Physicians, bioethicists and governments continue to debate the issue of brain death criteria for purposes of organ transplants and determining the exact moment of death has been a source of contention since organ transplants became common. Controversy continues to swirl around the issue as patients in apparently hopeless comatose conditions continue to confound doctors' expectations and awaken.

The problem is time and the rapid deterioration of most vital organs after the cessation of heart function. After death, corneas and bone marrow can still be used but soft vital organs such as the heart, lungs, pancreas and kidneys rapidly deteriorate and are unusable within a few hours. Traditional medical ethicists contend that soft and easily damaged organs such as the heart are impossible to obtain morally since they deteriorate more quickly and must be removed when a patient's condition is still disputed.


One of the most recent and contentious developments is the concept of "non-heart beating organ donation" (NHBD) in which organs are removed from a body as little as five minutes after the cessation of the heart function. In a facility where such criteria are followed, had other factors been favourable and given her lack of brain function, Mrs. Thomas might have been pronounced dead and been a candidate for removal of organs as soon as she arrived at the hospital.

The procedure is also known as donation after cardiac death (DCD), and typically involves a person who requires a ventilator and, while having measurable brain function, is determined to have no hope of recovery. After this judgement is made, doctors remove ventilation from the patient and wait for the heart to stop beating. If the heart stops for five minutes, death is pronounced and the organs are harvested by another surgical team.

The definition of "brain death" also remains controversial, but DCD is even more contested since the method leaves little time for ethical considerations. With "brain death" organs can be harvested at leisure since machines keep air flowing into the lungs and blood circulating; with DCD the stoppage of the heart necessitates very quick harvesting as organs deteriorate without blood flow.

Doctor John B. Shea, medical advisor to Canada's Campaign Life Coalition told LifeSiteNews.com that DCD does represent a potential threat to comatose patients.

Donors for DCD are chosen, he said, not because they are dead, but because their organs are particularly desirable for transplant. Dr. Shea said in a 2006 interview, "The typical scenario for such organ harvesting is a young person between the age of 5-55 who is in good health, is in intensive care due to an automobile accident and is on a ventilator. The doctor makes an arbitrary decision that treatment is futile."

"Those donors are known not to be brain dead but are usually first in a coma and the doctor decides treatment is futile."