More Hospitals & Governments Push for Organ Transplants 5 Minutes or Less After Heart Stops

A growing push has arisen from the medical community to increase the number of available human transplant organs by removing organs from non-brain-dead organ donors who experience “cardiac death” (CD) or 5 minutes of cardiac arrest. A recent article in the New Scientist, entitled “Not brain-dead, but ripe for transplant,” once again brings the contentious procedure back into the limelight. The procedure, known as “donation after cardiac death” (DCD) or non-heart beating organ donation (NHBD) gained notoriety earlier this year in Canada after an Ottawa hospital announced in June its first DCD transplant. Currently the Australian Health Ethics Committee (AHEC) is considering recommending that the government encourage DCD, and government support in the United Kingdom has swelled numbers of DCDs by six-fold in the last 15 years to 120 in 2005 [New Scientist]. Yet the procedure is fraught with pitfalls, with many expressing fear that more doctors may be willing to sacrifice patients in order to harvest their organs to supply the worldwide demand. The New Scientist article relates the story of a 20-year-old “Janet,” who, following a car accident, suffered such extensive injuries that she would have been deemed eligible to have her organs harvested according to DCD’s standards. Janet, however, subsequently recovered and is “wheelchair-bound but happy to be alive.” In many countries, transplant surgeries only take place after doctors determine that a donor-patient is “brain-dead”…and therefore has no chance of recovery. Heart and lung function are maintained by way of life support in order to preserve the donor’s organs until surgeons find a suitable moment to harvest them. The typical DCD donor patient, however, would have...

Truthfulness in Transplantaion: Non-Heart Beating Organ Donation

The Inconvenient Truth About Organ Donations Truthfulness in transplantation: non-heart-beating organ donation: Commentary Abstract   The Inconvenient Truth About Organ Donations: Physician sounds alarm about unethical or at least highly questionable practices of organ transplant industry There has been growing concern over the past several years about increasingly aggressive measures undertaken to harvest human organs from dying patients. Dr. John, Shea, a Toronto physician who has specialized in researching the issue, has just completed a report, Organ Donation: The Inconvenient Truth, that sounds an alarm about the unethical or at least highly questionable practices of the organ transplant industry. Dr. Shea reports on the modern and still very unsettled definition of "brain death" used by many organ transplant physicians to justify declaring organ donors dead and therefore fair game for immediate organ harvesting .   Shea points out, "There is no consensus on diagnostic criteria for brain death. They are the subject of intense international debate. Various sets of neurological criteria for the diagnosis of brain death are used. A person could be diagnosed as brain dead if one set is used and not be diagnosed as brain dead if another is used." It depends on what hospital or which doctor is involved in a particular case.  In fact, says Shea, "A diagnosis of death by neurological criteria is theory, not scientific fact. Also, irreversibility of neurological function is a prognosis, not a medically observable fact."   The coldly utilitarian goal of promoting the acceptance of brain death, says Shea, "is to move to a society where people see organ donation as a social responsibility and where donating organs...

Non Heart-Beating Donation (NHBD): 5 Articles 2006-07

1. Palliative Care and Organ Donation http://www.pallimed.org/2006/03/terminal-patients-in-icu-and-organ.html Monday, March 20, 2006 Terminal patients in the ICU and organ donation In my job as a palliative medicine doctor, I am frequently talking with patients and families about the potential of withdrawal of ventilators/pressors/dialysis in the ICU. Obviously this is not the only thing I talk about, but it often comes up in discussing dignity and futility and all the things that demonstrate our limits with modern medicine. One of the things I have not seen implemented well (in person or in literature) is a way to make organ donation and palliative medicine work a little closer together. An article in the current Intensive Care Medicine describes a pilot project to develop a program for non-beating heart donors (NBHD) after withdrawal of life support. This Swiss study was prospective and identified 73 of 516 deaths that might be appropriate for NBHD of kidney, liver or lung. While they found that there was too much variability in how patients died in the ICU after withdrawal to implement their program, they did come up with some interesting data and discussions. Part of the dilemma in implementing a NBHD organ procurement program was the variability of time after withdrawal of intubation or pressors. They note it would be hard to have a surgical team on standby for a variably prognostic cardiac death versus a brain death where the organs are procured in the OR after the aorta is clamped (from my ancient 1998 knowledge during my organ transplant rotation on surgery). But this does give some helpful prognostic information for professionals dealing with near-death...

Brain Death or NHBD – Important Distinction

For the past several years, a little-known but disturbing revolution has been occurring in organ donation. In the understandable but sometimes alarming zeal to obtain more organs, the procedure called non-heart-beating organ donation (NHBD) has been quietly added to brain death organ donation in more and more hospitals all over the country. Although “brain dead” is a term many people erroneously associate with a coma-like condition or use to humorously describe an ignorant person, brain death is a legal and medical term that describes the irreversible loss of total brain function, even when the body can be kept going for a while using technology such as a ventilator. Since 1970, every state has added brain death to the legal and more familiar definition of death as the irreversible end of breathing and heartbeat. The addition of brain death as a legal definition of death revolutionized organ transplantation, because waiting until a person died naturally to harvest organs often resulted in organs too damaged for successful transplant.  With brain death, organs could be taken before breathing and heartbeat stopped, and organ transplantation became commonplace. But when brain death did not meet the demand for organs, NHBD was invented in the 1990s as a way to obtain more organs. NHBD is very different from brain death organ donation.   While brain death organ donation means the person is legally dead but still has a heartbeat when organs are harvested, the potential NHBD patient is alive but termed “hopeless” or “vegetative” by a doctor, usually soon after suffering a devastating condition like a severe stroke or trauma and while still needing a ventilator...