An Ethical Debate: Elective ventilation of potential organ donors

Abstract

Elective ventilation describes the procedure of transferring selected patients dying from rapidly progressive intracranial haemorrhage from general medical wards to intensive care units for a brief period of ventilation before confirmation of brain stem death and harvesting of organs. This approach in Exeter has led to a rate of kidney retrieval and transplant higher than has been achieved elsewhere in the United Kingdom, with a stabilisation of numbers on patients on dialysis. Recently doubt has been cast on the legality of our practice of elective ventilation on the grounds that relatives are not permitted to consent to treatment of an incompetent person when that treatment is not in the patient's best interests. We are thus faced with the dilemma of a protocol that is ethical, practical, and operates for the greater good but which may be illegal. This article explores various objections to the protocol and calls for public, medical, and legal debate on the issues.

Bodies, organs and saving lives: the alternatives

“…In this protocol, potential donors were moved to the intensive treatment unit explicitly to maintain the patient in a condition to enable organ donation (and it would now be donation and not merely retrieval). 12 Data showed roughly a doubling in organ retrieval rates under that protocol until it was banned. So there are actually UK data, not just speculation, that donation rates could improve from a source currently untapped.…”

Bodies, organs and saving lives: old respects and new dilemmas

“…It was a policy of this sort in Exeter some years ago that was declared illegal when patients were identified and treated as potential donors -even though it doubled the number of organs retrieved. 18 Thirdly, the first taskforce report avoided any detailed discussion of policy on obtaining consent to organ retrieval. However it noted the different donation rates between native UK populations and those from a BME background, as detailed above.…”

Elective ventilation is cost effective and humane

“…EDITOR,--We expected that our defence of elective ventilation1 would provoke criticism and wish to respond here to letters on the issue 2. Peter G M Wallace rightly says2 that the published experience of elective ventilation is limited to nine patients.…”