Gerrymandering the boundary: “In August… Robert Truog of the Harvard Medical School and Franklin Miller of America’s National Institutes of Health, bioethicists both, published a paper in the New England Journal of Medicine describing a recent trend to revert to using cardiac death as the critical marker. But that is not good news for Dr Scaraffia and her followers for, according to Dr Truog and Dr Miller, the definition of cardiac death has changed over the years in just the sort of way that Dr Scaraffia predicted that it might.

Dr Truog and Dr Miller posit the example of a patient who has given informed consent to the withdrawal of life support in the case of his suffering devastating brain injury. The doctors respect his wishes and his heart stops beating. So far, so ethical. But instead of waiting a few minutes for his brain to die as well, they anticipate this inevitability and declare him dead immediately, so that they can hurry along with the business of removing his organs.

Death in such cases is therefore based on a decision not to resuscitate, not the impossibility of resuscitation. And their hypothetical case does seem to be happening more frequently in reality. In America, data from the Organ Procurement and Transplantation Network, an organisation that matches donors to recipients, show that those classified as cardiac-dead but not brain-dead represent the fastest growing proportion of donors, having risen from zero ten years ago to 7% in 2006.

Dr Truog and Dr Miller reckon this gerrymandering of the division between life and death will continue as long as doctors have to abide by the dead-donor rule—that although a living person can consent to have a non-vital organ removed for transplant (a single kidney, for example) vital organs can be removed only from dead bodies. Instead, they propose that someone whose brain is devastatingly and irreversibly damaged, and who has previously given his informed consent, should be able to donate vital organs while still alive.

In practice, says Dr Truog, this would not differ much from what happens now, except that doctors would be released from the temptation to fudge the definition of death, or to accelerate it by, for example, withdrawing life-sustaining treatment. Indeed, the British government is considering changing the regulations in a way that would allow just that to happen.” (The Economist)