Frozen Ethics: Melting the Boundaries between Medical Treatment and Organ Procurement

Abstract

When Renee Fox, medical sociologist and noted historian of organ transplantation, first learned of the proposal to use non-heart-beating cadavers as organ sources more than 25 years ago, she was appalled. She labeled the proposal the most elaborately macabre scheme for obtaining organs that I have encountered, adding that it borders on ghoulishness. She saw the procedure as beyond the pale of the medically decent, morally allowable, and spiritually acceptable (Fox 1993, 232). But medically decent has seldom gotten in the way of procuring organs for transplant, and we now seem to be on the verge of adopting an uncontrolled version of organ procurement from a non-heart-beating cadaver. In their commentary describing this new procedure (uncontrolled donation after circulatory determination of death or uDCDD), Arjun Prabhu, Lisa Parker, and Michael DeVita seek to normalize uDCDD by pairing it with an equally disturbing, highly experimental, long-shot emergency intervention for cardiac arrest due to exsanguination (emergency preservation and resuscitation or EPR) (Prabhu et al 2017). They argue that the central ethical question presented by uDCDD is how a hospital can avoid the appearance of conflicts of interest when proposing both uDCDD and EPR. A more fundamental ethical question, we suggest, is whether either of these procedures both done without informed consent on minority communities whose members will be used as human guinea pigs-should be done at all