Non-Heart-Beating Organ Donation: Process and Review

Abstract

To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.

Potential Suitability for Transplantation of Hearts From Human Non–Heart-Beating Donors: Data Review From the Gift of Life Donor Program

“…21 During the evaluation process for NHBDs, the clinician and GLDP coordinator try to determine if cardiac cessation will occur within 1 hour after discontinuation of support. Since then, the GLDP has evaluated all referrals of patients who sustained a non-recoverable neurologic injury but do not meet criteria for brain death, have preserved organ function, and whose families have chosen to withdraw life-sustaining therapies.…”

“…21 After cardiopulmonary arrest and an additional 5-minute waiting period, surgical recovery of the organ proceeds. The surgical recovery team prepares and drapes the patient in standard fashion.…”

Retrieving organs from non-heart-beating organ donors: a review of medical and ethical issues

“…1 In consequence, alternative sources of organs have been sought, including the retrieval from individuals declared dead by cardiopulmonary criteria i.e., when cardiac function ceases; known as a group as non-heart-beating donors (NHBD). 2,3 The rationale behind using NHBD includes: 1) the NHBD was the major source of organs for transplantation prior to the development and adoption of brain death criteria, 4 and remains so in countries, e.g., Japan, where the concept of 'brain death' has only recently been adopted in legislation, but has yet to be widely accepted by the general populace; 5,6 2) the recovery of organs from NHBD does not violate the ethical principle of the 'dead donor' rule (see below); and 3) the determination of death by cardiopulmonary criteria is far more common; therefore, the pool of potential donors would include a larger group of patients, not only those patients dying from catastrophic brain injury. 2,7 This article will review some of the medical and ethical issues surrounding the procurement of organs from NHBD.…”

A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study

“…(1, 2) However, DCD was eclipsed after brain death criteria for organ donation expanded in the 1970s(3) but has incrementally returned as a source of solid organ donation in the United States since the 1990s. In 2015, DCD donors accounted for 16.5% of all donors, and seven of the 11 donation service areas (DSAs) saw at least a 10% rise in DCD donors during this same time period.…”