The Wall Street Journal says 52-year-old Robert Osterrieder, a registered organ donor, was a “go-to-guy,” always willing to help.
Osterrieder’s wife and children thought organ donation reflected the way he had lived. But when they wanted to donate one of his kidneys in 2012, they couldn’t do it because Osterrieder was still alive.
Osterrieder suddenly experienced problems with his vision. Two days later, he was on a ventilator. After five months, he remained unconscious. His family decided to terminate life support.
Doctors said his heart would beat for hours after removal of the ventilator, and his organs would become unusable. So the family wanted Osterrieder to be a “living donor.” The removal of one of his kidneys wouldn’t be fatal. Life support would be terminated several days later.
Osterrieder’s doctors and hospital ethicists ascertained that his family was united in support of donation and became convinced that donation would be consistent with Osterrieder’s wishes, could he express them. But how would the family cope if their decision made the news? Criticism of their choice could be severe.
Nobody backed down.
The regional procurement agency contacted 14 transplant centers. Not one surgeon would perform the operation, citing ethical concerns and potential harm to the transplant process.
The family terminated life support. Osterrieder died 48 hours later. None of his organs could be transplanted. The Osterrieders felt they’d been denied the “sliver of comfort” they could have had if Osterrieder’s death could have saved someone else’s life.
“It was crushing,” son Daniel Osterrieder, 29, said.
The Osterrieder case was cited in The New England Journal of Medicine. It was presented to the ethics subcommittee of the United Network for Organ Sharing, which oversees the national transplant system. Osterrieder’s wife, Kathy, continues to advocate for rule changes.
A report by the UNOS working committee on “imminent-death donation” – a living donor’s surrogate allows donation before life support is withdrawn – will be posted for public comment. The report says the practice may be ethical depending on the circumstances, but some people disagree.
Dr. Neil Wenger, chairman of the UCLA Medical Ethics Committee, says that donation based on a patient’s assumed consent is, for some people, “a leap of faith that is unconscionable and for others a reasonable extension of the way we approach these cases.”
Many stakeholders with different and sometimes conflicting needs and viewpoints interact in the organ donation process – doctors, ethicists, regulators, procurement agencies, donor and recipient families. A stakeholder unmentioned in the coverage I read is the medical examiner.
Medical examiners and coroners have veto power over organ donation in deaths that fall under their jurisdiction. Some use it, typically in cases of suspected homicide or child abuse. Some, like me, do not.
I think it’s the medical examiner’s job to do whatever is necessary to fulfill the statutory obligations of death investigation while still supporting organ donation. If that means observing the procurement procedure, that’s what you should do.
An “imminent-death donation” case wouldn’t come under medical examiner scrutiny before donation. Medical examiner jurisdiction doesn’t kick in until after death. But if somebody died shortly after removal of an organ, the medical examiner or coroner might be asked to determine if the procurement procedure played a role in the death and if so, to certify a manner.
I fear a few might find imminent-death donation “unconscionable” and certify such a death a homicide. I wonder if the UNOS working committee ever thought to ask.
Dr. Carol J. Huser, a forensic pathologist, served as La Plata County coroner from 2003-12. She now lives in Florida and Maryland. Email her at firstname.lastname@example.org.