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Donor Demised

Claim:   Doctors let die those patients who've indicated they'll donate their organs.

LEGEND

Examples:

[Collected via e-mail, October 2005]

My wife does not want me to be an organ donor because a few of her friends (who "just so happen to be ER nurses") claim that when an organ donor is in a life & death situation on the table, doctors will not try and save them so that their organs may be used.

This sounds like it defeats the purpose; letting one die so another can live. But, she swears that it's true.
 

[Collected via e-mail, December 2006]

I heard that having the pink organ donor ticket on your driver license will cause the Paramedics to allow you to die in order to harvest your organs. The rumor claims that due to the long list of people on the organ waiting list, the Paramedics are instructed to allow organ donors to die.

 

Origins:   Most people find the process of contemplating their eventual deaths quite disturbing, which is why so many put off making wills, taking out life insurance, discussing with the godparent they've selected for their children their hopes for their offspring, or making pre-need arrangements (the "pay before you go" plan) with funeral homes. That same reluctance attaches to the question of organ donation; many people put off making such decision out of distaste for having to admit to themselves that they too must someday die.

While in the abstract organ donation is a reasonable idea by which parts no longer needed by one person are put to use in the rescue of another, some potential donors shy away from it in the specific because it's far too unsettling an outcome for them to make their peace with: The notion of their corporeal bodies being cut into after death and their organs being removed is gruesome enough all on its own, but when coupled with the realization that the items so procured will be installed into entirely different people (indeed, total strangers), the full "ick" reaction sets in. Organ donation is seen by some as a cold process in which doctors reduce what had so very recently been living, breathing, sentient individuals down to mere reclaimable parts, in effect placing a value on the people that used to be as no more than the worth of what can be recycled from their bodies.

That
assessment of "person as no more than an assemblage of reusable parts" underpins a widespread bit of contemporary lore attaching to organ donation, that doctors or other emergency services workers will fail to treat or will otherwise hasten the passing of the seriously injured if those patients are known to have given permission for their parts to be reused after their deaths. "Don't sign an organ donor card," says the rumor, "lest doctors leave you to die so that they can speedily harvest what's left of you."

While the rumor would appear to confirm the belief that physicians involved in harvesting organs will happily sacrifice one patient in their efforts to secure parts for others, such belief overlooks one particular facet of this conjecture: Doctors who fail to provide their best medical care to their patients can and will be sued. As professional healers, they are held to a higher legal "standard of care" than is the average person and thus aren't afforded the luxury in life or death situations of not attempting to do all in their power to save those whose lives hang in the balance. Additionally, in those instances where patients died, doctors who did decide to scale back care could well be charged with homicide.

The United Network for Organ Sharing says about the rumor of doctors' slacking off when working on potential organ donors:
Myth: If emergency room doctors know you're an organ donor, they won't work as hard to save you.

Fact: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ donation can only be considered after brain death has been declared by a physician. Many states have adopted legislation allowing individuals to legally designate their wish to be a donor should brain death occur, although in many states Organ Procurement Organizations also require consent from the donor's family.
Not everyone who dies in an emergency room is a viable candidate for organ donation. When it comes to harvesting transplantable material, time is so very often of the essence. Proper removal, storage, and shipment of such organs can take place only within a very limited window of opportunity. For this reason, those who have been pronounced brain dead and are on ventilators make the best candidates. That's why organ donors are usually accident victims with severe head injuries or people who have suffered catastrophic brain damage from natural causes such as a stroke.

Prior to the 1970s, "donation after cardiac death" (DCD) was the standard; the cessation and non-resumption of the beating of patients' hearts was used as the definition of death as far as organ retrieval for the purpose of transplantation was concerned. However, that changed in the 1970s when patients had to be declared brain dead by the doctors working on their cases before organ retrieval could be undertaken. (While it might seem obvious that there is only one moment of death, there are actually a few since not every component of a person stops working at the same instant.) In the 1990s, "non-beating heart" donations came back into vogue, a shift that allowed for the collection of organs from patients who had endured horrific brain damage (usually via a car accident or stroke) yet were still technically alive because their life functions were being maintained by machines. In those cases where family members had made the difficult decisions to discontinue ventilators or other life-sustaining treatments that were maintaining their loved ones, organ bank representatives could then talk to them about donation. Such patients would be removed to operating rooms where mechanical assistance would be withdrawn from them, then five minutes after their hearts had stopped beating surgeons would begin the process of harvesting their reusable parts. (The National Academy of Sciences' Institute of Medicine declared such practice ethical provided the decision to withdraw care was independent of the decision to donate organs and that surgeons waited until at least five minutes after the heart had stopped.)

This controversial approach to the procurement of usable organs has resulted in a marked increase in the number of organs collected and therefore in the number of transplants completed; however, some feel it has done so by sacrificing the best interests of the donors who are hurried through death's door. There is also potential for family members to feel pressured into terminating life-sustaining treatments they otherwise would have continued, as well as the specter of surgeons hovering over the about-to-expire, scalpels in hand, a mental image that borders on the macabre.

The "wait five minutes before proceeding" standard is also more of a guideline than a rule: doctors at some hospitals wait three minutes, others two. In Denver, surgeons at Children's Hospital wait only 75 seconds before starting to remove hearts from infants in order to maximize the chances that the organs will be useable.

The rumor about organ-hungry doctors prematurely offing potential donors gained an unfortunate shot in the arm from a 2006 case in San Luis Obispo, California.

Ruben Navarro, a 25-year-old man who suffered from the neurological disorder adrenoleukodystrophy as a child (by his early 20s his mental and physical condition had deteriorated to a point where he was placed in an assisted-care facility), was admitted lifeless and unresponsive to the Sierra Vista Regional Medical Center on 29 January 2006. His organs were subsequently retrieved for transplant five days later. (Those transplants, by the way, never took place because Navarro survived for more than seven hours after he was removed from life support and was given certain drugs, so his organs had deteriorated too much to be usable.)

Prosecutors charged Dr. Hootan C. Roozrokh, the surgeon who removed Navarro's organs, with felony counts of dependent adult abuse, mingling a harmful substance (Betadine) and prescribing a controlled substance (morphine and Ativan) without medical purpose. It was their assertion that rather than allow Navarro to die naturally, the doctor knowingly hastened the process by introducing into him excessive amounts of narcotic painkillers and sedatives for the express purpose of killing him. The doctor was also said to have administered the antiseptic Betadine through a feeding tube into Navarro's stomach while Navarro was still viable, a sterilization procedure typically done after a donor is dead (since it's likely to kill the living).

Roozrokh's attorney argued Navarro "was going to die shortly, whether in minutes or in hours" and said of the excessive painkillers used that "In that situation, you err on the side of ensuring that he's pain-free." Over-medicating the dying with morphine is not at all a new practice; terminal patients are sometimes given unusually high or overly-frequent doses of the drug in an effort (generally unstated but also generally understood by both medical staff and family members in attendance) to help the dying slip through death's door a bit more quickly and thus terminate sufferers' torments sooner. Such practice is generally roundly denied when spoken of openly, however.

In December 2008, Dr. Roozrokh was found not guilty of dependent adult abuse, a felony that carries a prison sentence of up to four years.

David Fleming, the executive director of Donate Life America, a nonprofit group that promotes donations, said this isolated case has "given some support to the myths and misperceptions we spend an inordinate amount of time telling people won't happen."

Barbara "the lone disarranger" Mikkelson

Last updated:   14 April 2014

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Sources:

    Chawkins, Steve.   "Doctor's Action Defended."
    Los Angeles Times.   29 February 2008   (p. B4).

    Chawkins, Steve.   "Transplant Surgeon Acquitted."
    Los Angeles Times.   19 December 2008.

    McKinley, Jesse.   "Surgeon Is Accused of Hurrying Death of Patient to Get Organs."
    The New York Times.   27 February 2008   (p. A1).

    Ornstein, Charles.   "Surgeon Pleads Not Guilty in Transplant Case."
    Los Angeles Times.   13 September 2007   (p. B5).

    Stein, Rob.   "New Trend in Organ Donation Raises Questions."
    The Washington Post.   18 March 2007   (p. A3).