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Emily Risner

Professor Russell Thomas

English 1201.525

19 Mar 2019

Myths Surrounding Organ Donation

Being an organ donor is one of the most selfless acts a human can choose to make in their

lifetime. Per the U.S. Department of Health & Human Services, there are currently over 113,000

people actively waiting for life-saving organ transplants. 36,528 organ transplants were

performed in 2018 provided from over 17,000 donors, living and deceased. The U.S. Department

of Health & Human Services indicates that every ten minutes, another person is added to the

transplant waiting list. If one organ donor can save up to eight lives, why are more people not

organ donors? The reality of this is only three in 1,000 people die in a way that make organ

donation possible, per the U.S. Department of Health and Human Services. If 95% of adults

agree with organ donation, then why are only 58% of people registered as organ donors (U.S

Department of Health & Human Services)? Some people believe they are too old or too sickly to

donate. They simply opt out of donation without truly knowing anything regarding eligibility.

Other common declarations against organ donation include religious beliefs and the conception

that organ donation is murder. Organ donation is generally regarded by most medical

professionals and clergy members as the ultimate gift of life. Myths and rumors regarding organ

donation are a large force as to why many people choose to not be organ donors at their time of

death.
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Many opponents of organ donation often use the defense that their religious affiliation

does not support organ donation. Some see organ donation as mutilation or dismemberment of

the human body that can prevent them from the afterlife or entering Heaven. Finger Lakes Donor

Recovery Network, a non-profit organ procurement agency (OPO) delves into these tight-held

beliefs by some religious groups, such as Gypsies [sic]. More properly referred to as Romani

people, they believe that a year after death has occurred, the soul retains its form and moves on

to retrace the steps it once went though. This belief is why the Romani people are more likely to

be against donation. These types of beliefs are few and far between with most major religions. A

very wide margin of religions support organ donation as a selfless act of generosity or see organ

donation as an individual choice. Catholicism, one of the largest religions in the world, embraces

organ donation. Pope Francis was quoted as referring to organ donation as a “testimony of love

for our neighbor” (CruxNow) during a conference with the Transplantation Committee for the

Council of Europe in 2014. Most Christian denominations either openly encourage organ

donation or believe it is a personal decision best made by the individual, not the church. This

includes Mormons (LDS Handbook), United Methodists (United Methodist Beliefs: Organ

Donation) and Lutherans (FAQ’s – LCMS Views).

One major argument that revolves around organ donation arguments, usually within a

professional setting, is the concept of brain death. Dr. Paul Byrne, a neonatologist and strong

opponent of brain death criteria equates organ donation to suicide or murder. This statement is

not only downright absurd, but also incorrect. UNOS, United Network for Organ Sharing, not

only has extremely strict criteria for organ donor qualification via OPTN/UNOS Policy Notice

Eligible Death Data Definitions, but they must adhere closely to brain death qualifications to

even pursue for donation in the first place. Byrne’s biggest argument against organ donation is
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that brain death is not true death. True death is only equal to cardiac arrest (Byrne). Clinically,

there are only two scenarios in which organ donation may take place, when brain death has been

declared or donation after cardiac death, also referred to as DCD.

Brain death and cardiac death are two very different things with different clinical criteria.

Cardiac death occurs when the heart ceases to beat and no cardiac movement is detected via

echocardiogram, a sonogram of the heart. Brain death occurs when the heart continues to beat,

but only the primitive area of the brain, the brain stem, is functioning. The brain stem is only

capable of maintaining the absolute minimum functions of life, such as maintaining a heartbeat.

In a clinically brain-dead patient, the brain stem itself does not even maintain and support

respiratory functions. The patient’s only method of respiration is via a mechanical ventilator, a

device that forces air in and out of a patient’s lungs. This is also alongside an array of

medications to support the patient’s blood pressure from plummeting. Brain dead patients do not

breathe on their own. It’s also important to know that brain death is not a comatose state, as

stated by James M. DuBois, Professor and Department Chair of Health Ethics at St. Louis

University. A patient who is in a coma still has brain activity, as opposed to a brain-dead person

who has no brain activity (U.S. Department of Health and Human Services). Brain death is not

something a person miraculously recovers from. As Dubois points out, no documentation exists

which provides evidence that a human has recovered after brain death has occurred.

Brain death criteria, which Byrne very publicly has spoken against, has not been incorrect

in assessing death in a patient when done correctly. Byrne references a story involving a young

man named Zack Dunlap from Oklahoma. The story, which was sensationalized and covered by

the Today Show, states that Zack was in an ATV accident in 2008. This accident was serious

enough for him to be declared brain dead. At that time, an organ procurement organization
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became involved in pursuing for donation. The family authorized donation. Prior to recovery, a

family member removed a pocketknife from Zack’s pants and ran it up the sole of his foot. He

withdrew from the knife. This is a clear indicator that a person is not brain dead. Brain death

criteria involves six major indicators, which includes meaningful reflexes, such as withdrawing

from pain. This was a clear case of brain death misdiagnosis. If Zack were truly brain dead, he

would have had no reaction to the knife. A video by Silverpod Productions helps us further

understand the criteria outlined to declare brain death. When it comes to just reflexes, Zack

Dunlap would also have ceased to have any pupillary reflexes (the pupil of the eyes constriction

response to bright light). He would have had no ocular movement when the head is moved from

side-to-side. Zack would have lacked proper eye response to cold water irrigation in the ear

(normal response being to look away), no corneal reflexes, loss of jaw reflexes, and void of

grimacing when his nail beds or top of his eye socket experienced deep pressure. Zack would

also have no gag response when his uvula stimulated, nor would he respond to suctioning of the

back of his throat by coughing. These guidelines defined are just meant to test the presence of

brainstem reflexes. Brain death criteria also includes apnea testing, which is when patients are

removed from mechanical ventilation to see if their brain will signal the lungs to breathe on their

own. Patient’s bodies are also tested by their reaction to drugs like Atropine, which would

normally increase a person’s heartrate. Full neurological exams also evaluate for outside

influences that could be falsely indicating brain death, such as use of paralytic drugs, certain

medical conditions and disease, and so forth. CT scans of the brain and EEG’s are also

performed to evaluate for any brain activity. This overload of information does not even cover

the entirety of how brain death is confirmed. For Byrne to allude to brain death testing being a

simple or haphazard process is not only wrong, but possibly offensive to the clinicians who
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institute these regulations and work hard to eliminate the potential of misdiagnosis of brain

death.

Brain death studies also include a brain flow study. Brain flow indicates the blood flow

that is going to and supplementing the brain with not only blood, but oxygen. Per Johns Hopkins,

a brain perfusion scan can test this by showing the amount of blood flow that is taken up to

certain areas of the brain. Within a normal functioning brain, brain perfusion would show that all

areas of the brain were receiving adequate blood flow without any obstructions or injury to the

brain. However, in a clinically brain-dead patient, supplemental blood flow to the brain will

cease and the brain, quite literally, will begin to die (see Fig. 1). Once this process begins, there

is no possible reversal of the damage the brain suffers, therefore this is one of the key indicators

of pronouncing brain death in a patient.

Fig. 1 Brain flow study. Normal brain flow (left) vs brain death (right). Source: Finger Lakes Donor Recovery
Network, www.donorrecovery.org/learn/understanding-brain-death/.
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A very common statement made by individuals who opt out of organ donation is that they

feel as though they are too sickly to be a suitable organ donor. While there are plenty of medical

conditions and comorbidities that would exclude a person from organ donation, there are also

many medical conditions that have no bearing on the donation process. UNOS’ Eligible Death

Data Definitions outlines their basic guidelines regarding conditions and medical situations that

would deem a person ineligible for donation, such as hemolytic cancers (Eg: Leukemia). While a

certain medical condition may rule out a specific organ for transplant, it may be perfectly

acceptable for other organs. For example, a diagnosis of pulmonary fibrosis is a deferral for lung

donation, yet other solid organs such as kidneys, heart, liver, etc. would still be acceptable.

Individuals should also keep in mind that these guidelines are subject to change at any time. For

example, by current standard, a person greater than 75 years old would be ineligible for

donation; per organdonor.gov, the oldest organ donor on record in the United States is a man

named Carlton. He became an organ donor just nine days prior to his 93rd birthday. Carlton

saved the life of a 69-year-old woman suffering from end stage liver disease. Every person can

sign up to be an organ donor. Each person is individually assessed for suitability if clinical

triggers for organ donation are met.

Many opponents of organ donation also refuse registering as a donor as they believe that

medical staff would not attempt all life-saving measures on them if they were signed up as a

donor. This is one of the biggest myths facing donation and is addressed on nearly every OPO

(organ procurement organization) website and organ donation source. This is entirely false. All

medical professionals have one goal in emergent situations and that is to save your life. They are

not concerned with or even thinking about the possibility of organ donation. What many people

do not realize is the OPO is not part of the hospital system. They are independent, third-party
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non-profit organizations that assess for suitability on their own. Registry status has no bearing on

whether someone qualifies for donation. That decision lies only in the clinical status of the

patient and their medical history. All organ procurement organizations employ their own team of

clinicians, nurses, surgeons, medical directors, coordinators, etc to aid in the assessment and

organ recovery process. The hospital may help coordinate the donation process such as by

reporting changes in the patient to the OPO, however the hospital has no authority to determine

whether the patient qualifies for donation. That is the responsibility of the organ procurement

organization. It is also to be noted that the OPO is often not alerted of a new potential candidate

for donation until once the patient is hemodynamically stabilized. As stated by organdonor.gov

in their Myths and Facts, “Donation doesn’t become a possibility until all lifesaving methods

have failed”.

There are many falsities surrounding the topic of donation that still lead many people down a

path of making a misinformed decision. While it may be true that organ donation is not

supported by all people, many of the most popular reasons for opposing donation are myths and

irrational fears perpetrated by those myths. Not every person will support the notion of organ

donation, but it is important for all people to make educated, informed conclusions regarding

their personal end of life decisions. The difference between believing one of these myths and not

could be saving eight lives, so the stakes have never been higher.
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Works Cited

“Age Is No Barrier to Sharing Life.” Age Is No Barrier to Sharing Life, U.S. Department of

Health and Human Services, www.organdonor.gov/statistics-stories/donation-

stories/carlton-liver-donor.html.

“Brain Perfusion Scan.” Brain Perfusion Scan | Johns Hopkins Medicine Health Library,

www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/brain_perfusion_sca

n_135,317.

Byrne, Paul A. "Brain Death Is Not an Ethical Criterion for Organ Removal for Transplant."

Organ Transplants, edited by Diane Andrews Henningfeld, Greenhaven Press, 2012. At

Issue. Opposing Viewpoints in Context,

link.galegroup.com/apps/doc/EJ3010483241/OVIC?u=dayt30401&xid=c04c44f3.

Accessed 14 Mar. 2019. Originally published as "The Demise of 'Brain Death',"

LifeSiteNews.Com, 18 Sept. 2008.

Celizic, Mike, “Pronounced dead, man takes ‘miraculous’ turn.” Today, 24 Mar. 2008,

https://www.today.com/news/pronounced-dead-man-takes-miraculous-turn-2D80555113.

Doyle, Rev. Kenneth, “Does the Church allow people to donate their bodies to science?”

CruxNow, 20 Apr. 2015, https://cruxnow.com/church/2015/04/20/does-the-church-allow-

people-to-donate-their-bodies-to-science/.

Dubois, James M. "Brain Death Is an Ethical Criterion for Organ Removal for Transplantation."

Organ Transplants, edited by Diane Andrews Henningfeld, Greenhaven Press, 2012. At

Issue. Opposing Viewpoints in Context,

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link.galegroup.com/apps/doc/EJ3010483240/OVIC?u=dayt30401&xid=fecdc205.

Accessed 14 Mar. 2019. Originally published as "Brain Death and Organ Donation,"

American Magazine, 2 Feb. 2009.

“Frequently Asked Questions – LCMS Views.” The Lutheran Church Missouri Synod, 2017,

https://www.lcms.org/about/beliefs/faqs/lcms-views#organ-donation.

“Handbook 2: Administering the Church.” The Church of Jesus Christ of Latter-Day Saints,

Article 21.3.7, 2017, https://www.lds.org/study/manual/handbook-2-administering-the-

church/selected-church-policies-and-guidelines/selected-church-

policies?lang=eng#title_number59.

“OPTN/UNOS Policy Notice Eligible Death Data Definitions.” Organ Procurement and

Transplantation Network, via U.S. Department of Health & Human Services, 1 Jan. 2017,

https://optn.transplant.hrsa.gov/media/2012/opo_policynotice_ie_20130701.pdf.

“Organ Donation Statistics.” Organ Procurement and Transplantation Network, via U.S.

Department of Health & Human Services, 12 Mar. 2019, https://optn.transplant.hrsa.gov/.

Pressman, Peter, and Claudia Chaves. “Confirmatory Tests for Brain Death.” Verywell Health, 7

Sept. 2018, www.verywellhealth.com/confirmatory-tests-for-brain-death-2488871.

Accessed 3 Mar. 2019.

“Religion and Organ Donation.” Finger Lakes Donor Recovery Network, 26 Mar. 2019,

http://www.donorrecovery.org/learn/religion-and-organ-donation/.

“Clinical Brain Death Testing.” YouTube, uploaded by Silverpod Productions, 12 Apr. 2015,

www.youtube.com/watch?v=qiZBGFWvv4E.
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“United Methodist Beliefs: Organ Donation.” United Methodist Church, 22 Mar. 2019,

http://www.umc.org/what-we-believe/united-methodist-beliefs-organ-donation.

U.S. Department of Health and Human Services. "Organ Donation: An Overview." Organ

Donation, edited by Laura Egendorf, Greenhaven Press, 2009. Opposing Viewpoints.

Opposing Viewpoints in Context,

link.galegroup.com/apps/doc/EJ3010652206/OVIC?u=dayt30401&xid=aec81a1.

Accessed 29 Mar. 2019. Originally published as "Decision: Donation," 2004, pp. 25-28.