I "heart" you

As with many of you, my driver's license is imprinted with a small red heart -- an announcement to whomever it might someday concern that I'm a registered organ donor. The decision to become a donor felt like a no-brainer: neither my scientific nor my religious beliefs suggest that I will in any way cherish my organs once I'm dead. Why not let someone else enjoy them?

Now comes the devil, whispering in my ear: "But how do you know you'll be dead?"

The devil, in this case, is Dick Teresi, who has just published a volume entitled -- chillingly -- The Undead.¹ I haven't read Teresi's book, but am relying entirely on its review by Elizabeth Royte in last Sunday's New York Times.

Teresi points out that no uniformly accepted criteria for death exist. I guess I've always realized that, and have been willing to take my chances. But Teresi also suggests that doctors confronting patients who appear near death are willing to relax their usual standards for determining death in order to preserve the viability and usefulness of the organs they are about to transplant. They no longer wait for the heart to stop beating and the lungs to stop breathing. Instead, they rely on a test for brain death. Not a test for certain termination of consciousness (controlled by the cortex), but death of the brain stem which controls basic physical functions of the body.

Furthermore, in order to determine "brain-death," doctors give "two rounds of tests with a Q-tip, a flashlight, ice water, a rubber hammer and the removal of the ventilator," Ms. Royte points out. Or, as author Teresi himself puts it, doctors are being allowed "to declare a person dead in less time than it takes to get a decent eye exam."

If you don't let the docs know otherwise during those two rounds of tests, the knives descend.

This unsettling information reminds me of Kazuo Ishiguro's novel, Never Let Me Go, a riveting tale of a future (or alternative) England in which human clones are produced and raised for the sole purpose of supplying an aging world with harvestable organs. These clones, the novel postulates, are unable to reproduce, and are therefore deemed animals without human souls -- even though they look, talk and act like everyone else. Once past adolescence the clones are required to check in -- like kids of an earlier era reporting for the draft -- for a staggered series of "donations" of organs. The first donation is rarely fatal, but few survive a third. When it becomes apparent that death is near, all remaining useful organs are immediately harvested, even when the patient still appears fully conscious.

I enjoyed the Ishiguro novel immensely, and was appropriately chilled by the ultimate fate of the clones -- young folks whom we had learned to love during the course of the story -- but I didn't really see any connection between their fate and my own long-contemplated, and completely voluntary, organ donation.

But now I do.

As Ms. Royte points out in her review, Teresi's book is a little one sided. It doesn't make sufficiently clear that in the overwhelming majority of cases, brain death does in fact indicate an irreversible condition, unaccompanied (at least, so far as anyone knows) by consciousness or sensation of pain, a condition that can result in a long period of vegetative deterioration before total organ failure results. And the book fails to give weight to the great need for fresh, undeteriorated organs for the use of otherwise healthy patients, organs that would make the difference between these patients' own imminent death and many future years of vigorous life.

(I'm tempted to add, "patients like Dick Cheney." But I'll refrain.)

Weighing these risks and benefits, I have no temptation whatsoever to revoke my organ donor status. But I can't help contemplating a creepy image of myself lying on an operating table, unable to whisper "I'm alive," as the scalpels are being readied.
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¹And subtitled, revealingly, Organ Harvesting, the Ice-Water Test, Beating Heart Cadavers -- How Medicine is Blurring the Line Between Life and Death.