Ethicists, Transplant Docs Mull Impact of Organ Case

A court case in which a doctor has been charged with hastening a disabled patient's death, in order to harvest his kidneys and liver, has sparked concern among ethicists and organ transplant experts alike.

According to a report in the New York Times, preliminary hearings began Wednesday for Dr. Hootan C. Roozrokh. The Times reports that the California doctor faces three felony counts, including the charge that he prescribed excessive and improper doses of drugs to 25-year-old Ruben Navarro in 2006. Navarro suffered from a rare metabolic disorder that had left him disabled and brain damaged.

Prosecutors allege that Roozrokh prescribed additional doses of sedative drugs in order to hasten Navarro's death and harvest his organs sooner, the Times reports. However, when Navarro died on Feb. 4 at Sierra Vista Regional Medical Center, about 150 miles northwest of Los Angeles, his organs had already deteriorated to the point that they could not be used.

Roozrokh has pleaded not guilty to the charges. If he is convicted on all counts, he could face up to eight years in prison.

A phone call to M.Gerald Schwartzbach, the Mill Valley, Calif., attorney representing Roozrokh, was not immediately returned.

Organ transplant and bioethics experts said the allegations, if true, point to the need for tighter controls to ensure that the interests of the potential organ donor are served first — particularly when the donor is disabled.

"As a disabled person, with a poor family who could not afford to stay near him every night, [Navarro] was a potentially very vulnerable individual who should have been protected from abuse," said Kathleen Powderly, acting director of the Division of Humanities in Medicine at SUNY Downstate Medical Center in Brooklyn, N.Y.

Of particular concern is the potential for the same doctor involved in organ transplantation to be involved with the end-of-life care of the potential donor. Most protocols for transplantation surgery maintain that end-of-life care and organ recovery be handled by two separate teams of doctors; however, as this case could reveal, these guidelines may not always be abided.

According to police reports obtained by the New York Times, one of the nurses present in the room, after Navarro's respirator was removed, said Roozrokh was also present. She also told police that he encouraged another nurse to administer additional doses of a sedative when he did not die right away.

"It is completely inappropriate for a transplant surgeon to be involved in managing the care of a dying patient," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "Until the person is deemed dead, control must reside in the hands of intensive care personnel.

"The motivation to get organs must always, always be subordinate to patient wishes about dying and the provision of patient oriented palliative and comfort care."

"The most critical aspect should be the total separation of 'church and state' — in other words, no one from the organ donor or transplant community should be involved in the process leading up to the declaration of death," agreed Dr. Vivian Tellis, chief of the kidney transplant program at Montefiore Medical Center in New York.

When 'Dead' Is Not Quite

The line between whether a potential organ donor is truly alive or dead is not always as fuzzy as it may have been in Navarro's case.

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