'Back from dead' case sparks ethical debate

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'Back from dead' case sparks ethical debate

Post  Ana on Mon Jul 14, 2008 2:37 am

'Back from dead' case sparks ethical debate
By Estelle Shirbon in Paris
June 11, 2008 07:55am
Article from: Reuters

THE case of a man whose heart stopped beating for 1-1/2 hours only to revive just as doctors were preparing to remove his organs for transplants is fuelling ethical debates in France about when a person is dead.

The 45-year-old man suffered a massive heart attack and rescuers used cardiac massage to try and revive him without success before transferring him to a nearby hospital.

Due to a series of complex circumstances, revival efforts continued for longer than usual for a patient whose heart was not responding to treatment, until doctors started preparations to remove organs.

It was at that point that the astonished surgeons noticed the man was beginning to breathe unaided again, his pupils were active, he was giving signs that he could feel pain - and finally, his heart started beating again.

Several weeks later, the man can walk and talk.

"This situation was a striking illustration of the questions that remain in the field of re-animation ... and what criteria can be used to determine that a re-animation has failed," says a report on the case, published online by an ethics committee.

The case has stirred debate among medical professionals and daily newspaper Le Monde on Tuesday dedicated a full page to the subject under the headline: "The organ donor wasn't dead".

"What is under consideration here is the status of a person, whether they are a patient who can be re-animated or a potential (organ) donor," said the ethics committee report.

The hospital where the man was treated is one of only nine in France that are allowed to perform organ transplants on patients in cardiac arrest, in very specific conditions, under a pilot programme launched in 2007. Elsewhere, organ transplants are possible on other categories of patients under older rules.

The programme, which was approved by the French agency in charge of bio-ethics, aims to help reduce the number of people waiting for a transplant by making it possible to take organs from new categories of patients.

Le Monde said more than 13,000 people were waiting for transplants in France and 231 people died last year as a direct result of the lack of a donor. The newspaper said the pilot programme had already yielded an extra 60 organs.

Assistance Publique-Hopitaux de Paris (AP-HP), a body that runs public hospitals in the Paris region, has set up a committee specifically to discuss ethical issues arising from the practice of transplants on people in cardiac arrest.

The committee, made up of medical professionals involved in the revival of heart attack patients as well as organ transplants, held lengthy discussions on the case of the man on Feb. 19 and a summary was later published on the AP-HP website.

"During the meeting, other re-animators ... spoke of situations in which a person whom everyone was sure had died in fact survived after re-animation efforts that went on much longer than usual," say the minutes of the committee meeting.

"Participants conceded that these were completely exceptional cases, but ones that were nevertheless seen in the course of a career."

My Commentary This article could be used for the discussion of human rights and some ethical issues in the medical sector. This rare incident shows that re-animation could happen to any patients who are about to die but the percentage is very low. This brings about the question on whether doctors should perform organ transplant even before the patient is confirmed dead or should they try to rescue the person(like how they treated the man while they were waiting for the surgeons to arrive) before they are dead? The reason why we should massage the heart is because as according to all the specialist literature, “anyone whose heart has stopped and has been massaged correctly for more than 30 minutes, is probably brain dead. But we have to accept that there are exceptions … There are no absolute rules in this area.”, according to Professor Alain Tenaillon, the organ transplant specialist at the French government’s agency of bio-medicine .In my opinion, the patients should be given the opportunity to survive to the very end as miracles may happen.
So how do doctors certify that the patient is dead before he is suitable for an organ transplant? In, Singapore, only one doctor is needed to certify a cardiac death (which is the most common form of death). This is according to the Singapore Human Organ Transplant Act (HOTA).I think that one doctor is not enough to determine the cardiac death. Perhaps there could be two or more doctors confirming the patients’ death to improve the level of accuracy.

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Re: 'Back from dead' case sparks ethical debate

Post  hafizuddin on Mon Jul 14, 2008 9:04 pm

i agree that this article is a very debatable issue, as one must address the patient's,community's,medical and religious perspective. how do we confirmed if the patient has survived "to the very end". I agree that we should to refer to several specialised doctors in different fields to confirmed the death statement but also seek permission from the patient's relatives to resume the organ-transplant. Despite inefficiency by doing so, one must respect life of the patient and his loved ones.

To what extent should lives of other patients be saved in the expense of others,who are in the verge of death but still might possess an oppotunity to continue living, in hope of a miracle.
Perhaps, in future to come, advancement in science and technology can help reduce dependence on human organ-transplant by refining animal organ-transplant to be safe and usable. However, another issue that rises is how to receive the cooperation of the community and the duration of this discovery of a substitute procedure.


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Re: 'Back from dead' case sparks ethical debate

Post  Naim Le Victoria on Mon Jul 14, 2008 10:11 pm

interesting article to start off with.
the review is like an AQ answer.
not in a bad way though.
im impressed at how a qoute from a renowned individual was used to support the review.
it is also good to see how contents from the article was able to be related to local context.
you may also include that this issue has proven that doctors are basically human, even they make mistakes, even though it may cost a person his or her life.
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Post  WANJING on Tue Jul 15, 2008 10:34 pm

I agree with your comment that one person is insufficient to judge the death of one's life. There should be more doctors, perhaps three, to certify one's death. This will improve the accuracy and mistakes will be minimised. Problems like unnecessary court cases and bad reputation will be eliminated. However, this might not be an effective measure. There are several cases which shows that wrong judgement of death still occurs even with a pool of certified doctors to do the job.

An example : A man whose family agreed to donate his organs for transplant upon his death was wrongly declared brain-dead by two doctors at a hospital in Fresno, California. Only after the man's 26-year-old daughter and a nurse became suspicious was a third doctor, a neurosurgeon, brought in. He determined that John Foster, 47, was not brain-dead, a condition that would have cleared the way for his organs to be removed, records of the Feb 21 incident show. 'It kind of blew my mind,' said the daughter, Ms Melanie Sanchez, 'like they were waiting like vultures, waiting for someone to die so they could scoop them up.' Mr Foster, who had suffered a brain haemorrhage, died 11 days later at Community Regional Medical Centre in Fresno. By then, she said, his organs were not viable for donation. The apparent close call is the second in recent months to raise questions about the organ transplant process amid a national organ shortage. Police in San Luis Obispo County are looking into a case where a transplant surgeon may have tried to hasten the death of a 26-year-old patient last year by ordering high volumes of pain medication. Organs cannot be retrieved until a patient is declared legally dead.

The Straits Times
13 April 2007
(Orginally from Los Angeles Times)

I also agree with another point of yours that "the patients should be given the opportunity to survive to the very end." Miracles do happen. It is whether if you choose to believe in it or not. If one is never given that chance (even if it's a slim) to survive, he/she will never be able to come back to life. In other words, this process is irreversible. Therefore, human transplant operation should not be carried out for patients who are considered 'dead' under the HOTA.

A question i would like to raise, which is :
Is ending one's life who are considered 'dead' under HOTA a form of murder?

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Re: 'Back from dead' case sparks ethical debate

Post  giselle on Sun Jul 20, 2008 11:40 pm

i agree that one doctor is not sufficient to certified the death of a person. Singapore definitely have to look into this issue of having one doctor would be sufficient. This is to minimise future problems from both the families of the recipient and donor, for example when the donor was wrongly certified dead. So how do you ensure that one person is really dead when there are so many incidents where people were revived after months they have been certified brain dead?

i guess there should be some form of policies to protect the rights of the "dead" where there's a certain rules to follow and also gain approval before they can remove the organs. The removal of organs in some beliefs means that the person is not dead as a 'whole' where this is against some values of ethics and religions. Since this issue have already led to an ethic debate, i believe some world organisation should step out to address this issue before resulting to further furious debates.


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