“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care

Abstract

BACKGROUNDOrgan donation after cessation of cardiac pump activity is referred to as non‐heart‐beating organ donation (NHBOD). NHBOD donors can be neurologically intact; they do not fulfill the brain death criteria prior to cessation of cardiac pump activity. For hospitals to participate in NHBOD, they must comply with a newly introduced federal requirement for ICU patients whose deaths are considered imminent after withdrawal of life support. This report describes issues related to NHBOD.METHODSA nonstructured review of selected publications and Web sites was undertaken.RESULTSScientific evidence from autoresuscitation and extracorporeal perfusion suggests that verifying cardiorespiratory arrest lasting 2–5 minutes does not uniformly comply with the dead donor rule, so that the process of organ procurement can be the irreversible event defining death in organ donors. The interest of organ procurement organizations and affiliates in maximizing recovery of transplantable organs introduces self‐serving bias in gaining consent for organ donation and abandons the basic tenet of obtaining true informed consent. The impact of donor management and procurement protocols on end‐of‐life (EOL) care and the potential trade‐off are not disclosed, raising concern about whether potential donors and their families are fully informed before consenting to donation.CONCLUSIONSThe use of comprehensive quality indicators for EOL care can determine the impact of NHBOD on care offered to donors and the effects on families and health care providers. Detailed evaluation of NHBOD will enable the public to make informed decisions about participating in this type of organ donation. Journal of Hospital Medicine 2007;2:324–334. © 2007 Society of Hospital Medicine.

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences

“…Cardiopulmonary resuscitation can inflict physical injuries indistinguishable from those caused by violent assault (Hashimoto, Moriya & Furumiya, 2007). The logistics of organ donation interrupt Islamic end-of-life rituals in several ways: 1) the dying patient is started or maintained on life support systems to preserve organs until surgical procurement can be accomplished (Verheijde, Rady & McGregor, 2007a); 2) medical and surgical interventions to prepare for organ donation can disrupt the quality of palliative and end-of-life care delivered to the dying patient (Rady, Verheijde & McGregor, 2007); 3) interventions required for organ preservation can influence the temporal course of the dying process (Motta, 2005;Phua et al, 2007); 4) resuscitative procedures (e.g., cardiopulmonary bypass) and the administration of medication to suppress spontaneous cardiac and brain reanimation may be applied after the declaration of death (Dejohn & Zwischenberger, 2006); 5) the blood is drained from the body and replaced with preservative fluids before any organ is removed (D'Alessandro, 2000).…”

“…The expectations and spiritual experiences of families are strongly linked to the observance and respect of religious and cultural rituals at the end of life (Lobar, Youngblut & Brooten, 2006). Traumatic memories in family members (Kesselring, Kainz & Kiss, 2007) and moral distress in health care providers (Mandell et al, 2006) may ensue when end-of-life rituals are sacrificed for organ donation (Rady, Verheijde & McGregor, 2007). The belief in human dignity may conflict with end-of-life practices in organ donation, which transforms a peaceful death into a "high-tech" death in an operating room environment surrounded by medical personnel ready to conduct the surgical removal of organs.…”

“…A declaration of death by circulatory criterion of loss of arterial pulse at E2a (Table 2) can be followed by spontaneous cardiac autoresuscitation (i.e., spontaneous recovery of cardiac and brain functions including those in the brain stem) at E3 (Table 2) after as long as 10 to 15 minutes of circulatory arrest in human beings (Joffe, 2007a;Rady, Verheijde & McGregor, 2007). The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1981) has recommended that the criterion of circulatory arrest is longer than 15 minutes to ensure that there has been an irreversible cessation of function of the whole brain, including the brain stem, for a uniform determination of death.…”

Issues in Organ Procurement, Allocation, and Transplantation

“…Donation after Cardiac Death (DCD), formerly known as non-heart-beating organ donation (NHBOD), is now recognized when defining death. In DCD, solid organs are procured after the heart stops beating (usually within 5 minutes of cardiac arrest) following withdrawal of life-sustaining treatment (WLST) (Rady, Verheijde, & McGregor, 2007). Organ retrieval in this case occurs only after "irreversible cessation of respiration and circulation has been declared" (Rabinstein et al, 2012, p. 414 citizens who are not U.S. residents (OPTN, 2012c).…”

Enforcement of presumed-consent policy and willingness to donate organs as identified in the European Union Survey: The role of legislation in reinforcing ideology in pluralistic societies

“…Countries that legislate presumed consent for organ donation are obligated to inform and disclose to their citizens who are presumed to donate organs about the trade-offs in their end-of-life care because of the medical procedures required to preserve organs before death until the organs are procured [11][12][13]. The lack of transparency about end-of-life practices in organ donation for transplantation can create distrust in the medical profession [14].…”