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

Abstract

P Pu ur rp po os se e: : The increasing gap between numbers of individuals awaiting organ replacement surgery and the supply of organs available for transplant underpins attempts to increase the number of organs available. One practice, used in other countries, is the recovery of organs from non-heart-beating organ donors (NHBD). The purpose of this review is to discuss ethical issues surrounding the use of organs from these donors.S So ou ur rc ce e: : Narrative review from selected Medline references, and other published reports.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : NHBD protocols have been established in many countries including the United States. Despite numerous publications, and extensive debate in the literature, significant ethical issues remain unresolved in the retrieval of organs from donors that have died from cessation of cardiac activity. The ethical concerns primarily arise in the determination of death, the tension between the time constraints on recovering organs viable for transplantation, and procedures to enhance organ viability. Despite a concerted effort in the United States, less than half of the organ procurement organizations have NHBD protocols.

Systematic Review of Attitudes Toward Donation After Cardiac Death Among Healthcare Providers and the General Public*

“…One possibility of increasing donation after death is the increased use of donation after cardiac death (DCD)-transplanting the organs of persons who have died after suffering cardiorespiratory arrest. Estimates show that the use of these organs could increase the availability of organs by over 20% (2). However, obtaining organs from these donors raises many issues (3)(4)(5) that may differ from those raised by using organs from donors who participate in donation after brain death (DBD).…”

Kidney donation after cardiac death

“…There are further issues regarding how consent is obtained and whether sufficient respect and care is given to the patient and his family [42,43] . It is important to develop an ethical framework for DCD that enjoys community-wide support.…”

“…Decisions around withdrawal of life-sustaining therapies, management of the dying process and the determination of death by cardio-circulatory criteria should be separate from and independent of donation and transplant processes [14] . Ongoing controversies relate to whether the DCD donor is dead after 5 min of absent circulation [42] . Three of 39 potential donors achieved successful cardiac resuscitation when mechanical chest compression was applied [41] .…”

Ethical controversies at end of life after traumatic brain injury: Defining death and organ donation

“…Institutions participating in DCD have frequently done so without consistent protocols and policies (50,51). There have been worrisome conflicts of interest among procurement (transplant) coordinators, who have at times acted on behalf of both the donor and the recipient.…”

“…There have been worrisome conflicts of interest among procurement (transplant) coordinators, who have at times acted on behalf of both the donor and the recipient. There are many ethical concerns about the definition of death and the administration of therapies to the organ donor that may hasten death (50,51). Many believe that the care and needs of the dying patient will not be met because of a shift of priorities toward the organ recipient, and this is increased by the sometimes inappropriate assignments of end-of-life care to OR physicians and healthcare workers who do not have adequate knowledge, experience or training in the many complex issues surrounding death, including the relief of physical and psychological suffering.…”