An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death

Total Page:16

File Type:pdf, Size:1020Kb

An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Fall 2006 An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death: When is Dead Dead and Why Some Donation After Cardiac Death Donors Are Not Leslie Whetstine Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Whetstine, L. (2006). An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death: When is Dead Dead and Why Some Donation After Cardiac Death Donors Are Not (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1359 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death: When is Dead Dead and Why Some Donation After Cardiac Death Donors Are Not A Dissertation Presented to the Faculty of the McAnulty College and Graduate School of Liberal Arts Duquesne University in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Leslie Mary Whetstine iii For my grandparents, Marguerite and Joseph Tantalo iv Acknowledgements I share this accomplishment with many individuals who supported me throughout this endeavor. First and foremost, I wish to express my deepest gratitude to my parents, George Edward and Candace Ellen Whetstine. I hold my father in the greatest esteem for cultivating my appreciation of the humanities and for showing me the elegance of the written word. I am beholden to my mother for instilling in me the value of education and for providing me every opportunity to pursue it. I am indebted to my committee members, David F. Kelly, Aaron L. Mackler, and John W. Hoyt for their guidance and insights throughout this process, with special thanks to Dr. Kelly for directing this work. To the many friends and family members who lent their encouragement, I cannot give enough thanks. In particular, I am grateful to Joseph A. Nelson, for providing unconditional emotional encouragement and for his enduring patience. My deep appreciation also goes to my colleagues, especially to Laurie Balog for her unique perspective and sensitivity and to Matthew Butkus for helping me to hone my analytical skills. The Gumberg Library Reference staff at Duquesne University was also instrumental in enabling this work. With special thanks to Valerie C. Sweeney, a consummate researcher and the most dedicated librarian I have had the pleasure of working with over the years. I consider myself lucky to have interacted with medical experts through the International Critical Care Medicine Group CCM-L, especially Thomas P. Bleck and Michael G. Darwin, who routinely shared ideas and criticisms throughout this process. I sincerely appreciate the support provided by Robert A. Fink, who devoted much time to cultivating the ideas contained herein. I am also particularly grateful to James L. Bernat, a leading expert in the definition of death debate, who was especially generous with his time and expertise. In addition I wish to thank Leda Heidenreich from Mercy Health System, Greg Burke from Geisinger Medical Center and Michael A. DeVita from the University of Pittsburgh Medical Center for providing me with their insights as well as access to their Donation After Cardiac Death Protocols for my scrutiny. Finally, I am indebted to David W. Crippen who introduced me to the international medical community, mentored my career development, and became a dear friend. If I faltered over the years or thought that I could go no farther he was there to pick me up, confident that I would persevere. I am eternally grateful for his motivation and guidance throughout my graduate studies. v Preface Human fascination with transplantation has been portrayed in mythology and legend as well as in art and literature throughout history. It has both horrified and captivated our collective conscience and has progressed, in a relatively short time period, from science fiction to a modern accomplishment that can improve longevity and enhance quality of life. The primary obstacle for transplantation is no longer scientific in nature but is predominantly one of supply and demand and carries with it attendant ethical concerns. Specific to this work is the question of whether a particular method of organ procurement known as Donation After Cardiac Death procures organs from the newly dead or from the imminently dying. Since the normative rules that guide transplantation require that one may not be killed for or by the removal of one’s organs determining the nature of death is of paramount importance. Accordingly, the primary question concerned herein is whether Donation After Cardiac Death donors are dead at the moment of organ recovery. This work focuses on the conceptual underpinnings of why a person is said to be dead according to particular definitions and when specific criteria and tests are fulfilled. Much attention is devoted to exploring why the irreversible loss of cardio- respiratory functions or the irreversible cessation of all functions of the entire brain signifies death and whether these two criteria represent distinct types of death or if they instantiate the same overarching definition. The first two chapters of this work are structured as a chronology demonstrating how our conception of death was intimately tied to the ability to test for certain bodily functions. These notions would quickly change when medicine developed technologies that could substitute for such functions and when transplantation demonstrated that the brain, not the heart, was of primary importance in determining life from death. The third chapter focuses on clinical and theoretical arguments with the discussion of the traditional biological definition of death and the whole brain death criterion. Chapter four continues by challenging the biological definition of death as internally inconsistent and advances an ontological position while retaining the neurologic criterion. The dissertation concludes by drawing on the arguments established throughout to ultimately claim that some Donation After Cardiac Death Donors are not yet dead at organ procurement according to either a traditional or an ontological definition of death. Transplantation saves lives and is a social good that society ought to continue to support. The aim of this dissertation is not to denigrate the field. On the contrary, if donation is to thrive we must ensure that our definition and criteria for death are coherent and that the methods for procurement operate accordingly. vi An Examination of the Bio-Philosophical Literature on the Definition and Criteria of Death: When is Dead Dead and Why Some Donation After Cardiac Death Donors Are Not Table of Contents Acknowledgments iv Preface v Chapter One: The History of the Definition of Death 18th Century to the 20th Century 1 The Cardio-Respiratory Standard 2 Premature Burial 7 Safeguards to Prevent Premature Burial 13 Medical Advancement 24 Chapter Two: The History of Organ Transplantation 29 Mythology and Legend 29 Early Experimentation 33 Phenomenon of Rejection 35 Overview of Immune System 39 Modern Era of Transplantation 41 Cardio Pulmonary Resuscitation 45 Logistics of Organ Transplantation 51 Historical Shift 55 Chapter Three: On the Legitimacy of Whole Brain Death 66 The Relationship Between Transplantation and Death 67 The Concept of Whole Brain Death 72 The Brain as the Primary Integrator of the Organism as a Whole 84 Diagnosis of Whole Brain Death 94 Debate and Reevaluation of the Definition of Death 105 Chapter Four: Evaluating a Higher Brain Death Definition 111 and Criterion for Death Revisiting the Problem of Whole Brain Death 114 vii Approaches to Define Death 116 Competing Concepts of Death 124 A New Definition of Death 131 Conceptual and Clinical Difficulties with the Higher Brain Death Criterion 145 A Hybrid Approach 154 Chapter Five: On the Legitimacy of Donation After Cardiac 160 Death Background: Defining Donation After Cardiac Death 165 DCD and the Institute of Medicine 171 Auto-Resuscitation and Manual Resuscitation 176 Defining Irreversibility 192 Heart-dead Versus Brain-dead 203 Additional Procedural Concerns 211 Conclusion 221 Appendix A 226 Appendix B 227 Appendix C 228 Appendix D 229 Bibliography 230 1 Chapter 1 The History of the Definition(s) of Death 18th century to the 20th century A person is dead when a physician says so.1 This dissertation will argue that some Donation After Cardiac Death (DCD) donors are not dead at the moment of organ recovery because the practice uses a criterion of death that prognosticates death rather than diagnoses it. The analysis of DCD is reserved for the final chapter, with each prior chapter addressing a particular issue that contributes to the foundation of that claim. This first chapter is not concerned with a conceptual exploration of what death “is” but focuses instead on when death occurs (determination of death) and the operational criteria used to confirm it (tests). The question of why death is said to occur when particular criteria are met will be more fully examined in chapter three during the discussion of cardio-respiratory death versus brain death. The purpose here is to chronicle when and how death has been determined beginning in the 18th century until the mid 20th century. An interesting dynamic will be shown across these time periods. Physicians in the 18th century were certain that death occurred when the heart and lungs ceased but lacked adequate tests to certify it. In the 20th century the moment of death became less clear, and for that reason the tests physicians had finally perfected proved insufficient. This chapter lays the foundation for this dissertation 1 Kenneth V. Iserson, Death to Dust (Tuscon: Galen Press Ltd., 1994) 19.
Recommended publications
  • 2. the Diagnosis of Brain Death Applied to the Brainstem Death Concept and the Whole Brain Death Concept
    BRAIN DEATH DIAGNOSIS Index: • 1. The concepts and definitions of brain death • 2. The diagnosis of brain death applied to the brainstem death concept and the whole brain death concept 1 Subject 1. The concepts and definitions of brain death. Section 1: Introduction At present, the main difficulty involved in the development of organ transplant programs is the insufficient amount of organs available for transplantation. Organ supply still proceeds mainly from brain dead deceased. For this reason, the brain death diagnosis is an essential step for the procurement of organs for transplantation. Brain death diagnosis is not only the responsibility of transplant co-coordinators. Therefore all health professionals involved in the donation-transplantation process must have enough knowledge of all the ethical and social aspects besides the concepts of brain death. This information will help them to: 1. Improve the information on brain death, needed to increase transplant programs, 2. Improve the approach towards the potential donors' relatives, giving accurate answers to the questions that they may have concerning brain death, 3. Assess all health professionals not acquainted with the diagnostic methods of brain death, 4. Collaborate logistically (instrument management, serum drug levels, etc.) in difficult cases that may need more atypical methods of diagnosis, and 5. Comprehend the ethical aspects of death diagnosis, since nowadays brain death is synonymous of death; therefore all patients diagnosed with brain death must not be underwent to any further measures to prolong their lives. Section 2: Death. Death as a process Biologically, the death of a human being is not an instantaneous but an evolutionary process through which the different organ functions are gradually extinguished, ending when all the body's cells irreversibly cease to function.
    [Show full text]
  • A Critique of Vicarious Liability in the Medical Malpractice Context
    THE BUCK STOPS WHERE? A CRITIQUE OF VICARIOUS LIABILITY IN THE MEDICAL MALPRACTICE CONTEXT C. J. COLWELL† In Canadian tort law, liability is almost always linked to some notion of fault, save for a few well-established exceptions. By far the most common exception is vicarious liability, i.e. the liability of employers for the torts of their employees. In its 1999 ruling in Bazley v. Curry, the Supreme Court of Canada articulated 2008 CanLIIDocs 35 exactly why this kind of faultless liability exists in Canada, and how it is justifed. In medical malpractice cases involving teaching hospitals, there are usually three possible defendants to a negligence action: the attending physician, the treating resident, and the hospital. Due to the legal nature of their employment relationship, if the resident is found liable, so too is her employer, the hospital. Tis liability is regardless of fault. Te attending physician, on the other hand, can only be held liable with fault. Tis paper proposes that imposing vicarious liability on the hospital or any other party in this type of action is inconsistent with the justifcations outlined in Bazley v. Curry. Liability in this particular context, it is argued, should be limited to liability with fault. Tis paper also briefy explores possible reasons why the courts have demonstrated a general preference to have hospitals, rather than attending physicians, pay judgments to injured plaintifs. It takes notice of a newly emerging non-delegable duty of care owed by hospitals to patients, and further points out the unique public source of funding for malpractice judgments regardless of who is liable.
    [Show full text]
  • Corporate Liability for Economic Crime, Call for Evidence
    Corporate Liability for Economic Crime Call for evidence This Call for Evidence begins on 13 January 2017 This Call for Evidence ends on 24 March 2017 Corporate Liability for Economic Crime Call for evidence Presented to Parliament by the Lord Chancellor and Secretary of State for Justice by Command of Her Majesty January 2017 Cm 9370 © Crown copyright 2017 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government- licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at https://consult.justice.gov.uk/ Any enquiries regarding this publication should be sent to Criminal Law & Sentencing Policy Unit at [email protected] Print ISBN 9781474139052 Web ISBN 9781474139069 ID 181116 01/17 Printed on paper containing 75% recycled fibre content minimum. Printed in the UK by the Williams Lea Group on behalf of the Controller of Her Majesty’s Stationery Office About this call for evidence To: This call for evidence invites academics, business, civil society, lawyers and other interested parties across the UK to consider whether there is a case for changes to the regime for corporate criminal liability for economic crime in the United Kingdom. Duration:
    [Show full text]
  • The Knowledge Standard for ISP Copyright and Trademark Secondary Liability: a Comparative Study on the Analysis of US and EU Laws
    The Knowledge Standard for ISP Copyright and Trademark Secondary Liability: A Comparative Study on the Analysis of US and EU Laws A Thesis Submitted for the Degree of Doctoral of Philosophy in Law By: Mohammad Sadeghi 1002256 School of Law Brunel University London 2013 i Declaration I declare that the work presented in this thesis is my own except where it is stated otherwise. Mohammad Sadeghi i Abbreviations Used DMCA: Digital Millennium Copyright Act ECD: Electronic Commerce Directive ECJ: European Court of Justice Electronic Commerce Directive: Directive 2000/31/ EC of the European Parliament and of the Council of 8 June 2000 on Certain Legal Aspects of Information Society Services, in Particular Electronic Commerce, in the Internal Market UK CDPA: The Copyright, Designs and Patents Act 1988 UK: United Kingdom US: United States of America ii Abstract Holders of rights sue ISPs for copyright and trademark infringement: specifically, for contributory liability through the ISP’s knowledge of user infringement. Knowledge about user infringement has been prevalently recognised as a crucial element of ISPs’ secondary liability, but the approaches concerning the knowledge standard are different in US copyright case law (traditional tort), the US Digital Millennium Copyright Act, the US Lanham Act, US trademark case law, and the EU Electronic Commerce Directive. Their differences have posed questions on the efficacy of the current knowledge standards and case law interpretations to omit legal ambiguities and offer appropriate guidance for tackling issues. This research presents that the US knowledge standards and the ECD knowledge standard apply broad knowledge standards to evaluate ISPs’ knowledge but they differ in terms of their elements and conditions for permitting ISPs and copyright holders to co-exist and combat copyright infringement.
    [Show full text]
  • Bountiful Harvest: Essays in Honor of S. Kent Brown Andrew C
    Brigham Young University BYU ScholarsArchive Maxwell Institute Publications 2011 Bountiful Harvest: Essays in Honor of S. Kent Brown Andrew C. Skinner D. Morgan Davis Carl Griffin Follow this and additional works at: https://scholarsarchive.byu.edu/mi Part of the Religious Education Commons Recommended Citation Skinner, Andrew C.; Davis, D. Morgan; and Griffin,a C rl, "Bountiful Harvest: Essays in Honor of S. Kent Brown" (2011). Maxwell Institute Publications. 17. https://scholarsarchive.byu.edu/mi/17 This Book is brought to you for free and open access by BYU ScholarsArchive. It has been accepted for inclusion in Maxwell Institute Publications by an authorized administrator of BYU ScholarsArchive. For more information, please contact [email protected], [email protected]. bountiful harvest bountiful harvest essays in honor of s. kent brown Edited by Andrew C. Skinner, D. Morgan Davis, and Carl Griffin Cover design by Stephen Hales Creative, Inc. Frontispiece by Mark A. Philbrick Neal A. Maxwell Institute for Religious Scholarship Brigham Young University Provo, UT 84602 maxwellinstitute.byu.edu © 2011 The Neal A. Maxwell Institute for Religious Scholarship All rights reserved Printed in the United States of America 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Bountiful harvest : essays in honor of S. Kent Brown / edited by Andrew C. Skinner, D. Morgan Davis, and Carl Griffin. p. cm. Includes bibliographical references and index. ISBN 978-0-8425-2804-7 (alk. paper) 1. Theology. 2. Church of Jesus Christ of Latter-day Saints. I. Brown, S. Kent. II. Skinner, Andrew C., 1951- III.
    [Show full text]
  • Historical Perspectives of Lung Transplantation: Connecting the Dots
    4531 Review Article Historical perspectives of lung transplantation: connecting the dots Tanmay S. Panchabhai1, Udit Chaddha2, Kenneth R. McCurry3, Ross M. Bremner1, Atul C. Mehta4 1Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ, USA; 2Department of Pulmonary and Critical Care Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA; 3Department of Cardiothoracic Surgery, Sydell and Arnold Miller Family Heart and Vascular Institute; 4Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA Contributions: (I) Conception and design: TS Panchabhai, AC Mehta; (II) Administrative support: TS Panchabhai, RM Bremner, AC Mehta; (III) Provision of study materials or patients: TS Panchabhai, U Chaddha; (IV) Collection and assembly of data: TS Panchabhai, U Chaddha, AC Mehta; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Atul C. Mehta, MD, FCCP. Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Staff Physician, Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA. Email: [email protected]. Abstract: Lung transplantation is now a treatment option for many patients with end-stage lung disease. Now 55 years since the first human lung transplant, this is a good time to reflect upon the history of lung transplantation, to recognize major milestones in the field, and to learn from others’ unsuccessful transplant experiences. James Hardy was instrumental in developing experimental thoracic transplantation, performing the first human lung transplant in 1963. George Magovern and Adolph Yates carried out the second human lung transplant a few days later.
    [Show full text]
  • HARBIN. NOVEMBER 2017. Sergio
    POWER OVER LIFE AND DEATH Natalie Köhle ARBIN. NOVEMBER 2017. Sergio NESS is NOT in the BRAIN, which seeks HCanavero and Ren Xiaoping 任晓 to prove the existence of an eternal 平 announced that the world’s first hu- soul on the basis of near death experi- man head transplant was ‘imminent’. ence, as well as two guides on seducing They had just completed an eight- women. He also drops flippant refer- een-hour rehearsal on two human ca- ences to Stalin or the Nazi doctor Josef davers, and now claimed to be ready Mengele. for the real deal: the transplant of a human head from a living person with a degenerative disease onto a healthy, but brain-dead, donor body.1 Ren — a US-educated Chinese orthopaedic surgeon, was part of the team that performed the first hand transplant in Louisville in 1999. Canavero, an Italian, and former neu- rosurgeon at the university of Turin, is the more controversial, maverick per- sona of the team. In addition to many respected scientific publications, he Frankenstein’s Monster from The Bride of Frankenstein (1935) published Immortal: Why CONSCIOUS- Source: Commons Wikimedia 276 tor function and sensation. It would 277 also depend on the unproven capacity of the human brain to adjust to — and gain control over — a new body and a new nervous system without suffering debilitating pain or going mad.2 So far, Ren and Canavero have Sergio Canavero transplanted the heads of numerous Source: 诗凯 陆, Flickr lab mice and one monkey, and they Ren and Canavero see the head have also severed and subsequently Power over Life and Death Natalie Köhle transplant, formally known as cepha- mended the spinal cords of several POWER losomatic anastomosis, as the logical dogs.
    [Show full text]
  • Kids Connection Video on March 29Th 2020
    JESUS beats DEATH LAZARUS IS RAISED TO LIFE PARENTS GUIDE Hello! I hope week one of home schooling is going okay! This pack is meant to be used alongside the Kids Connection video on March 29th 2020. If you've not watched the video yet they can be found at thebeaconchurch.com/kidsconnection. Watch the videos as outlined on the webpage, then take a look through this pack. We have included lots of activities to cover all ages and preferences. We are definitely not expecting you to give all of them a go!! Pick a couple that work for you and your family and then join us at the live chat (2pm Sun 29th March) to let us know how you got on. Details of how to join the live chat are on the Kids Connection page. We would love if you shared what you got up to with us. You can email us at [email protected] or post a comment or message on facebook. Hopefully we will then be able to share your kids amazing efforts on live chats. We'd also be delighted if you made use of some of these activities throughout the week. If you do, let us know how you got on. For other children's events you can check out the events page on our website. Look out for Professor beacon experiments (Fri's 10am) and coming soon a Kids Quiz. Take Care Hannah beacon Children's Church Team TELL THE STORY Choose these activities to help you reinforce the story we have just learnt about.
    [Show full text]
  • Brain Death Protocol Nuclear Medicine
    Brain Death Protocol Nuclear Medicine Chorionic Freddie still encrypts: sensory and noble-minded Noel scrubbed quite gorily but lollop her pipes sulkily. Anatol still professionalized exultantly while hydrophilous Wojciech understating that triplication. Flaring and macabre Arlo never preforms his lounges! Brain stem is brain death protocol and twitch response Please read and brain death in medicine technology study and adults: lippincott williams and management of all criteria by iodinated contrast enhancement. Neither the brain hemorrhage before performing a decision is a diagnosis of medicine because the diagnosis of eeg was an incorrect management. Open so they did not brain death protocol is frequently useful only after cardiocirculatory death must leave no coming back. A recent of except and Death Anesthesiology American Society. Brain Death Past Present yet Future Insight Medical. Brain perfusion scintigraphic evaluation protocol using the portable gamma-camera PGC. PulmCrit- Brain death mimics and flow scans EMCrit. Pediatric neurology and neurosurgery nuclear stick and neuroradiology was. To explain brain death criteria a patient encounter have suffered a dream and demonstrably. Confirmatory Tests for eternal Death Verywell Health. The presence of disconnecting a brain death? Radiation oncologists medical physicists and persons practicing in allied professional fields The American. Determination of church by Neurological Criteria algorithm. Grade system depressor drugs, brain death protocol or where such. Brain death criteria The neurological determination of death. The brain death and npv differed among prospective clinical examination must be repeated twice six patients pronounced dead are replacing eeg test for organ recovery. Stored on the University of Kansas Medical Center site Potential participants were.
    [Show full text]
  • Emily White Finished Thesis
    A critical analysis of the legal history of vicarious liability and its applications WHITE, Emily Charlotte Available from the Sheffield Hallam University Research Archive (SHURA) at: http://shura.shu.ac.uk/21451/ A Sheffield Hallam University thesis This thesis is protected by copyright which belongs to the author. The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the author. When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given. Please visit http://shura.shu.ac.uk/21451/ and http://shura.shu.ac.uk/information.html for further details about copyright and re-use permissions. A CRITICAL ANALYSIS OF THE LEGAL HISTORY OF VICARIOUS LIABILITY AND ITS APPLICATION Emily Charlotte White A thesis submitted in partial fulfillment of the requirements of Sheffield Hallam University for the degree of Master of Law by Research September 2017 ABSTRACT This thesis presents an examination of the historical developments of vicarious liability law in the English legal system over the past 200 years. The developments considered date from the principles laid down in Joel v Morison [1834] EWHC KB J39 to the most recent case of Bellman v Northampton Recruitment Ltd [2017] IRLR 124. The various tests for employment status and the course of employment are discussed, with specific analysis into why the tests have changed and developed. Case law and academic criticism is presented to emphasise how the changes have had a positive or negative impact on the clarity and fairness of the area of law.
    [Show full text]
  • Lung Transplantation Adriaan Myburgh
    Lung Transplantation Adriaan Myburgh ! UNIVERSITY OF CAPE TOWN ! Department of Anaesthesia and Perioperative Medicine ! ! ! ! ! ! ! Disclosure Jenna Lowe “ Get me to 21” • 4065 Donors Phalo - URE History • 1947: Vladimir Demikhov performs first successful animal lung transplantation • 1963: James Hardy performs first human lung transplantation in Jackson Mississippi 3 December 1967: First Human heart transplant Denise Darvall to Louis Washkansy • 1986: Joel Cooper performs first successful human double lung transplantation • 2001: Stig Steen performed first successful Non Heart Beating lung transplantation • 2007: Stig Steen performs first ex-vivo reconditioning human lung transplantation Recipients Relative contraindications to lung transplantation • Age > 65 years • Critical or unstable condition (eg, shock, ECMO) • Severely limited functional status • Colonization with highly resistant bacteria, fungi or mycobacteria • Severe obesity (BMI > 30 kg/m2) • Severe osteoporosis • Mechanical ventilation • Other significant medical conditions Orens JB et al. J Heart Lung Transplant 2006; 25: 745-55 Contraindications ? Relative contraindications to lung transplantation • Age > 65 years • Critical or unstable condition (eg, shock, ECMO) • Severely limited functional status • Colonization with highly resistant bacteria, fungi or mycobacteria • Severe obesity (BMI > 30 kg/m2) • Severe osteoporosis • Mechanical ventilation • Other significant medical conditions ECMO Bridge-to-transplant Lung assist device (Novalung®) ECMO Strueber M. Curr Opin Organ
    [Show full text]
  • The Morality of Head Transplant: Frankenstein’S Allegory
    5 THE MORALITY OF HEAD TRANSPLANT: FRANKENSTEIN’S ALLEGORY Aníbal Monasterio Astobiza1 Abstract: In 1970 Robert J. White (1926-2010) tried to transplant the head of a Rhesus monkey into another monkey’s body. He was in- spired by the work of a Russian scientist, Vladimir Demikhov (1916- 1998), who had conducted similar experiments in dogs. Both Demikhov and White have been successful pioneers of organ transplantation, but their scientific attempts to transplant heads of mammals are often remem- bered as infamous. Both scientists encountered important difficulties in such experiments, including their incapacity to link the spinal cord, which ended up by creating quadriplegic animals. In 2013, neurosurgeon Sergio Canavero claimed his capacity and plan to carry out the first human head 1 I am grateful to the Basque Government sponsorship for carrying out a posdoc- toral research fellowship at the Uehiro Centre for Practical Ethics of the University of Oxford, and to the latter institution for its warm welcome. Also, I would like to thank David Rodríguez-Arias for his invaluable comments and suggestions for the improvement of this paper. As usual, any error is solely the author’s responsibility. This work was carried out within the framework of the following research projects: KONTUZ!: “Responsabilidad causal de la comisión por omisión: Una dilucidadión ético-jurídica de los problemas de la acción indebida” (MINECO FFI2014-53926-R); “La constitución del sujeto en la interacción social: identidad, normas y sentido de la acción desde la perspectiva de la filosofía de la acción, la epistemología y la filosofía experimental” (FFI2015-67569-C2-2-P), and “Artificial Intelligence and Biotechnol- ogy of Moral Enhancement Ethical Aspects” (FFI2016-79000-P).
    [Show full text]