By Ellen Arkfeld
A new heart transplant technique in Australia has the potential to increase the number of heart transplants by 30 per cent. This could be extremely beneficial to patients in Australia as the country has a shortage of organ donors: only 100 hearts are transplanted in Australia every year, and around 1,600 people are on organ transplant waitlists at any given time.
This technique enables hearts to be taken from donors who have died from circulatory deaths rather than from brain deaths. Traditionally, heart transplants have only been possible using hearts that are still beating. These hearts are taken from donors who are brain dead but still have beating hearts. The new procedure allows doctors to restart hearts that are no longer beating and successfully transplant them into patients.
Australia is a world leader for successful transplants. But while the procedure is safe, transplant legislation may make the procedure risky for doctors. Some commentators say that doctors who use this technique risk being charged for manslaughter.
The procedure raises ethical questions because of controversy as to whether these patients who have died from circulatory deaths are really dead. If doctors are able to restart hearts outside of donor patients in order to transplant them to new patients, how can doctors be sure that they would be unable to restart the hearts for the donor patients?
A significant part of the controversy may be due to semantic ambiguity. The donors of this procedure have suffered from circulatory death, which occurs when all other vital organs stop working. This is different from cardiac death, in which the heart muscle dies. However, cardiac death is often used as a synonym for circulatory death. Those who question the legality of the process insist that cardiac death and circulatory death are equivalent.
There are also issues surrounding the word “irreversible”. In order to declare circulatory death, circulation must have ceased irreversibly. However, because the hearts can be restarted outside the patient, there are questions as to how irreversible these deaths really are. There is no definition of “irreversible” in the legislature, and some say that the word must be refined or removed in order to ensure that the procedure is legal.
Some assert that the legislation must be refined so that the language used reflects differences of phenomena and procedures. Others say that the procedure is completely in line with the legal requirements for the determination of death and for organ transplantation.
Still others point out that other organs have been transplanted from donors who suffered circulatory deaths for years. Kumud Dhital, the cardiothoracic and transplant surgeon who led the team that developed this heart transplant technique, says that the controversy arises because people think of hearts as more significant than other organs.
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