Legal Battle In Ohio Over Organ Donation Highlights Controversy Over Defining Death
by Connor McCleskey
Posted on July 23, 2013
A legal battle in Ohio over the organs of a brain dead young man who died in a bicycle accident has highlighted the conflict over how to define death, and how the definition may vary from person to person.
21-year-old Elijah Smith was riding his bicycle on July 3rd, 2013, when he was struck by a car, severely injuring him. The following day, doctors at Grant Medical Center declared him to be brain dead. Unbeknownst to his family,Elijah had previously signed up to be an organ donor, meaning that doctors were planning to keep him on life support until his organs could be properly removed and transplanted. Had Elijah not been an organ donor, he would not have been kept alive by life support after being declared brain dead
However, his family did not consent to have Elijah’s organs removed and transplanted, saying that Elijah did understand the choice he had made when signing up to be an organ donor. Instead, they wished for “him to be unplugged, to see him die completely, to know that we did everything we could,” according to his mother, Pam Smith.
Though it is difficult to point to a single concept of “death” as conceived by many of the public, the medical definition of “brain death” is relatively straightforward. Even if a patient is still technically alive through the use of artificial respirators or other machinery, the modern definition of brain death involves the loss of activity in the brain stem. This is distinct from being in a coma, as there is almost no chance whatsoever of recovery following brain stem death, outside of a few extraordinary cases. Doctor look at a variety of criteria, testing the gag reflex, pupil dilation, and other bodily responses to rule out any other explanation for the patient’s apparent loss of life. Additionally, a second opinion is always required to make a declaration of brain death. Though doctors are understandably methodical about making this decision, it is never an easy one to make. For the families of these patients, it can be heart-rending announcement to hear about a loved one, especially if he or she appears to be breathing.
On July 7th, the Smiths wrote a letter explaining their wishes to Grant Medical Center and Lifeline, an Ohio charity that “promotes and coordinates the donation of human organs and tissues for transplantation.” Ms. Smith says that the family isn’t against organ donation, they just object to the process. She wants people “to better understand what organ donation entails and to discuss it with family members.”
The family wrote that, “We do not want our son to die like this. We not want our son to be an organ donor. We were hoping he would continue breathing… If he did not, then that would be how we would finally accept that he was dead.”
Though the hospital deferred to the family, Lifeline filed a complaint in the Franklin County Probate Court, seeking a court order to allow them to proceed with the removal and transplantation of Mr. Smith’s organs. Their attorney stated,“Under no circumstances, no one—not even the family—can undo what he did.” Citing Elijah’s status as an organ donor, a judge signed the order the next day. Ohio law prohibits anyone other than the donor in question to change his or her status as an organ donor following death.
A spokeswoman for Lifeline, Marilyn Pongonis, acknowledged that some who had previously signed up as organ donors objected to the organization’s decision to take legal action, and have subsequently removed themselvesfrom the list. Dorrie Dils, Lifeline’s chief clinical executive, said, “We are obligated and responsible for fulfilling that wish to be a donor.” In a statement, Lifeline admitted that families have objected to organ donation before, but this was the first time they had gone to court over the decision.
This case has shown just how difficult end-of-life decisions can be, particularly when weighed against the dire need for organs for transplantation. Less than 1% of deaths are classified as brain deaths, but these cases make up the majority of donations, as doctors prefer organs that are still connected to a functioning heart and body.
Ohio currently has 5.3 million registered organ donors, but the need still far outstrips supply. 18 people die every day in the US waiting for a transplant.
Website for Lifeline of Ohio: http://lifelineofohio.org/
