Surgeons may no longer have to wait at least two minutes after the heart stops beating before retrieving organs for transplant, the Washington Post reports. New rules under consideration by the United Network for Organ Sharing (UNOS), the group that coordinates U.S. organ allocation, would eliminate the ban on considering anyone for donation before doctors and family members have decided to cease resuscitation efforts.
New rules proposed for donation after cardiac death
UNOS’ proposed organ donation rule changes would constitute the first major change since guidelines were set in 2007 regarding donation after cardiac death, or DCD. Proponents of the change claim it will strengthen the transplant system and better honor the wishes of donors and loved ones. Former UNOS President Charles Alexander said that his organization is committed to maintaining trust.
“The ultimate goal is to facilitate the dying wishes of patients who wish to be donors and save the lives of the 112,000-plus patients who are in need,” said Alexander. “We are always very aware of our public trust.”
Yet critics are quick to point out the risk of people who may yet survive, only to have life taken from them by overzealous doctors looking to harvest donor tissue. Dr. Michael Grodin, a Boston University professor of health law, bioethics and human rights, sees the potential horror.
“This is another step towards this idea of hovering, hovering, hovering to get more organs,” said Grodin. “The bottom line is that they want to do everything they can to increase organ donation.”
Taking from the brain-dead
Since the early 1970s, brain death has been required in addition to a lack of cardiac activity. However, in the 1990s, DCD-only organ donations began to reappear as the need for transplants rose. Despite being considered “ghoulish” by many, the National Academy of Sciences deemed DCD ethical in 1997, provided that the decision to discontinue care was made independently of the organ donation decision and that surgeons wait at least five minutes after the heart stops before extraction.
As more hospitals intensified the organ salvage process, the DCD wait time decreased to two minutes. At Children’s Hospital in Denver, Colo., however, surgeons tried waiting only 75 seconds before taking the hearts of brain-damaged newborns if there was an emergency need for them. The procedure sparked such a backlash that the hospital went back to waiting two minutes.
Is he dead yet?
Rulings on what officially constitutes death have also come under fire. Yet Alexander argues that emergency medicine specialists are best-equipped to make the tough call.
“The existing recommendations were essentially arbitrary and not based on data,” Alexander said. “What we’ve come to realize is the hospital and the care team in charge of that patient is really the most qualified to make the determination of death.”
Health Resources and Services Administration: http://bit.ly/nOgxSI
National Academy of Sciences: http://www.nap.edu/openbook.php?isbn=0309064244
United Network for Organ Sharing: http://www.unos.org/
Washington Post: http://wapo.st/r4DdYe
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