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“Non‐heart‐beating,” or “cardiac death,” organ donation: Why we should care
Author(s) -
Rady Mohamed Y.,
Verheijde Joseph L.,
McGregor Joan
Publication year - 2007
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.204
Subject(s) - organ donation , medicine , donation , organ procurement , intensive care medicine , procurement , medical emergency , transplantation , surgery , business , law , marketing , political science
Abstract BACKGROUND Organ 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. METHODS A nonstructured review of selected publications and Web sites was undertaken. RESULTS Scientific 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. CONCLUSIONS The 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.