Ever since its inception in the 1950s, organ transplantation has been accompanied by questions about the ethics of taking organs from the dead and living and giving them to others. Discussions abound among physicians, ethicists, policy makers, and the public. At first living and willing relatives were used as organ sources for transplantation, due to antigenic incompatibility between unrelated persons. But with the development of powerful immunosuppressive drugs came an increase in cadaveric grafts. The supply shortage of transplantable organs stimulated society to search for new ways of procuring them. At the end of the 1960s, when surgeons first contemplated the systematic use of irreversibly unconscious patients as a source of human organs, a new legal definition of death was urgently needed to protect physicians from being charged with murder. It was essential that the new death be a diagnosable event and that it be timed to allow the removal of organs before onset of ischaemia.
[...] The Virtues in Medical Practice. New York, NY: Oxford University Press; 1993:124. Jonsen AR. What does life support support? In: Winsdale ed. Personal Choices and Public Commitments: Perspectives on the Humanities. Galveston, Tex: Institute for the Medical Humanities; 1988:66-67. Youngner SJ, Landefeld Coulton CJ, Juknialis BW, Leary M. "Brain death and organ retrieval: a cross-sectional survey of knowledge and concepts among health professionals". JAMA. 1989; 261:2205-2210. Halevy Brody B. Brain death: reconciling definitions, criteria, and tests. Ann Intern Med. 1993; 119:519-525. [...]
[...] Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. BMJ 1996; 313: 13-16.- The House of Lords in Airedale NHS Trust v. Bland [1993] 1 All ER 821, [1993] 2 WLR 316 ultimately had to decide whether that young man should live or die. Anthony Bland had been in a PVS for four years when his family and doctors applied to the Court for a declaration that to withdraw nutrition and hydration would be lawful. Their lordships were in complete agreement that a doctor is under no duty to provide or continue treatment which is not in the patient's best interests and that Tony Bland's condition was irreversible, rendering the continuation of treatment “futile”. [...]
[...] The concept of brain death is seen by many as a creation of technological medicine, devised to hasten the end of life. Possible revisions to the meaning of brain death are emerging; including alterations to its criteria to expand the pool of organ donors so that brain death may be understood as imminent death. But my position is different. The term brain death, with its ambiguity, should be dropped. A diagnosis of irreversible loss of consciousness together with a permanent loss of spontaneous breathing should be medically and legally recognized as death of a person,”[39] this would not affect decisions about organ donation as they stand at present. [...]
[...] However, intensive care units have developed to replace both the respiratory functions as well as the hormonal and other regulatory activities of the damaged stems.[25]This technology is utilized in cases in which a pregnant woman is diagnosed as brain-dead and an attempt is made to maintain her until the foetus reaches viable gestation, as well as for prolonging the organ viability of brain-dead patients awaiting organ procurement.[26]A definition of death predicated upon the "inevitable" development of a cardiac arrest within a short period of time is therefore inadequate since this is no longer an empirical fact. [...]
[...] MISDIAGNOSIS OF THE VEGETATIVE STATE: RETROSPECTIVE STUDY IN A REHABILITATION UNIT (BMJ) 1996 Prednisone and later cyclosporin A “Death in Technological time: Locating the end of a meaningful Medical Anthropology Quarterly (1996), 10:575. Published in the Journal of the American Medical Association “Report of the ad hoc committee of the Harvard Medical School to examine the definition of brain death. A definition of irreversible Journal of the American Medical Association (1968), 205:337 This condition was carefully distinguished from a PVS, whose brain stems continued to function. [...]
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