An Ethical Discussion: Use of ECMO in Organ Donation Observations from Buddhism and Phillip Camp, M.D. Director, Lung Transplantation Director, Adult ECMO Program Director, Transplant Administration Brigham and Women s Hospital Harvard Medical School Associate Medical Director New England Organ Bank Boston, MA BRIGHAM AND WOMEN S HOSPITAL HARVARD MEDICAL SCHOOL I have no disclosures Although here as suggested by I will be commenting or interpreting their position from my own personal perspective. There are two mistakes one can make along the road to truth not going all the way, and not starting. Buddha 1
Why are we even asking this question? This morning: Total US waiting list: 120,315 persons waiting for transplant Active US List: 77,187 persons waiting Transplants Annually: <30,000 Vision statement To promote long, healthy and productive lives for persons with organ failure by promoting maximized organ supply, effective and safe care, and equitable organ allocation and access to transplantation. Mission statement To advance organ availability and transplantation by uniting and supporting its communities for the benefit of patients through education, technology and policy development. 2
stewardship Stewardship We act on behalf of those we serve to manage the resources and gifts entrusted to us, especially the gift of life. unity We work collaboratively and respectfully, guided by consensusbuilding, sharing responsibility, time, and abilities. trust We demonstrate integrity and reliability through consistency, openness, and honesty. excellence We achieve high quality through measurement, evaluation, and continuous improvement of our standards, processes, and effectiveness. accountability We take ownership of our actions and fulfill our commitments to our stakeholders and each other. Governing Body for Transplant NO official position regarding ECMO or other means of increasing or improving transplant outcomes Society / Community Drives Ethical and or Moral Impact on Transplantation Working on discussion of how mechanical technologies are to be considered in terms of organ allocation Obligated to follow regulatory directives for organ allocation in United States Fairness Equality Transparent 3
Donation after Cardiac Death Not a nationally controlled process Impact of local and state regulatory process Still a moving target on how to optimize ECMO? Far more visible to public in terms of ethical, emotional and moral interpretation Potential for overall impact on donation Good or Bad? Buddhism Disclaimer: I am no expert on religion or Buddism This has been an interesting task and learning opportunity Journal of Buddhist Ethics Buddhism and ECMO with Organ Donation Organ donation in setting of Buddhist Ethical Paradigm Factions with differing opinions Center of Discussion is the Concept of Death, the assessment of the time of death and the tools by which death is declared Fundamental misalignment of traditional Buddhist vs. Western Medicine definitions of Death Conflict of core Buddhist values and Death 4
Buddhism Traditional reasons expressed for supporting organ donation Donation severs one s attachment to one s body Places another person s welfare above one s own Donation of organs with the pure motivation to benfit others will bring great fruits of merit in future lives Globally considered a good thing but with caveat that religious expert is consulted Karma Lekshe Tsomo Buddhism The death process in Buddhism is a very important time and to be treated with the greatest care and respect Central to Buddhism is the wish to relieve suffering, to be generous of one s self Death must not be compromised by organ donation, and it is the definition of the moment of death that adds confusion Buddhism Problem with all organ donation is the definition of death Variance in several sects of Buddhism Tibetan: Even following brain death there is a subtle body still present with functioning winds and drops that may be active for several days Organ donation is acceptable in Theravada Buddhism. It is a Buddhist virtue to generously extend help to other sentient beings and this covers the case of organ donation. Phramaha Laow Panyasiri 5
Buddism and ECMO Must then be aligned with the particular view of the individual, be consistent with their global view of organ donation and not interfere with their definition of death To do so need to understand that there are several criteria that fall outside traditional western medicine in terms of determination of absolute death. Buddism and ECMO For more rigid sects there are three criteria for distinguishing a living body from a dead body. Āyu: or Vitality Usmā: or heat Viññāna: or conciousness In general the time for these to fully present make traditional donation impossible. The physiologic impact of ECMO for donation interferes with at least one, or more, of these criteria Buddism and ECMO Role of ECMO in light of these religious criteria for the status of dead becomes very murky. Restitution of any vital signs in either more liberal or more rigid sects would seem to run counter to allowed view of organ donation. However, IF ECMO was to allow for a period of clarity regarding the absolute state of death would it become acceptable? Temperature, Flow, Perfusate, Technique 6
Thank You 7