Another matter of life and death: what every anesthesiologist should know about the ethical, legal, and policy implications of the non-heart-beating cadaver organ donor.

Abstract

Summary It remains to be seen whether the use of NHBCDs willsignificantly increase the number of organs available fortransplantation. Organ retrieval from such donors maybe ethical, provided that conflicts of interest amonghealthcare providers are defined and prevented, the ex-ploitation of vulnerable persons is avoided, the with-drawal of care is in accordance with accepted and ap-propriate medical standards, the inadvertent harvestingof vital organs from living patients does not occur, andthe humane treatment of dying patients and their fami-lies is safeguarded. Further, the process must not beimplemented in ways that cause distrust among dyingpatients that their medical and social needs will be putsecondary to those of patients needing transplantableorgans. It is arguable whether any existing protocolcompletely addresses all of these issues.Any anesthesiologist involved with either policies orcare of patients who will become NHBCDs should beeducated about the legal, ethical, and medical issuesinvolved and should not undertake such duties withoutadequate knowledge and training. Even when with-drawal of care is anticipated in an operating room set-ting, only physicians with appropriate knowledge, train-ing, and experience in the withdrawal of life support andcomfort care of the dying patient should be involvedwith the NHBCD. Such specialty expertise is not withinthe customary training and practice of most anesthesiol-ogists. The physician withdrawing life support should besomeone who has been involved with the patient andfamily throughout the decision-making process, so thatdeath does not become, as Renee Fox described it, a“desolate, profanely ‘high-tech’ death that the patientdies, beneath operating room lights, amid masked,gowned, and gloved strangers.”