Non-heart Beating Organ Donation Research Articles

Truthfulness in transplantation: non-heart-beating organ donation

The current practice of organ transplantation has been criticized on several fronts. The philosophical and scientific foundations for brain death criteria have been crumbling. In addition, donation after cardiac death, or non-heartbeating-organ donation (NHBD) has been attacked on grounds that it mistreats the dying patient and uses that patient only as a means to an end for someone else's benefit.Verheijde, Rady, and McGregor attack the deception involved in NHBD, arguing that the donors are not dead and that potential donors and their families should be told that is the case. Thus, they propose abandoning the dead donor rule and allowing NHBD with strict rules concerning adequate informed consent. Such honesty about NHBD should be welcomed.However, NHBD violates a fundamental end of medicine, nonmaleficience, "do no harm." Physicians should not be harming or killing patients, even if it is for the benefit of others. Thus, although Verheijde and his colleages should be congratulated for calling for truthfulness about NHBD, they do not go far enough and call for an elimination of such an unethical procedure from the practice of medicine.

Are terminally ill patients dying in the ICU suitable for non-heart beating organ donation?

To evaluate the feasibility of implementing a program of controlled non-heart beating organ donation, in patients undergoing the withdrawal of intensive care treatment. Prospective observational study. Medical and Surgical ICUs in a tertiary university hospital. Consecutive patients younger than 70 years dying in the ICU after treatment withdrawal for dire neurological prognosis. We analyzed prospectively collected data from the ICU clinical information system. Seventy-three of 516 ICU deaths (13%) were identified, equally distributed among traumatic, stroke, and anoxic brain injury. The management and the course in these three diagnostic categories were similar. All patients underwent withdrawal of mechanical ventilation and half were extubated. Median time to death was of 4.8 h (IQR 1.4-11.5). In 70% of cases the patient received analgesia and 30% sedation. Such treatment was not related to earlier death. Hypotension was observed in 50% of patients during the 30 min preceding cardiac death. With our current management of terminal patients controlled non-heart beating organ procedure may be difficult due to the duration and variability of the dying process. This observation suggests that we can perform better by evaluating this process more closely.

Non-heartbeating organ donation: clinical process and fundamental issues

This case report outlines the clinical process whereby a patient with severe traumatic brain injury became a non-heartbeating organ donor after a withdrawal-of-care decision. This process raises a series of ethical questions regarding decision-making on grounds of futility, the role of the next of kin, informed consent, the accommodation of manoeuvres directed towards organ retrieval at maximal viability, and the timing and determination of death. Although many aspects of the process can be accommodated within fundamental ethical principles and a broad interpretation of the concept of the 'best interests', the variance with established law requires authoritative clarification if a need for transplantable organs is to be responded to without compromising the reputation of practitioners involved in this area of care. Therefore, this recruitment strategy warrants wide public and professional debate to achieve longer-term sustainability and ensure the protection of all parties.

The Ethics of Heparin Administration to the Potential Non-Heart-Beating Organ Donor

The increasing need and limited sources for organs has stimulated a renewed interest in non-heart-beating organ donation (NHBOD). NHBOD is the donation of organs from cadavers that have been declared dead by cardiopulmonary criteria. Emerging protocols for heparin administration to the potential non-heart-beating organ donor (NHBD) deserve scrutiny. This topic is presented within a limited discussion of organ donation in general. The definition of death has been refined to its present state because of the need for clear parameters in light of a desire to procure organs for transplant. The administration of heparin to the NHBD is intended to prevent the formation of blood clots in the kidneys and liver. Heparin at high doses is clearly not given for the benefit of the patient, and some professionals are concerned that administration may hasten death. Nurses are guided by codes that require the consideration of the ethical principles of autonomy, informed consent, beneficence, and justice while providing compassionate care. An eagerness to procure viable organs for positive transplant outcomes must not be the guiding force in protocols that allow the administration of heparin to the potential NHBD. Heparin administration is supported for these donors within specific parameters.

Nonheart-Beating Donation in the Neurologically Devastated Patient

A national shortage of organs for transplantation has led to a renewed interest in an old concept of using nonheart-beating organ donors as a source of organs for transplantation. Nonheart-beating donors are patients who have organ procurement obtained after death has been declared by cardiopulmonary criteria as opposed to the traditional heart-beating donor who has been declared dead by neurological criteria. The practice seems promising to increase the available organ supply. This article reviews the history, classification, protocols, and ethical issues involved with nonheart-beating organ donation.

Non-heart beating organ donation.

Increasing the levels of non-heart beating organ donation (NHBOD) is a potential means of improving the supply of transplantable organs. NHBOD may provide a mechanism to enable a patient's prior wishes to be realised and to provide comfort to a family in grief. There is an overriding ethical principle to strictly divide the responsibility for the care of the dying patient and the potential transplant recipient. Medical protocols need to be written, and institutional ethics committees and our national organ procurement system need to be involved if we are to protect public confidence and see NHBOD realise its full potential.

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

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. Narrative review from selected Medline references, and other published reports. 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. Canadian centres can learn from the difficulties encountered in other centres that have developed NHBD protocols. A moratorium on Canadian NHBD protocols should be considered until a National consensus reflecting Canadian values has been undertaken.

Brain stem death and organ donation—11 years on

We studied previously patterns of organ donation in a teaching hospital. Eleven years later we repeated the study to investigate how patterns had changed. We also wanted to see whether non-heart beating donation was being practised in our intensive care units. All deaths were prospectively audited to identify potential heart beating and non-heart beating organ donors. The actual organ donors and reasons for not donating were identified. Overall, there was a significant reduction in the number of potential organ donors in the 11-yr period. This was accompanied by an increase in refusal rates by relatives from 10 to 29%, and a decrease in refusal rates by the coroner from 28 to 11%. In this hospital the number of potential and actual organ donors has fallen in 11 yr. This is a combination of decreasing numbers of patients becoming brain dead and increased relative refusal rate. It has only been partially offset by a more liberal attitude of the coroner and non-heart beating donors.

Non-heartbeating organ donation: a review.

Organ transplantation is one of the groundbreaking achievements in medicine in the 20th century. In the early days of transplantation, organs were obtained from non-heartbeating (NHB) cadavers. With time, better options for organ sources became available (for example, living-related and "brain dead" donors), and the practice of obtaining organs from NHB cadavers fell out of favor. Improvements in the field of transplantation have led to an increased demand for organs. Various strategies have been employed recently to increase the supply, one of them being non-heartbeating organ donation (NHBOD). NHBOD can take place in controlled or uncontrolled circumstances. Recently, national organizations have supported and proposed guidelines for NHBOD and to aid clinicians in identifying potential donors. Outcomes of organs obtained from NHB cadavers are comparable to those obtained from heartbeating donors. The practice of NHBOD is increasing and has proven that it can contribute to increasing organ availability.

Non-heart beating organ donation: old procurement strategy—new ethical problems

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor (NHBOD) is founded...

Defining death in non-heart beating organ donors

Protocols for retrieving vital organs in consenting patients in cardiovascular arrest (non-heart beating donors, NHBD) rest on the assumptions that irreversible asystole a) identifies the instant of biological death, and...

Legal and Ethical Issues Related to Nonheart Beating Organ Donation

Major breakthroughs in immunosuppressant medication and advances in surgical techniques have increased the number of successful transplantations, but the demand for organs far outweighs the supply. People continue to die while waiting for donor organs to become available. Nonheart beating organ donation is a means of increasing the supply of organs to be transplanted. It is based on cardiac cessation criteria. This article explores the ethical and legal considerations, as well as implications for perioperative nurses.

Pro/con ethics debate: is nonheart-beating organ donation ethically acceptable?

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.

Recommendations for nonheartbeating organ donation. A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine.

A Position Paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine Author Information

Non-heartbeating organ donation: ethical controversies and medical considerations.

Non-heartbeating organ donation: ethical controversies and medical considerations.

The potential benefits of the pediatric nonheartbeating organ donor.

To examine the population of the pediatric intensive care unit in a large children's hospital to determine the potential importance of pediatric nonheartbeating organ donors (NHBDs). We analyzed retrospectively the 6307 admissions to the pediatric intensive care unit at the Children's Hospital of Philadelphia from January 1992 to July 1996 to identify all deaths. The hospital records of the children who had died were then reviewed to determine the mode of death, organ donation rate of heartbeating donors, and the number of potential NHBDs. Criteria for the NHBD included the decision to forgo life-sustaining therapy, death occurring within 2 hours of withdrawal of life support, and the absence of sepsis, HIV, hepatitis, or extracranial malignancy. Of 319 deaths, 102 (32.0%) died with resuscitation, 84 (26.3%) were brain-dead, 111 (34.8%) had withdrawal of life support, and 22 (6.9%) were on do-not-resuscitate orders. Of the 84 brain-dead children, 74 (88.1%) were medically suitable heartbeating donors, and 43 (58.1%) donated organs. Of the 111 patients who had life support withdrawn, 31 (27.9%) qualified for NHBDs. The routine use of the NHBD has the potential to increase organ donation at our institution by 42%. We discuss the ethical issues relating to NHBDs required to properly include these patients as potential organ donors.

Reflections on non-heartbeating organ donation: how 3 years of experience affected the University of Pittsburgh's Ethics Committee's actions.

In 1991, the University of Pittsburgh Medical Center (UPMC) implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria (Non-Heartbeating Cadavers or NHBC). This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy (typically but not necessarily a ventilator), and after the patient is pronounced dead, procuring organs.

Non-heart-beating organ donation: a reply to Campbell and Weber.

In the preceding commentary, Campbell and Weber raise two valid and important issues concerning non-heart-beating organ donation (NHBOD). First, because the procedure links withdrawal of life support and the potential for subsequent organ donation, the desire for organs may create a situation in which care of the dying individual has relatively less importance and the dying may receive suboptimal care. Second, even if concerns about care of the dying were dealt with adequately, there will not be enough non-heart-beating donors to significantly decrease the organ shortage that exists, making the procedure not worth the risk. We agree that attention to the important details of caring for the dying are, and must be, the primary concern of all health care workers caring for those individuals. Ensuring the patients' comfort, dignity, and autonomy, and providing for family and social support are the mainstays of this care. All policies for NHBOD should clearly support and mandate these concepts. Regarding the second concern, we agree that NHBOD is currently rare; however, evidence is increasing that this type of donation has great potential. Continued growth of the practice in this country will depend largely on public acceptance, which we believe will be directly influenced by whether the public perceives that care of the dying is not compromised by this procedure.

Correction Non-heart beating organ donors

Correction Non-heart beating organ donors