legacy.  

However, some of these body procurement programs have been termed “body brokers” by critics.  Such non-transplant tissue banks acquire cadavers, usually by offering free cremation as an incentive for donation.  They then process the cadaver for usable tissue and body parts to sell for research and demonstration (often to medical product manufacturers), though the price charged is based, presumably, on the processing work they perform in this largely unregulated business.  More information on such organizations can be found here and here.

In countries where VAD laws allow injections of lethal substances, such as Canada and Belgium, the procedure can be done in a hospital, where both organ and tissue procurement would be possible.  This article discusses one such case.

If you are interested in being an organ and tissue donor, don’t think that your age will affect your ability to donate.  Several organ and tissue procurement organizations and medical organizations emphasize the following:

“There’s no defined cutoff age for donating organs [and tissue]. The decision to use your organs is based on strict medical criteria, not age. Don’t prematurely disqualify yourself. Let the doctors decide at the time of your death whether your organs and tissues are suitable for transplantation.”

There is no medical reason why a person who hastens their death because of suffering or unacceptable quality of life should be precluded from being an organ or tissue donor.  What is important is the medical history of the prospective donor, the location at time of death, and the timely discovery of the body after a non-hospital death, which affects tissue donation.

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Thanks to Ted Ballou and Tom Tuxill for their research into the effect of inert gases on organs and tissue.