Doctors at the University of Alabama at Birmingham and the NYU Langone Transplant Institute in New York City reported successfully implanting genetically modified pig kidneys into two “brain dead” men in August.
The New York patient, a 57-year-old man, has demonstrated continuous kidney function for over a month, the longest time that a gene-edited pig kidney has functioned successfully in a human. The team planned to observe the patient’s kidney functioning through mid-September, during which time he would be provided with cardiopulmonary support in a critical care setting.
In Alabama, a 52-year-old man with both brain death and renal failure underwent removal of his native kidneys and was implanted with a pig kidney that had received ten genetic modifications. In contrast to last year’s results (in which a xenograft kidney placed into a brain-dead person failed to function correctly), Jayme Locke, M.D. and her team reported that this time the xenograft kidney functioned well for the full seven-day study period, which included daily kidney biopsies.
“These xenografts not only made urine, but they cleared … toxins and maintained normal renal function, and really, stability in this model for a full seven days,” said Locke in a video. “And, in fact, at study completion, the kidneys were still working.”
Experiments Without Consent
Medical ethicists are less impressed. Joel Zivot, M.D., discussed the importance of establishing “a bright line between life and death,” in an opinion piece for MedPage Today.
“Broadly, the rightness or wrongness of this type of procedure [is] the consequence of a series of moral choices, thus far unreported and unexamined, and include[s] the problems of brain death, human experimentation, consent, rationing, and animal rights,” writes Zivot.
The concept of brain death has turned people into resources, commodities to be used for the valuable vital organs they possess, Zivot argues. Most people do not receive real informed consent opportunity when they selflessly sign a donor card at the Department of Motor Vehicles; they have no idea that they can be considered dead while they are still breathing and have a beating heart.
They also are unaware that doctors currently are not following the legal definition of death by neurologic criteria under the Uniform Determination of Death Act (or UDDA, some form of which has been passed into law by all 50 states).
Loosened Standards
Although the UDDA requires “cessation of all functions of the entire brain, including the brainstem” for a diagnosis of brain death, doctors now generally follow the 2010 American Academy of Neurology Guidelines, which require only documentation of coma, a bedside test of brainstem reflexes, and an apnea test. No other special studies of “the entire brain” are required.
“Death is the permanent absence of the signs of life,” writes Zivot. “Permanence remains a problem in the case of ‘brain death’ as we can’t know the durability of the state of death until it proves itself durable. Mistakes have been made in determining death. …
“Brain death determination continues to have uncertainty,” writes Zivot. “It is conceivable that a tiny remnant of brain function may elude detection. As functional brain imaging advances, we will likely detect brain activity we thought absent. How comfortable are we with the possibility that some deep brain function might still be present in those we call brain-dead?”
Respecting the Dead?
In 2008, The President’s Council on Bioethics published a white paper on “Controversies in the Determination of Death.” The Council justified continuing the neurological standard for brain death because of strong moral convictions about the respect owed to the newly dead.
However, the two “brain-dead” men discussed above receive no such respect. The patients are being maintained on ventilators as xenograft hosts until the experiment is terminated and they are sacrificed for pathological examination. It is very unlikely that these men were given the chance to consent to this treatment.
“Current advance directives contain no language for such postmortem wishes,” writes Zivot. “Individuals may sign up to be organ donors in advance of death, but donating one’s entire brain-dead body to host a xenograft transplant is without clear precedent. … Brain death, as a criterion for death, must constantly reflect what is known and justify why the possibility of a wrong brain death diagnosis can be set aside if a xenograft experiment, or any other experiment, is at stake.”
The best possible outcome might be that some of these “brain dead” people now being used as xenograft hosts would demonstrate neurological improvement during the time they are being given top-flight ICU care as medical test subjects.
The diagnosis of brain death is usually a self-fulfilling prophecy, with these unfortunate people either quickly becoming organ donors or having their medical support withdrawn. More and more people, however, such as Zack Dunlap, Jahi McMath, Taylor Hale, Trenton McKinley, and others, are proving doctors wrong about their brain death diagnoses.
These “brain death” survivors prove that this diagnosis can be made in error and that using these people for medical experimentation is ethically unjustified.
Heidi Klessig, M.D. (heidi@respectforhumanlife.com )is a retired anesthesiologist and pain management specialist. A version of this article appeared in American Thinker. Reprinted with permission.
