The nightmare scenario of organ donation

While the claim that organ donation almost always involves killing a living person may strike most Catholic ethicists and physicians as exaggerated, few dispute the potential for abuse. The recent case of Ruben Navarro offers a chilling nightmare scenario.

Navarro died in February 2006, just six days shy of his 26th birthday, in a hospital in San Luis Obispo, Calif. Suffering from a degenerative genetic disease, Navarro lapsed into a coma and eventually lost his pulse. His mother decided it was time to let her son go, and told doctors to discontinue his ventilator. Informed that he was a candidate to be an organ donor, she consented to a procedure known as “donation after cardiac death,” in which Ruben would be wheeled into an operating room, removed from his ventilator and allowed to die, at which point a team of transplant surgeons would swiftly remove his organs.

(“Donation after cardiac death” differs from transplants involving brain death, because donors still have some brain activity. Life support is removed and death is verified by cessation of breathing and circulation. It’s critical that this happen in a matter of minutes because otherwise the organs deteriorate.)

In theory, Navarro’s care was supposed to remain the paramount concern of the medical team until he was actually dead, with transplant surgeons stepping in only after death had occurred. In reality, a Kaiser Permanente specialist who had flown in to perform the procedure repeatedly directed nurses to administer massive doses of sedatives. Within 40 minutes, Navarro’s levels of morphine and another painkiller soared to 20 times above normal dosages. The sedation served no medical end, prosecutors would eventually conclude, other than to hasten Navarro’s death so his organs would remain viable.

The physician’s apparent callousness shocked even his colleagues: “Let’s just give him more candy,” is how one nurse recalled his words. The physician, Dr. Hootan Roozrokh, was eventually charged with three felony counts, including “dependent adult abuse” and “unlawful prescribing of a controlled substance,” the first time a surgeon has faced criminal action in a transplant case. On Oct. 29, he pleaded “not guilty” and is awaiting trial.

In the end, Navarro still didn’t die quickly enough, so the procedure was scrubbed and he was taken to a patient room, reportedly frothing at the mouth and squirming. He died the following morning.

Though experts say what happened to Navarro is an aberration, the sense of urgency to expand the organ supply is undeniably widespread. In the United States, there were 29,000 solid organ transplants in 2006, according to figures from the American Medical Association, while as of June 2007, 97,000 people languished on the waiting list. Solid organ transplant involves kidney, liver, pancreas, heart, lung, cornea, bone marrow and bone and soft tissue. Estimates are that 17 Americans die every day awaiting a transplant. A February 2007 report from the President’s Council on Bioethics predicts that given rapid aging of the population, a projected surge in diabetes, and other factors, the gap between the supply of organs and the demand will continue to grow.

Catholic ethicists say the Navarro case offers a “wake-up call” about protecting patients against these pressures.

“Many of us have reviewed our policies and procedures because of it,” said Jesuit Fr. Peter Clark, director of the Institute of Bioethics at St. Joseph’s University in Philadelphia. For example, Clark said, there’s a need for a uniform standard of how long one has to wait with a “donation after cardiac death” case to pronounce the donor dead; current practice varies from 75 seconds to 10 minutes.

The June 2007 issue of Health Care Ethics USA, published by the Catholic Health Association, was devoted to discussion of donation after cardiac death, also called “non-heart beating donation.” Two authors recommended caution on matters such as ensuring that donors are truly dead, and avoiding procedures such as administering anticoagulant drugs to ensure a steady flow of blood that could harm the patient. James Dubois of the Center for Health Care Ethics at St. Louis University, on the other hand, argued that with appropriate safeguards, donation after cardiac death is “consistent with the principles of medical ethics.”

-- John L. Allen Jr.

National Catholic Reporter, November 16, 2007