Abstract
This pro/con debate explores the ethical issues surrounding nonheart-beating organ donation (NHBD), a source of considerable controversy. It is estimated that NHBD can increase the number of organs available for transplant by 25% at a time of great need. However, should NHBD be ethically acceptable? In support of NHBD, it may be acceptable practice if there is a separation of the rationale to withdraw life support/to withhold cardiopulmonary resuscitation from the decision to recover organs, if no conflicts of interest exist, if a waiting time precluding spontaneous return of circulation is included, and if NHBD conforms to a standardized protocol. Against NHBD, there are questions regarding the ambiguity and cultural perspectives of death, regarding whether a separation of rationale between withdrawal and donation is sufficient to preclude conflicts of interest, and regarding whether variable protocols arise that subordinate the patient to the goal of donation. Such concerns suggest NHBD may damage the trust in patient–physician relationships and may adversely affect organ donation rates.
Highlights
Laura Hawrylucknonheart-beating organ donation (NHBD) is currently a source of considerable ethical controversy
Two organ recovery procedures are described [1]: ‘uncontrolled’ NHBD, in which organs are recovered from a cardiac arrest patient who fails attempts at resuscitation; and ‘controlled’ NHBD, in which organs are recovered after life support is withdrawn
While the details of these protocols vary, they all typically include a waiting time after asystole occurs, commonly ranging from 2 to 5 min [1,2]. This waiting time is meant to preclude any possibility of spontaneous return of circulation and to allow death to be pronounced with confidence [1,2]
Summary
NHBD is currently a source of considerable ethical controversy. Two organ recovery procedures are described [1]: ‘uncontrolled’ NHBD, in which organs are recovered from a cardiac arrest patient who fails attempts at resuscitation; and ‘controlled’ NHBD, in which organs are recovered after life support is withdrawn (as portrayed in the following case). After extensive discussions with the intensivist and the neurosurgeon, his wife and family agree to withdraw him from life support At this time, Mr Henry is not brain dead. After a period of 5 min of asystole, of an absence of a pulse and blood pressure via the arterial catheter or noninvasive blood pressure monitor and of an absence of respirations, the preserving solution is infused via the central line His wife and family leave the operating room and his organs are harvested. To obey the dead donor rule, NHBD protocols typically include a waiting time after the declaration of death to begin organ recovery. NHBD is an extension of this process and may soon be fully integrated into clinical practice to increase kidney and liver donation given the increasing number of patients waiting for an organ transplant.
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