Name: Cole Hartman.
Died: August 4, 2013.
Age at death: 8.
Cause of death: Removed from ventilator, given Fentanyl overdose.
Location: Los Angeles, California, USA.
Cole had Fragile X and autism.
His father found him head-first under water in the washing machine and called paramedics. He had stopped breathing, but they were able to revive him and put him on life support at the hospital, where he remained alive but in a coma and on a ventilator.
Although Cole was not brain-dead, doctors encouraged Cole’s parents to remove life support so that Cole’s organs could be transplanted. In a situation like this, organs cannot be transplanted until the patient’s heart has stopped, so the doctors hoped Cole’s heart would stop quickly so that his organs would not degrade. His parents agreed to terminate life support, and the ventilator was withdrawn.
But Cole kept breathing. The anesthesiologist, seeing this, gave him an overdose of Fentanyl, a strong opioid which can stop breathing even in healthy people when given in high doses. After this overdose, Cole stopped breathing and died.
A coroner’s investigator specializing in child deaths made sure that Fentanyl was listed as a contributing cause of death on Cole’s death certificate.
Editor’s note: We would like to stress the differences between Cole’s death and that of the vast majority of organ donors in the United States. A brain-dead organ donor has no living brain tissue; there is truly no hope for recovery when the brain is dead.
But Cole was not dead. He had sustained a brain injury, but his brain was still working. He had spent only four days in a coma before doctors wrote him off as a lost cause, probably influenced by his Fragile X. It is impossible to tell in only four days how much function someone with a hypoxic brain injury, especially a child, will recover in the long term. Had Cole survived, he might have been severely disabled; but he was never given that chance. As a child with a disability to begin with, doctors seem to have seen him as not worth trying to save.
That Cole’s kidneys and liver were transplanted has become a focus of the investigation. However, it is important to remember that it is not organ donation which causes these deaths; it is the belief that doctors who treat critically ill disabled people are “wasting their effort” because we are “not worth saving”. Most critically ill disabled people who are denied treatment in this fashion are not candidates for organ donation. The doctors who decide to terminate life support are not given credit for any lives saved with the deceased person’s organ, nor are transplant teams typically affiliated with the hospital where the donor dies. The specter of killing the disabled for their organs has not become reality in America. However, denying medical treatment to those who could survive, because they have a disability, is a daily reality.
Organ donation saves lives. This editor urges everyone to sign an organ donor card, but also to have a serious talk with loved ones, urging them to advocate for you if you are ever incapacitated, and not to allow themselves to be convinced, as Cole’s parents were, that your life will not be worth living. If you are still afraid that an unscrupulous doctor might kill you for your organs and do not want to sign an organ donor card, I recommend arranging for body donation for medical student education or research as an alternative. We all die, and it’s sad that we do; but at least we can do some good on our way out. Rest in peace, Cole; you deserved better.
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