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 last few years, many hospitals have begun using such donors. One recent study of 500
hospitals by Dr. Bethany Spielman, 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 Marine, 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.
The patients would receive two drugs that would not benefit then but would help preserve their
or Bans: heparin, which prevents blood clotting, and regitine, which widens blood vessels so the
organs would be well supplied with blood. Then, 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 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
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
al Cleveland State University, and her student Peggy Rickard Bishop Bargholt began providing
Mr. Marino with information that Ms. Bargholt had found while she was working at the clinic.
Mr. Marino said Dr. Waithe and Ms. 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.
Dr. Waithe and Ms. Bargholt also wrote to the Ohio Attorney General, who referred the case to
Mr. Marino's office.
Mr. 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 aid. He provided the manuscript of the medical paper, which said the
proposed program in Cleveland "may cross the line between permitting and inducing death."
Mr. Marine said he would insist that his office approve any protocols before the clinic tried to
take organs from donors whose hearts had stopped beating.
Dr. 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 report on the
dispute tonight. 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, Dr. 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. Gears Agich, and his recently
retired predecessor, Dr. George Canoti, said the were outraged that Ms. Bargholt an Dr. Waithe
had never spoken to them about their concerns and had never told them that they were providing
documents to the county prosecutor.
Dr. Canoti said, "I'm the first to say that if we did something bad w should own up to it." But, he
added "I can't see any major ethical problems" with the proposal. No one was planning to kill
patients or accelerate their deaths to get organs, he said.
Dr. 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
essentials killing patients to get their organs?
Dr. Michael DeVita, an expert in critical-care medicine and the chair man 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."
When doctors take dying patients off life support, Dr. DeVita said, they can "use medicines for
the patient's comfort that may as a consequence also hasten death." But, he said, "drugs given
exclusively to hasten death and not for a patient's comfort are considered active euthanasia."
Ragitine could fall into that category, he said. So, he added, "that's specifically why we don't use
it at Pittsburgh."
But Dr. Hans Sollinger, the chairman of the division of transplantation at the University of
Wisconsin School of Medicine and the president of the American Society of Transplant
Surgeons, vehemently disagrees. In recent years, Dr. Sollinger said he had taken organs from 12
donors whose hearts had stopped beating, giving them regitine and heparin. He also said he had
given drugs to the thousands of brain-dead patients to preserve their donated organs. And yet, he
said, "we have never seen a significant drop in blood pressure and I have, in thousands of cases,
never seen a cardiac arrest, never seen a significant cardiac arrhythmia.
Dr. Norman Fost, the director of the ethics program at the University of Wisconsin and a visiting
professor this year at Princeton University, said it was "flat-out wrong" to say the drugs speed
"The immediate cause of death is the removal of ventilator support," Dr. Fost said. The donors in
question are not brain-dead, be said, since "it takes the brain a day or two to be completely dead."
But he said death "is a philosophical, a legal, a religious concept," not a medical concept. In
medicine, Dr. Fost said, a patient is dead when a licensed doctor declares the patient dead. In
Wisconsin, with organ donors whose hearts have stopped, that moment is defined as five minutes
after the heart stops. In other medical centers, it is two minutes or three minutes or, someimes,
six minutes after there is no heart beat.
But such definitions, according to some ethicists, are part of the problem. Dr. Spielman, the
ethicist at Southern Illinois University, said her survey showed that there was no uniformity in
hospitals' policies for such donors. Some hospitals, she said, do not even have a policy.
Dr. Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania,
described the situation this way: "There's a real danger here. If you scare people about fuzzing
the line between life and death, if you frighten people into thinking that doctors kill patients to
obtain organs, you will devastate the system. The whole system depends on altruism, and
altruism depends on clear standards that everyone agrees to. You can't innovate in this area,
institution by institution, doctor by doctor."
Already, said Debbie May-Johnson, a spokeswoman for Life Banc, the Cleveland area's organ
depository, news reports about the controversy appears to be having devastating effects.
Normally, there are three organ donations every four days in the area. But since The Cleveland
Plain Dealer reported the accusations by Mr. Marion on April 3, there has been a single donation
and it came on Friday.