February 28, 2008

When is the organ transplant doctor committing murder?

In California, a doctor, Hootan C. Roozrokh, is charged with murder:
In brain-death donations, the donor is legally dead, but machines keep the organs viable by machines. In cardiac-death donations, after the patient’s ventilator is removed, the heart slows. Once it stops, brain function ceases. Most donor protocols call for a five-minute delay before the patient is declared dead. Transplant teams are not allowed in the room of the potential donor before that....

According to a police interview with Jennifer Endsley, a nurse, the transplant team, including Dr. Roozrokh, stayed in the room during the removal of the ventilator and gave orders for medication, something that would violate donation protocol. Ms. Endsley, who stayed to watch because she had never participated in this type of procedure, also told the police that Dr. Roozrokh asked an intensive care nurse to administer more “candy” — meaning drugs — after Mr. Navarro did not die immediately after his ventilator was removed.


rhhardin said...

They're prisoners of the male need for a theory.

The truth is more feminine in this case.

It's covered better, that is to say, by adding complexity, and not particularly aiming for a decision.

It would end up, in this case, saying to the legal team, ``Why don't we do something else?''

George M. Spencer said...

[Thomas] Jefferson was no fan of the doctors, to the point where he would look upwards for a buzzard whenever he saw three physicians together....

Chip Ahoy said...

Here we see starkly the difference between human doctors and Himself. God doesn't go around thinking he's a doctor.

New York said...

The terminally ill are sometimes victimized by careerist doctors even while they're still conscious.

This one doctor tried to convince my cancer-ridden mother to undergo a risky surgical procedure even though there was little hope for improving her condition.

titussss said...

Fellow republicans I have something embrarassing to admit.

This morning, while lounging naked around my fabulous loft, I farted and a kernel of popcorn flew out and one of the rare clambers ate it.

Bob said...

*foot slides on wet clay*

Damn, this slope is slippery!

AllenS said...


Get a terminally ill patient declared "child-like", then you need to proceed to a diagnosis of "fetus-like", then you can kill them and harvest their organs.

Anonymous said...

We've replaced the concept of the sanctity of life with the quality of life.

Trooper York said...

HOLY COW, the babe from the Flava
Flav show is commenting on Althouse. I must admit that I am very impressed.

Hoosier Daddy said...

This morning, while lounging naked around my fabulous loft, I farted and a kernel of popcorn flew out and one of the rare clambers ate it.

Does this mean we can call you Jiffy Pop now?

KCFleming said...

What difference does it it make, 5 seconds or 5 minutes? Death of its own accord or hastened a bit, if death is indeed inevitable?

The end often dictates the means. Slopes are indeed slippery.

Roger J. said...

I'm with Pogo on this one. The man was going to die; there is no doubt about that. I think it could be argued that the organs to be harvested would deteriorate were the donor to be kept in a situation where removing the organs would be delayed.

Those organs are not going in the trash--they are brining life, sight, and other benefits to a lot of other people. I think the Doc made the right call--and for those that would like to make this situation a legal issue, the prudent response of any doctor would be to get out of the organ transplant business. Is that what the end result should be?

Christy said...

Yes, Pogo, but we have all seen that BBC mini-series, Mother Love, wherein Diana Rigg rips all the life support from her comatose son and he comes miraculously back to life.

The protocols are what make us, well, me anyway, comfortable about signing that donor card.

KCFleming said...

I do not suggest at all that the doctor was right. Instead, I favor strict adherence to the protocols in order to avoid precisely this outcome. I am very troubled by the ethicakl problems inherent in the transplant industry.

The very nature of organ transplantation, even by the words it chooses to describe its actions("harvesting"), belie a drift toward viewing other humans as objects, as sources for something we need, and not having an inviolable dignity that must always be respected.

The slippery slope is active here. The doctor sees no difference between 5 seconds or 5 minutes, because the object is the organ. The dying patient is the delivery vehicle. At least that's what tends to happen.

I was being snarky before, commenting that once we let mere utility determine human value, these things will always occur.

rhhardin said...

Normally murder is about considering the voice of the deceased (a voice that is missing, and the place that society accords that voice is why there's a death penalty).

The voice of the deceased here is quite otherwise, and is not missing.

They might have wished that the transplant be successful, and so be exactly on the doctor's side.

If you want to do moral issues, these are the things to lay out ; not something about slippery slopes.

Richard Dolan said...

If it's not important to observe carefully drawn lines when the issue is life and death, it's hard imagine a context in which that would be important. Transplant protocols are based on finely drawn lines precisely for the benefit of doctors like the transplant team here, because it is normal (and predictable) that they will place a much hihger value on saving the life of the transplant recipient than on respecting the life of the transplant donor. Objective guidelines are essential; it's amazing that highly trained transplant teams did not observe them scrupulously.

The whole area of organ transplants is based on these kinds of protocols, beginning with the criteria for selecting potential transplant recipients. Particularly in situations where there are many more qualified recipients than donated organs, life-and-death choices are made daily by transplant teams. The only alternative to these strict protocols throughout the transplant process is to allow the doctors in charge to play God in a way that most (including most of those doctors) will, I think, find unacceptable.

The part of this story that seems a bit off is the resort to the criminal process to deal with any departures from the applicable protocols. I assume that the focus of the criminal charge is the administration of the "candy" designed (apparently) to hasten death, rather than any violation of the protocols. But the story suggests that the administration of those drugs is part of the accepted protocol; perhaps the issue will turn on the dosage or the timing of the additional dose. In all events, it's an area that will inevitably involve some interplay between legal definitions of homicide and transplant protocols where, at least from certain perspectives, the organ donor is still intentionally not-quite-dead if one or another traditional notion of "death" were applied.

It will also be interesting to see how the various players will line up, compared to how the same players lined up in the Schiavo case. Schaivo, too, involved a definition of "death" that was at odds with some traditional notions. It turned on who got to decide (husband vs. parents); whether a negative act (withholding nutrition/hydration) was a killing; and had the same overtones of quality of life vs. respect for life. This transplant case presents a twist on the "who decides" issue (the transplant team or the protocols), but in the context of an affirmative act (administering the extra "candy").

A criminal trial strikes me as a crude forum to try to resolve issues like that. But it is a great way to get everyone's attention, particularly the doctors on the front lines of these issues.

KCFleming said...

They might have wished that the transplant be successful

But considering that England wants to make donor status mandatory (euphemistically called presumed consent ...and aren't euphemisms a nice way of avoiding tough issues in tranplantation? hence harvesting and not organ removal), I'll stick with the slippery slope argument.

Seems to me alot of people presume to speak for the voiceless, and what comes out is, amazingly, the very same message that the speaker himself supports. Curious thing, that.

KCFleming said...

CART MASTER: Bring out your dead!
CUSTOMER: Here's one.

CART MASTER: Ninepence.
DEAD PERSON: I'm not dead!
CUSTOMER: Nothing. Here's your ninepence.
DEAD PERSON: I'm not dead!
CART MASTER: 'Ere. He says he's not dead!
CUSTOMER: Yes, he is.
CART MASTER: He isn't?
CUSTOMER: Well, he will be soon. He's very ill.
DEAD PERSON: I'm getting better!
CUSTOMER: No, you're not. You'll be stone dead in a moment.
CART MASTER: Oh, I can't take him like that. It's against regulations.
DEAD PERSON: I don't want to go on the cart!
CUSTOMER: Oh, don't be such a baby.
CART MASTER: I can't take him.
DEAD PERSON: I feel fine!
CUSTOMER: Well, do us a favour.
CUSTOMER: Well, can you hang around a couple of minutes? He won't be long.
CART MASTER: No, I've got to go to the Robinsons'. They've lost nine today.
CUSTOMER: Well, when's your next round?
CART MASTER: Thursday.
DEAD PERSON: I think I'll go for a walk.
CUSTOMER: You're not fooling anyone, you know. Look. Isn't there something you can do?
DEAD PERSON: [singing] I feel happy. I feel happy.
CUSTOMER: Ah, thanks very much.
CART MASTER: Not at all. See you on Thursday.

former law student said...

The transplant doctor, panting greedily to harvest the donor's organs, can in no way be said to be in a doctor-patient relationship with the donor: he clearly put the interests of the organ recipients above the best interests of the donor. Therefore he had no authority to prescribe medicine for the donor. His license should be lifted. The hospital should be sanctioned for allowing their nurses to carry out his orders.

This is my biggest fear about signing the back of my license: that I would be valued more as a source of spare parts than as a human being deserving medical treatment.

former law student said...

An important omission: the transplant surgeon ordered the donor injected with a toxic antiseptic solution Betadine, as well as morphine and Ativan. There is no medical indication for Betadine injection, so I believe this is what the murder charge hangs on.

Revenant said...

It sounds like murder to me; the guy's brain appears to have still been fully functional, and the doctor took steps to kill that brain.

PatHMV said...

I would point out that one could still maintain appropriate rules and safeguards for transplants without calling failure to adhere to such protocols murder.

Bruce Hayden said...

I would point out that one could still maintain appropriate rules and safeguards for transplants without calling failure to adhere to such protocols murder.

The problem there appears to be that the transplant surgeon ordered the donor injected with a toxic antiseptic solution Betadine, as well as morphine and Ativan. The injection of the Betadine is likely what is behind the call for murder charges. But it appears so far that prosecutors have charged Dr. Roozrokh with felony counts of dependent adult abuse, mingling a harmful substance (Betadine) and prescribing a controlled substance (morphine and Ativan) without medical purpose.

jennyloels said...

"mingling a harmful substance (Betadine) "

Is mingling a legal term of art? It has no medical meaning here, and used in an inappropriate context.

bruce hayden states (apparently speculatively since there is nothing in the referred article that supports his interpretation) that it describes "the donor injected with a toxic antiseptic solution Betadine". Mingling does not equal injected.

Although Betadine is used extensively topically, it has also been used internally and intravenously. I used to work with a transplant surgeon who administered it intravenously to his goats to treat Candida. It is also used as an antibiotic irrigation in contaminated wounds.

If the prosecutors or the journalists are screwing up such an easily checkable fact, I wonder about the rest of their facts.

former law student said...

The NYT article said the complaint said Dr. Roozrokh introduced Betadine, a topical antiseptic, into Mr. Navarro’s system; Betadine, the complaint said, is “a harmful substance that may cause death if ingested.”

An earlier article, in the local paper, said Rookrokh was charged with injecting Betadine into the donor's feeding tube:
They allege that Roozrokh violated state law and Sierra Vista’s protocol Feb. 3, 2006, when he took control of the care of Ruben Navarro and ordered a nurse to give the 25- year-old abnormally high doses of morphine and Ativan to hasten death. They also say Roozrokh injected Betadine, a topical antiseptic, into Navarro’s feeding tube.


From the Betadine MSDS:

Potential Health Effects
Betadine® Solution is a topical microbiocide. Its active ingredient is povidone iodine.

High concentrations of iodine in the blood from inhalation or ingestion may cause thyroid disorder (hyperthyroidism), renal disturbances, acidosis, and electrolyte disturbances such as increased iodine levels and severe hyponatremia.

If swallowed, do not induce vomiting. Drink several glasses of milk or water.
Never give anything by mouth to an unconscious person. Get medical attention.

NikiiS said...

this is why i am not a donor. i have heard of a lot of these cases, in which a person who could be saved is left to die because they have a donor sticker. while the donation of organs is a wonderful thing, the potential for human manipulation can sometimes make it unacceptable. until they get this type of thing sorted out, i won't be putting a donor sticker on my id anytime soon.

cntrywinds said...

I use to think like you Nikii! I refused to donate my sisters organs because I was ignorant to the procedure. I recently received a liver donation from an acute situation due to medication. I am alive now because of this gift of life. I use to think they would let you die if you were a donor. I don't think all Doctors are as evil as this doctor was. It is GODs choice not a doctors. I am now a donor and am confident that the transplant community will do the right thing atleast in the states. I hope! If they don't I beleive you will answer to a higher power. My children and I thank all donors for the gift of life. This "doctor" should be held accountable for hurting the transplant community!!!!