Ignazio Marino

"While it is true that, in the US, one person dies every minute due to a shortage of organs for transplantation and that the country needs to find a solution to this pressing issue, it is also essential to safeguard the rights and wishes of individuals who, while still mentally competent, have considered the sensitive question of how they wish to be cared for (or not cared for) in the final stages of their lives and how they wish their body to be disposed of. The new measures have received enthusiastic support from a large part of the US transplant community, despite bioethics experts warning of the risk that the law could turn individuals who would not have wished to do so into organ donors, force certain family members to accept decisions they do not agree with, and even encourage doctors not to administer certain medications to terminally ill patients for fear of damaging the quality of organs that would otherwise be available for harvesting and transplantation. These concerns may be exaggerated, but they are entirely legitimate. For decades, efforts have been made to close the gap between organ demand and supply, but this does not mean that we should not proceed with the utmost caution. It may seem obvious to point out a fundamental principle, but we must always bear in mind that it is not acceptable to place more value on one life than on another – in this case, on the life of a man or woman on the transplant waiting list than on the life of a person who is nearing the end of their life on an intensive care unit. We must act with caution, demonstrating that the ultimate concern is always, and only, the respect and health of citizens, at whatever stage of life they are, at whatever age, and in whatever situation."

"Indeed, throughout human history, the end of life has always coincided with the cessation of the heartbeat: every hero worthy of the name has died because their heart stopped beating. Literature, works of art, and old medical textbooks provide ample evidence of this. [...] With the first cardiac surgery procedures and the invention of extracorporeal circulation, it became clear that the function of the heart could be replaced by an artificial mechanism: the person continued to live without a beating heart in his chest, as long as blood continued to flow to their brain. Doctors had recorded numerous signs, and the idea that the brain played a crucial role in human life was already well established. Based on these assumptions, a debate developed at Harvard that brought together not only doctors but also lawyers, philosophers and representatives of different faiths, as the aim was to find a definition of death that took into account the ethical concerns and the context at a given point in history. Since the Harvard guidelines, death is certified when all vital brain functions have irreversibly ceased."

"Therefore, the new definition of death was not merely the result of a discussion between scientists; above all, it was the first shared bioethical statement to have a tangible impact worldwide. Indeed, brain death formed the basis for the development of transplant medicine as we know it today; it enabled organ donation and harvesting from donors whose hearts were still beating. And it is thanks to that work that, today, tens of thousands of organ transplants are performed worldwide each year, and that, thanks to this treatment, countless patients who would otherwise be facing certain death are saved. Therefore, the definition of death is based on scientific certainties that there is no reason to question. Moreover, it is clear that if a doctor had the slightest doubt about a person's death, they would never proceed with organ harvesting."

"Some people currently argue that the definition of death should be revised in light of the technological innovations that have transformed the world of medicine. Personally, I believe that the way in which the end of life is defined is scientifically correct. More importantly, however, I believe that if anyone has doubts, they should raise them in the appropriate forums and present the scientific arguments that support their position to everyone. Otherwise, suggesting that an individual who has hitherto been defined as dead is no longer dead is an irresponsible act that risks jeopardising the opportunity to save hundreds of thousands of lives through post-mortem organ donation, a generous act motivated solely by a sense of solidarity between human beings."

"In the USA, I have always refused to perform transplants from altruistic donors, although such transplants were carried out, albeit rarely, at the centres I have managed. On the other hand, I have always supported, performed and encouraged transplants from living donors with whom there is an emotional bond. I am not convinced that it is right to subject someone who is not related to the recipient to the risk of surgery. I wouldn't go so far as to ban them, but I'm not convinced that they are an ethical approach or a solution to the appallingly long waiting lists, especially for kidney transplants."

"I said that five years ago, the then mayor, (Gianni Alemanno) , ran for office with a campaign focused on the issue of security. He had a vision of a film, the 'sheriff mayor' film, but it turned into a different film, the 'all talk and no action' sheriff film."