Non-heart-beating donors (individuals whose deaths are determined by cessation of heart and respiratory function rather than loss of whole brain function) could potentially be of major importance in reducing the gap between the demand for and available supply of organs for transplantation. Prompted by questions concerning the medical management of such donors—specifically, whether interventions undertaken to enhance the supply and quality of potentially transplantable organs (i.e. the use of anticoagulants and vasodilators) were in the best interests of the donor patient—the U.S. Department of Health and Human Services asked the Institute of Medicine to examine from scientific and ethical points of view "alternative medical approaches that can be used to maximize the availability of organs from [a] donor [in an end-of-life situation] without violating prevailing ethical norms...."
This book examines transplantation supply and demand, historical and modern conceptions of non-heart-beating donors, and organ procurement organizations and transplant program policies, and contains recommendations concerning the principles and ethical issues surrounding the topic.
- Non-Heart-Beating Organ Transplantation
- Copyright
- Preface
- Contents
- Executive Summary
- 1 Introduction
- 2 Transplantation Supply and Demand
- SUPPLY
- DEMAND
- IMPROVING SUPPLY
- 3 Background
- THE HISTORICAL NHBD
- NEUROLOGIC CRITERIA FOR DEATH
- 4 The Modern Non-Heart-Beating Donor
- THE CONTROLLED NHBD
- THE UNCONTROLLED NHBD
- CURRENT STATUS OF THE NHBD IN TRANSPLANTATION
- 5 Survey of Organ Procurement Organization and Transplant Program Policies
- INTEREST IN OPO NHBD PROTOCOLS
- PROTOCOL STATISTICS
- IDENTIFICATION OF POTENTIAL DONORS
- APPROACH TO FAMILY FOR CONSENT
- OPO AND PROCUREMENT TEAM INTERVENTION BEFORE DEATH
- MEDICATION
- WITHDRAWAL OF LIFE SUPPORT AND DECLARATION OF DEATH
- UNCONTROLLED NHDS
- CONCLUSION
- 6 Analysis, Findings, and Recommendations
- GENERAL PRINCIPLES
- POLICIES AND OVERSIGHT
- MEDICAL INTERVENTIONS AND ETHICS
- CONFLICTS OF INTEREST
- DETERMINATION OF DEATH
- FAMILIES
- References
- Appendix A Letter to the Institute of Medicine from the Department of Health and Human Services
- Appendix B Agenda and Summary of Workshop on Medical and Ethical Issues in Maintaining the Viability of Organs for…
- AGENDA
- WORKSHOP SUMMARY
- Federal Government and Political Considerations
- UNOS: Procurement, Allocation, and Data Collection
- Organ Procurement Issues in the Context of the NHBD
- Scientific Issues and Medical Perspectives
- TRANSPLANT COORDINATION
- NHBD Supply, Results, Projections, and Other Information
- Consumer Concerns of Donors and Recipients
- Scientific Issues and Surgical Perspectives
- Ethical Concerns
- Determination of Death
- Interventions to Promote Organ Viability
- Conflicts of Interest
- Conclusion
- Appendix C U.S. Organ Procurement Organizations and Letter of Request for Non-Heart-Beating Donor Protocols
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