Academic journal article Issues in Law & Medicine

Nat'l Catholic Bioethics: Moral Issues in Lung Transplantation Surgery

Academic journal article Issues in Law & Medicine

Nat'l Catholic Bioethics: Moral Issues in Lung Transplantation Surgery

Article excerpt

As a clinician involved in caring for transplant patients, the author encounters many moral issues surrounding organ transplantation. The more common matters involve (1) the differences between ordinary and extraordinary means for preserving a life, (2) informed consent, (3) conflicts of interest, (4) the determination of death, (5) scarce organ allocation, and (6) the conduct of organ procurement agencies. This essay is not intended to be comprehensive, nor will it cover moral considerations in other organ transplant surgeries, although many themes are common to all.

Lung transplantation almost always involves cadaveric donation from a person who has been declared dead according to either brain death or, more recently, cardiac death criteria. It thus depends on the time-honored dead-donor rule--that organs should be taken only from dead patients.

Donation after brain death is currently less controversial than donation after cardiac death, and it is, in a sense, better established. The Church recognizes death as a separation of the body from the soul, and to the degree that this is reasonably said to occur in a stipulation following the rubrics of a well-designed, appropriately carried out protocol to establish brain death, donation after brain death is not morally problematic.

Donation after cardiac death (DCD) is a different matter. For one thing, the notion of irreversible cardiac function has recently incited some debate, particularly as it concerns cardiac transplantation. It is arguably less of an issue in lung transplantation, but other critical factors remain. First, how long does one wait after cardiac asystole (the cessation of cardiac activity) before declaring death? What about the possibility of auto-resuscitation?

Ever since the concept of brain death was introduced, commentators have wondered whether the definition of death was being contrived to permit organ transplantation. …

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