The biggest difference of all was that my entire mission had been turned on its head. The patient on the operating table was, in fact, not the patient at all. He was not the one to whom we have sworn to “do no harm.” In effect, our patients were all the potential recipients of the organs. My new duty was to preserve the organs as well as possible until the removal of the heart—and then to simply shut off the ventilator and monitors, walk out, and eventually collect my rather lucrative fee for assisting. The normal dynamic of physician helping patient was absent; I felt like the temporary caretaker of an “organ farm,” one to be harvested with my assistance.
This experience was jarring, and I dreaded any further organ harvest assignments after the first few. These cases felt like a gross alteration in mission; they went against everything I had trained for and did on a daily basis. It is one thing in theory but quite another in practice to switch gears and “anesthetize the dead.”
To make matters worse, I was personally involved in at least two cases where proper protocol and criteria for declaring “brain death” were not applied. In one case, we discovered the patient had paralytics on board in the intensive care unit during an apnea test. We reversed the paralytic, and it became clear that the patient, while critically ill, was not dead. In another instance, I could find no documentation that proper testing had been done at all; I insisted on conducting my own makeshift apnea test in the operating room before I let them proceed. This ruffled a few feathers, but I stood my ground. This was the last harvest I participated in; I refused from that point on. My comfort with assisting with these cases, even accepting the concept of brain death, was tenuous at best. The realization that the application of brain death criteria was variable and, sometimes unreliable, was a bridge too far.
