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Biological Responses in Context
Published in Arthur T. Johnson, Biology for Engineers, 2019
And then there are the psychosocial definitions of death, meant to satisfy complex legal requirements of human society. Clinical death occurs when there is no heartbeat and no spontaneous breathing (Smith, 1998). Brain death is characterized by no electroencephalogram (EEG) activity, a complete lack of reflexes, total failure to respond to stimuli and no breathing without a respirator. Social death involves terminally ill patients who are hospitalized for long periods before dying and require elaborate life-support equipment to maintain any semblance of life.
Ethics in Biotechnology
Published in Firdos Alam Khan, Biotechnology Fundamentals, 2020
There is currently a severe global shortage in the number of donor organs available for transplantation. For example, despite Ireland having one of the highest rates of organ donation (per million population) in the world, the number of people on transplant waiting lists there is increasing. Presently, Ireland operates an opt-in system where people are asked to sign an organ donor card. However, to reduce transplant waiting lists, other options are being explored, each with their own social, ethical, and economic implications. Traditionally, human organs used in transplants were acquired from brain dead donors (i.e., where permanent stoppage of all brain activity occurs). Now, the expansion of posthumous donation criteria to include cardiac death (i.e., where stoppage of heart and lung function occurs) is being contemplated, as is the establishment of a live donor program where organs such as kidneys are donated by a relative. Another system being considered is that of “presumed consent,” whereby if someone does not expressly opt-out (e.g., via their driving license form), they are presumed to be willing donors. Some international commentators have gone so far as to call for automatic posthumous donation, like other mandatory civil obligations like jury service or compulsory military service, where individual consent is not required. Due to the global shortage of donors, people have been using more sinister methods to procure organs for donation. In recent years, a black market in organs has arisen, where people from developed nations in desperate need of a transplant travel to developing countries and pay tens of thousands of dollars to receive a life-saving transplant. There are grave concerns that the commercialization of organ donation has led to the coercion and exploitation of the economically disadvantaged. People have also raised concerns regarding the practice in the Philippines where prisoners are offered the chance to have their death sentences commuted to life imprisonment in return for an organ, and in China, where organs are procured from executed prisoners.
Ethics in biotechnology
Published in Firdos Alam Khan, Biotechnology Fundamentals, 2018
There is currently a severe global shortage in the number of donor organs available for transplantation. For example, despite Ireland having one of the highest rates of organ donation (per million population) in the world, the number of people on transplant waiting lists there is increasing. Presently, Ireland operates an opt-in system where people are asked to sign an organ donor card. However, in order to reduce transplant waiting lists, other options are being explored, each with their own social, ethical, and economic implications. Traditionally, human organs used in transplants were acquired from brain dead donors (i.e., where permanent stoppage of all brain activity occurs). Now, the expansion of posthumous donation criteria to include cardiac death (i.e., where stoppage of heart and lung function occurs) is being contemplated, as is the establishment of a live donor program where organs such as kidneys are donated by a relative. Another system being considered is that of “presumed consent,” whereby if someone does not expressly opt-out (e.g., via their driving license form), they are presumed to be willing donors. Some international commentators have gone so far as to call for automatic posthumous donation, similar to other mandatory civil obligations like jury service or compulsory military service, where individual consent is not required. Due to global shortage of donors, people have been using more sinister methods to procure organs for donation. In recent years, a black market for organs has arisen, where people from developed nations in desperate need of a transplant travel to developing countries and pay tens of thousands of dollars to receive a life-saving transplant. There are grave concerns that the commercialization of organ donation has led to the coercion and exploitation of the economically disadvantaged. People have also raised concerns regarding the practice in the Philippines, where prisoners are offered the chance to have their death sentences commuted to life imprisonment in return for an organ, and in China, where organs are procured from executed prisoners.
Diagnosing death 50 years after the Harvard brain death report
Published in The New Bioethics, 2021
Francis J. O’Keeffe, George L. Mendz
The Report recommends that ‘brain death’ be understood as ‘the complete and permanent loss of brain function as defined by an unresponsive coma with loss of capacity for consciousness, brainstem reflexes, and the ability to breathe independently’ (Greer et al.2020, p. E4). The document suggests that the terms whole brain death and brainstem death be abandoned and replaced with ‘brain death’ or ‘death by neurological criteria’ (BD/DNC). The rationale is that the clinical diagnosis of whole-brain death or brainstem death typically leads to the same conclusion, ‘differing only in the rare case of isolated primary brainstem or posterior cerebral circulation pathology’ (Greet et al.2020, p. E4). The Report acknowledges that brain-stem death and whole-brain death are distinct concepts, and that in some instances a proper diagnosis of whole-brain death requires more stringent measures. The BD/DNC criteria have limitations because ‘there remains a possibility that a person whose brain stem is destroyed but who nonetheless retains some higher-brain functions could be declared dead in the United Kingdom but not in the United States’ (Hanley 2020, p. 35). Countries such as France, Italy, Spain and Singapore have legislated a ‘four vessel test’ that measures blood flow in the right and left carotid and vertebral arteries, the test requires that there be zero blood flow ascertained by angiography after contrast dye has been injected into the blood vessels supplying the brain (Tonti-Filippini 2012).
On the idea of person and the Japanese notion of ningen and its relation to organ transplantation
Published in The New Bioethics, 2019
To understand the extent to which Japanese people are against the idea of brain death, it is necessary to survey the history of organ transplantation in Japan. Transplantation’s success depends largely on the existence of a legal and social framework that supports the notion of brain death because unlike other forms of organ donation, donations from brain-dead patients are most often in an optimal condition for successful transplantation (del Río and Núñez 2008, pp. 135–147).