A prosecutor in Cleveland has accused a nationally renowned medical center there of seeking to hasten the deaths of terminally ill patients to obtain their organs for transplant.
Officials at the medical center vehemently deny the charges. Even so, some medical experts fear that the dispute will make an already skittish public even more reluctant to donate organs.A proposal by the Cleveland Clinic Hospital was to allow doctors to take organs from patients within minutes after their hearts had stopped beating. Virtually all donors today are in a different category: Their hearts are beating while their brains have all but ceased to function. But many ethicists say it should also be permissible to take organs from patients whose hearts have stopped - the traditional definition of death.
In the past few years, many hospitals have begun using such donors. One recent study of 500 hospitals by Dr. Bethany Spiel-man, a lawyer and ethicist at the Southern Illinois University School of Medicine, found that nearly a third were using donors whose hearts had stopped beating in addition to those who were deemed brain-dead.
At issue is one of the most delicate areas of medicine. Organ procurement has always made the public nervous, and studies have shown that many people will not sign donor cards because they are afraid that doctors will speed their deaths to get their organs. So, ethicists say, transplant doctors have tried to reassure the public, steering clear of murky areas.
But the Cleveland Clinic walked right into an area murky enough that Carmen Marino, the first assistant prosecutor for Cuyahoga County, declared that its proposal was a matter "of grave concern." Under the draft proposal, which has not been carried out, organs would be taken from people who were not brain dead but who were gravely ill, with no chance of recovery, and kept alive only by a respirator.
With the consent of family members, the doctors would turn off the respirator while the patient was in an operating room. Within minutes after the heart stopped beating, surgeons would remove the patient's kidneys, pancreas and liver. The patients would receive two drugs that would not benefit them but would help preserve their organs: heparin, which prevents blood clotting, and regitine, which widens blood vessels so the organs would be well supplied with blood.
The idea was that some good would come out of the act of turning off a respirator, that the families might be comforted by knowing that another person's life might be saved, clinic officials said.
Those who have raised the alarm in the Cleveland case contend that the two drugs, regitine in particular, would hasten death, and that therefore the transplant surgeons would be killing patients to get their organs. Experts disagree about whether the drugs would speed death.
The imbroglio began when Dr. Mary Ellen Waithe, the director of advanced studies in bioethics at Cleveland State University, and her student Peggy Rickard Bishop Bargholt began providing Marino with information that Bargholt had found while she was working at the clinic.
Marino said Waithe and Bargholt had tried other avenues first, submitting an article to The Journal of the American Medical Association, which, he said, rejected it. Jeff Molter, a spokesman for the journal, said it did not comment on whether it had accepted or rejected papers. Waithe and Bargholt also wrote to the Ohio attorney general, who referred the case to Marino's office.
Marino, whose jurisdiction includes Cleveland, said a draft of the clinic's proposal revealed what the doctors really wanted. "The ultimate motive for declaring death comes into play - to harvest organs," he said. He provided the manuscript of the medical paper, which said the proposed program in Cleveland "may cross the line between permitting and inducing death."
Marino said he would insist that his office approve any protocols before the clinic tried to take organs from donors whose hearts had stopped beating.
Waithe said she could not comment in detail because she had signed an exclusivity agreement with the CBS News program "60 Minutes," which is to broadcast a report on the dispute Sunday night. But she said she thought that the doctors at the clinic would be murdering patients to get their organs. The patients were about to die, Waithe said, but "suppose your mother was dying of breast cancer and you knew she was going to die soon but you didn't know when." And then, she said, suppose that "you put a pillow over her face," and so hastened her death. With the use of regitine, she said, "that is exactly what this is."
The head of the ethics department at the Cleveland Clinic, Dr. George Agich, and his recently retired predecessor, Dr. George Canoti, said they were outraged that Bargholt and Waithe had never spoken to them about their concerns and had never told them that they were providing documents to the county prosecutor.
Canoti said, "I'm the first to say that if we did something bad we should own up to it." But, he added, "I can't see any major ethical problems" with the proposal. No one was planning to to kill patients or accelerate their deaths to get organs, he said.
Agich said that "the clinic has been very baffled" and that the criticisms "are now tarnishing the whole organ procurement program and the donation effort."
But would the drugs have hastened the deaths of patients? And, if so, are doctors who use them essentially killing patients to get their organs?
Dr. Michael DeVita, an expert in critical-care medicine and the chairman of the ethics committee at the University of Pittsburgh Medical Center, says regitine does lower blood pressure and so, he said, "it can certainly hasten death."