in Permanent Vegetative State
Be Used for Transplantation?
R. Hoffenberg, M. Lock, N. Tilney,
C. Casabona, A. S. Daar, R. D. Guttmann,
I. Kennedy, S. Nundy, J. Radcliffe-Richards,
and R. A. Sells
A shortage of donor organs limits most transplant programs: some patients die of otherwise untreatable end-organ failure, others, in chronic renal failure, are obliged to continue with costly and distressing dialysis procedures. We discuss whether organs taken from patients in a permanent vegetative state (PVS) could be used for transplantation once a decision has been taken to withdraw treatment and allow the patient to die. In the USA, there are an estimated 10,000-25,000 adult patients and 4,000-10,000 children in PVS; 1 figures for the UK are likely to be substantially less pro rata, perhaps 1,000 in all. The UK figure applies to all those who have been vegetative for longer than three months, many of whom die within the first year, so no decision would be taken to withdraw treatment in their lifetimes and they would not be regarded as potential organ donors. As yet, few court decisions have given consent to withdraw treatment from such long-standing cases, but the numbers may increase as the process becomes more widely accepted. There would be obvious benefits if this potential source of organs were to be made available for transplantation, but some arguments have been adduced against this proposition.
First, there is continuing uncertainty and controversy about the definition and diagnosis of PVS, higher brain death, and the recognition of residual consciousness. Errors in diagnosis could result in faulty prognosis. 2,3 Therefore, no decisions should be taken to end the life of patients thought to be in PVS. However, Andrews and colleagues2 affirm that an accurate diagnosis of PVS can be made if the patient is assessed over a period of time by an experienced team, and that the fear of misdiagnosis should not constitute an argu____________________